Judith Bell-Krotoski

The repeatability of testing with Semmes-Weinstein monofilaments

Forty-one filament kits were measured for filament application force, single and multitester application force repeatability, and comparison of filament repeatability with that of other hand held instruments. Results of this study show that if their lengths and diameters are correct, the filaments produce application forces that are repeatable within a predictable range. All hand held instruments vary in application force. The Semmes-Weinstein monofilaments vary relatively little and are a controlled reproducible force stimulus for use in clinical testing.

Testing Sensibility, Including Touch-Pressure, Two-point Discrimination, Point Localization, and Vibration

Sensibility is much more than protective sensation, and the examiner needs to consider the various degrees of residual sensibility that influence both diagnosis and prognosis. Towards that end, objective tests of the extent and nature of peripheral nerve involvement should be employed. Objective tests reflect the current condition of sensibility and are not affected by cognitive influences, such as re-education. Most current clinical instruments used for measurement of sensibility fail to meet the criteria of an objective test because they: (1) can be shown to lack necessary sensitivity, and (2) are too variable. As a consequence, regardless of whether these instruments have been used in controlled clinical studies or are in common use, their results will not replicate with repeated testing. Unfortunately, therefore, sensibility changes will potentially go unrecognized in a large number of patients and many will be detected only in the later stages of peripheral nerve abnormality, when possibilities of treatment are less effective. This article discusses sensibility testing from the standpoint of what is known regarding strengths and weaknesses of various tests and sensory modalities, and makes an appeal for clinicians to review the instruments they use critically for sensibility measurement with regard to stimulus control. Clinicians must insist on validity and reliability in their instruments before they have confidence in the data obtained.

Torque range of motion in the hand clinic

Abstract Goniometric measurement of passive range of motion is a classic evaluation tool of hand therapy, yet there is no objective quantification of the torques applied from one measurement to the next, or position of the proximal joints during measurement. This paper discusses a method of controlled torque and joint position that has been used experimentally and clinically as a tool for objective assessment of passive range of motion. Case illustrations demonstrate the usefulness of this technique in clinical case management.

A Study of Peripheral Nerve Involvement Underlying Physical Disability of the Hand in Hansen's Disease

Abstract Hansens disease (HD) belongs within the family of peripheral nerve diseases and disorders. Measurements of hand dysfunction in HD patients for the most part have focused on disability, the end result of peripheral nerve involvement. Disability measurement alone can underestimate actual prevalence of primary peripheral nerve involvement, and can be misleading regarding its status and course. Patients treated at the Gillis W. Long Hansens Disease Center, Carville, LA, were given hand screening examinations developed to measure the peripheral nerve involvement underlying physical disability of the hand. This study models peripheral nerve involvement as it relates to physical disability of the hand, and supports the need for direct measurement of peripheral nerve involvement in other patient populations. This information is important in determining whether a patient is improving or becoming worse, whether neuropathy can be treated or prevented, and whether there is more or less neuropathy resulting in disability with various anti mycobacterial treatments for the disease.

Biomechanics: The Forces of Change and the Basis for All That We Do

Correspondence to Judith A. Bell-Krotoski, OTR, FAOTA, CHT; CAPT, U.S. Public Health Service, Chief, Hand and Occupational Therapy Department, Clinical Research Therapist, Gillis W. Long Hansens Disease Center, 5445 Point Clair Road, Carville, LA 707219607; or Elaine Ewing Fess, MS, OTR, FAOTA, CHT, Hand Research, 635 Eagle Creek Court, Zionsville, IN 46077. has both strength and preCISIon, in a smoothly orchestrated, versatile, and flexible system. Often our lifeline to the world, the hand responds quickly without thought, protecting the body from harm in a myriad of reflexes and patterns programmed in the brain. Its touch imprints the mind, as it becomes our interface for thoughts, dreams, and ideas, transferring them into creative action. It expresses our anger, our love, and our prayers, and is part of the beauty at the heart of the human soul, an outward sign of our inner being, gesturing without speaking, extending friendship, and, when needed, becoming an alternate language. Not fully appreciated until there

Research in Clinical Testing of Sensibility: A Personal Journey

It is a distinct honour and a pleasure to be asked to address the British Association of Hand Therapists. My work has been intertwined in so many ways with persons and knowledge originating in Britain. Simply put, our roads have often crossed, and we share similar objectives and problems.