Outcome Measures for Aged Hand Function
Original Editor - Tolulope Adeniji
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Introduction[edit | edit source]
Hand function is vital to human activities and independent living, more so, it influences task performance especially those tasks that requires dexterity[1], But hand functions such as grip strength, dexterity, prehensile activities and ability to pinch 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. Recently, evidence is point towards hand function like grip strength as one of the marker of longevity[2] and it therefore essential to evaluate some of these hand function in other to provide optimal care for older adults hand. This write up, therefore, centred on elaborating on popular outcome measures for hand function among the aged.
Hand Outcome measures[edit | edit source]
Hand function is essential for activities of daily living and these functions depends on the hand motor and sensory functions as well as dexterity function. Due to multi-dimensional nature of hand functions multiple outcome measures or battery of measures is usually recommended.[3] This paper will discuss outcome measures for assessing older adults hand functions under hand motor control and dextrity, and sensory/sensorimotor functions.
Hand motor control and dexterity test[edit | edit source]
Grip strength is usuallly use to assess muscular strength of the hand and forearm in older adults. The Grip-ball and the Jamar dynamometer are usually choice of outcome measure to evaluate grip strength.
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 coefficients0.97 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 dueling older adults whereas the Jamar dynamometer did.[5]
Others hand motor and dexterity measures[edit | edit source]
Hand motor function
Hand motor function can be quantified in terms of coordinated upper extremity function in performing activities of daily living, ADL. This include amount of time a given daily activities is completed in a given time by hand. Example include the Box and Blocks test [6] and the Crawford Small Parts Dexterity test.[7] Others are Nine Hole Peg test[8] and the Functional Dexterity test[6] are among other measures for hand motor control and dexterity outcome measures.
A battery of measures are also available to assess a set of hand motor functional abilities like the Jebsen Taylor Hand Function (Jebsen et al., 1969) and TEMPA tests (Desrosiers et al., 1995).
Box and Blocks test[edit | edit source]
Box and Blocks test 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.
Psychometric properties
Box and Blocks test had an excellent test-retest reliability (intraclass correlations coefficients of 0.89 to 0.97) among older adults.[9]
It is a valid tool in measuring hand dexterity among older adults as it has correlations with upper limb performance.[9]
Crawford Small Parts Dexterity test[edit | edit source]
Nine Hole Peg test[edit | edit source]
Functional Dexterity test[edit | edit source]
Hand sensory/sensorimotor test[edit | edit source]
Sensory acuity tool for hand sensory test includes Weber two-point discrimination[10] and the AsTex sensitivity tests.[11] One sensorimotor control test is Strength-Dexterity (SD) test.[12]
Weber two-point discrimination[edit | edit source]
AsTex sensitivity tests[edit | edit source]
References[edit | edit source]
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 5.0 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 9.0 9.1 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.
- ↑ Dellon AL, Mackinnon SE, Crosby PM. Reliability of two-point discrimination measurements. Journal of Hand Surgery. 1987 Sep 1;12(5):693-6.
- ↑ 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.
- ↑ 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.
