Outcome Measures for Aged Hand Function

Original Editor - Tolulope Adeniji

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Introduction[edit | edit source]

Hand function is vital to human ability to perform day to day activities for independent living including ability to perform special dexterity functions.[1] Among hand functions are Grip strength, dexterity, prehensile activities and ability to pinch and these functions decreases as we get old. One explanation for this changes is degenerative changes in hand as a result of decline in physiological and anatomy of hand that come with ageing. Some of these changes are structural changes in older adults hands musculoskeletal system, vascular and nerve supply nerve and receptors etc. Recent evidence had shown that hand function like grip strength is one of the marker of longevity[2] Thus, quantifying hand function objectively is a key concept in older adult assessment, Therefore, this write up will elucidate on elaborating on popular outcome measures for hand function among the aged.

Hand Outcome Measures[edit | edit source]

Outcome measures are tools designed to measure patient or test taker current status on a particular subject of interest. This tool can be used as an element of evaluating prognosis, outcome of an intervention or in planning of an intervention. Outcome measures for hand function evaluates hand ability and functions. These abilities and functions include hand motor and sensory ability as well as dexterity function. Due to multi-dimensional nature of hand ability and functions, multiple outcome measures or battery of measures  is usually recommended.[3]  This paper will discuss common outcome measures for assessing older adults hand ability and functions under hand motor control and dexterity and sensory/sensorimotor functions.

Hand Motor Control[edit | edit source]

Motor Control entails regulation of purposeful muscle function by neuromuscular activation and it involves process of initiating, directing, and grading purposeful voluntary movement.

Hand motor control may be in form of gross hand movement or fine motor control and specificifically these functions are grip, grasping and fine motor activities to form precise hand movements. Grip strength is a function of muscular strength of the hand and forearm and common outcome measure to evaluate this function are Grip-ball and the Jamar dynamometer.

Instruction for using Grip-ball &Jamar dynamometer for grip strength[edit | edit source]

Grip strength with dynamometer can be measured while patient is standing with arm down at side or arm out and it can also be measured when patient is sitting with arm down at side or elbow flexed to 90 degrees by side, neutral wrist position. In any of this protocol Grip strength for each hand is calculated as the mean of 3 trials,

The Grip-ball is a modified dynamometer in form of a ball and it is made up of a pressure and temperature sensors with an electronic wireless communication system in it.[4] It is a modified dynamometer that measures grip strenght when test taker squeeze the ball.

Psychometric properties of Grip-ball and the Jamar dynamometer[edit | edit source]

Among 59 community dwelling older adults Vermeulen,[5] result showed that when Grip-ball was used for grip strength it had Intraclass correlation coefficients of  0.97 and 0.96 for the left and right hands, respectively (P < .001) while Jamar dynamometer had Intraclass correlation coefficients 0.97 and 0.98 for the left and right hands, respectively (P < .001). The authors also reported that Grip-ball and the Jamar dynamometer had Pearson correlations  of 0.71 (P < .001) and 0.76 (P < .001) for the left and right hands, respectively. Meaning that the two means of measuring grip strength is highly correlated. However, it was noted that Grip-ball measurements did not confirm higher grip strength of the dominant hand of the nursing home and community dwelling older adults whereas the Jamar dynamometer did.[5]

Other Hand Motor and Dexterity Measures[edit | edit source]

Hand dexterity is a fine motor skill that requires an individual to make coordinated hand movement to grasp and manipulate object. Fine motor skills including hand dexterity may be quantified in terms of coordinated upper extremity function in performing activities of daily living. And it can also be measured by using an amount of time a given daily activities is completed in a given time by hand. Box and Blocks test [6] , Crawford Small Parts Dexterity test.[7] , Nine Hole Peg test[8] and the Functional Dexterity test[6] are among common outcome measure to assess hand dexterity. A battery of measures are also available to assess a set of hand motor function both gross and fine motor skills and one example of this is Jebsen Taylor Hand Function test.

Box and Blocks Test[edit | edit source]

Box and Blocks test, BBT, is used to measure a manual dexterity that requires repeatedly moving 1-inch blocks from one side of a box to another in 60 seconds. In Box and Blocks test there are test box with 150 blocks and a partition in the middle is placed lengthwise along the edge of a standard-height table. The test taker is instructed to quickly pick up one block at a time with his or her right or left hand. Then carry the box over the partitioned and drop it and it is important for the patient to know that each successful execution is one point and he or she carries two it will be counted as one. The number of blocks that the test taker successfully transferred will becomes the final score and the higher the score the better the gross manual dexterity of the test taker. Desrosiers et al. had shown that BBT norm score among 360 older adults subjects rrespective of sex was an average of 66,9 with standard deviation of 9.2 for right hand and for the left hand the mean reported was 66.3 and standard deviation of 9.4.[9]

Psychometric Properties[edit | edit source]

Box and Blocks test had an excellent test-retest reliability (intraclass correlations coefficients of 0.89 to 0.97) among older adults.[10]

It is a valid tool in measuring hand dexterity among older adults as it has correlations with upper limb performance.[10]

Nine Hole Peg Test[edit | edit source]

Nine Hole Peg test , NHPT, is designed to measure finger dexterity and it is a paper and pencil test. In other to perform NHPT, there is need for a container with nine small pegs and a corresponding target pegboard that have nine holes. Then the test taker will be instructed to pick pegs from the container one after the order. The picked pegs are to be inserted into the pegboards until the task is completed and the pegs are then picked one after the other back into the container.[11] This will be repeated two times for each hands starting with the dominant hand. Then the two trials for each hand are averaged and converted to the reciprocals of the mean times for each hand, after which, the two reciprocals are averaged. See NHPT score guide

Psychometric Properties[edit | edit source]

Hand Sensory Test[edit | edit source]

The sensory innervation are provides by cutaneous nerves and hand receives its sensory innervation from cutaneous branch of the median nerve, ulnar nerve, radial nerve and sometimes from lateral antebrachial cutaneous nerve.[12][13] Sensory test for hand are not limited to Weber two-point discrimination[14] and the AsTex sensitivity tests.[15] Strength-Dexterity (SD) test[16] is a test that has a hand sensory and motor component to it.

Cutaneous-innervation-of-hand.jpg

Weber Two-Point Discrimination[edit | edit source]

Weber described two-point discrimination in reference to using points of a calipers that are held against the skin at different distances from each other. This test describes ability of the test taker to differentiate minimal distance at which he or she can distinguish one or two points contact of the caliper with his/her skin.[17] For a test taker to be considered to have good two point discrimintation, the American Society for Surgery of the Hand recommends that he or she should have got the two point discrimination correct on seven out of 10 for two-point discrimination test.[17]

Some Selected Special Tests for Hand[edit | edit source]

Some special test for hand function that may be access in older adults as well.

Under palpation  test, grind test is used to access pathology of hand that involve  the thumb carpometacarpal joint (CMC). A positive test elicit pain, repitus, instability of CMC joint. Another palpation test is Finkelstein's that is used to test for the DeQuervain's tenosynovitis and this test is positive if pain is elicited along the  along the 1st compartment of hand.[18]

Another group of test is stability assessment  and one of it is scaphoid shift test (Watson's test) this test is used to access for scapholunate ligament tear. This maneuver is positive when it reproduces the patient pain in dorsal wrist and "clunk" may indicate instability. Another stability test is lunotriquetral ballottement test for lunotriquetral ligament tear integrity. A positive test will indicate  increased laxity and accompanying pain along the line of test of this ligament. Others are not limited to ulnar carpal abutement and Gamekeeper's test.[18]

For nerve assessment tests, tinel's test is used for carpal tunnel syndrome confirmation test and this test is positive when the test taker report parathesias in the distribution of median nerve. Another example of median nerve test is Phalen's test. For ulnar nerve assessment Froment's sign can be used to assess  for ulnar nerve motor weakness. This test is carried out by asking the patient to hold a piece of paper with thumb and radial side of the index fingers. Inability of the patient to hold unto this paper when the examiner pulled away this paper and the patient flexes the thumb IP joint in an attempt to hold on to paper indicates a positive test. Another test to assess for ulnar nerve motor weakness is Wartenberg's sign and [[|Jeanne's Sign|Jeanne's sign]].[18]

References[edit | edit source]

  1. Lawrence EL, Dayanidhi S, Fassola I, Requejo P, Leclercq C, Winstein CJ, Valero-Cuevas FJ. Outcome measures for hand function naturally reveal three latent domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing. Frontiers in aging neuroscience. 2015 Jun 5;7:108.
  2. Musalek C, Kirchengast S. Grip strength as an indicator of health-related quality of life in old age—a pilot study. International journal of environmental research and public health. 2017 Dec;14(12):1447.
  3. Lawrence EL, Dayanidhi S, Fassola I, Requejo P, Leclercq C, Winstein CJ, Valero-Cuevas FJ. Outcome measures for hand function naturally reveal three latent domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing. Frontiers in aging neuroscience. 2015 Jun 5;7:108.
  4. Jaber R, Hewson DJ, Duchêne J. Design and validation of the Grip-ball for measurement of hand grip strength. Medical engineering & physics. 2012 Nov 1;34(9):1356-61.
  5. 5.0 5.1 Vermeulen J, Neyens JC, Spreeuwenberg MD, van Rossum E, Hewson DJ, de Witte LP. Measuring grip strength in older adults: comparing the grip-ball with the Jamar dynamometer. Journal of geriatric physical therapy. 2015 Jul 1;38(3):148-53.
  6. 6.0 6.1 Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Archives of physical medicine and rehabilitation. 1985 Feb 1;66(2):69-74.
  7. Boyle AM, Santelli JC. Assessing psychomotor skills: the role of the Crawford Small Parts Dexterity Test as a screening instrument. Journal of dental education. 1986 Mar;50(3):176-9.
  8. Mathiowetz V, Weber K, Kashman N, Volland G. Adult norms for the nine hole peg test of finger dexterity. The Occupational Therapy Journal of Research. 1985 Jan;5(1):24-38.
  9. Desrosiers J, Bravo G, Hébert R, Dutil É, Mercier L. Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Archives of physical medicine and rehabilitation. 1994 Jul 1;75(7):751-5.
  10. 10.0 10.1 Desrosiers J, Bravo G, Hébert R, Dutil É, Mercier L. Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Archives of physical medicine and rehabilitation. 1994 Jul 1;75(7):751-5.
  11. Johansson GM, Häger CK. A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke. Journal of NeuroEngineering and Rehabilitation. 2019 Dec 1;16(1):8.
  12. Sulaiman S, Soames R, Lamb C. The sensory distribution in the dorsum of the hand: anatomical study with clinical implications. Surgical and Radiologic Anatomy. 2015 Sep 1;37(7):779-85.
  13. Keplinger M, Marhofer P, Moriggl B, Zeitlinger M, Muehleder-Matterey S, Marhofer D. Cutaneous innervation of the hand: clinical testing in volunteers shows high intra-and inter-individual variability. British journal of anaesthesia. 2018 Apr 1;120(4):836-45.
  14. Dellon AL, Mackinnon SE, Crosby PM. Reliability of two-point discrimination measurements. Journal of Hand Surgery. 1987 Sep 1;12(5):693-6.
  15. Miller KJ, Phillips BA, Martin CL, Wheat HE, Goodwin AW, Galea MP. The AsTex®: clinimetric properties of a new tool for evaluating hand sensation following stroke. Clinical Rehabilitation. 2009 Dec;23(12):1104-15.
  16. Valero-Cuevas FJ, Smaby N, Venkadesan M, Peterson M, Wright T. The strength–dexterity test as a measure of dynamic pinch performance. Journal of biomechanics. 2003 Feb 1;36(2):265-70.
  17. 17.0 17.1 Dumontier C, Tubiana R. Physical Examination of the Hand. In Plastic Surgery Secrets Plus 2010 Jan 1 (pp. 749-754). Mosby.
  18. 18.0 18.1 18.2 Physical Exam of the Hand - Hand - Orthobullets [Internet]. [cited 2021 Feb 28]. Available from: https://www.orthobullets.com/hand/6008/physical-exam-of-the-hand