Journal of Hand Therapy

Gateway to the World of Hand Therapy

Dorit Haenosh Aaron, Jerry J. Coverdale, Perry Boineau, Judy C. Colditz — 2010-01-01

In Australia, clinicians are using ultrasound in hand therapy clinics for diagnosis and biofeedback. In Israel, therapists are treating patients using virtual reality. In Sweden, researchers are doing advanced work on the intelligent hand and the plastic brain. In Norway, clinicians use mirror therapy for pain management in phantom limb and complex regional pain syndrome. Imagine a time when therapists from across the globe can come together and share research, innovative techniques, and ideas for the future. In fact, this summer, more than 29 countries will come together to exchange ideas and further the science of hand therapy at the Triennial Congress of the International Federation of Societies of Hand Therapy (IFSHT), which is immediately preceded by the annual meeting of the American Society of Hand Therapists (ASHT) in Orlando, Florida.

Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist

Elisabet Hagert — 2009-12-07

Abstract: Study Design: Narrative review. Recent years have brought new research findings on the subject of wrist joint proprioception, which entails an understanding of the wrist as part of a sensorimotor system where afferent information from nerve endings in the wrist joint affects the neuromuscular control of the joint. An understanding of proprioception is also essential to adequately rehabilitate patients after wrist injuries. The aim of this narrative review was to give the reader a background of proprioception as it relates to neuromuscular control and joint stability, what is presently known in relation to the wrist joint and how these findings may be applied to the field of wrist rehabilitation.Level of Evidence: 5.

Hand Therapist Management of the Lateral Epicondylosis: A Survey of Expert Opinion and Practice Patterns

2009-12-03

Abstract: Lateral epicondylosis (LE) is a common condition. Knowledge on practice patterns underlies identification of knowledge to practice gaps. The purpose was to determine the practice patterns and beliefs of hand therapists in managing LE. The study design used was a descriptive survey. A survey of Certified Hand Therapists and members of the American Society of Hand Therapists was conducted (n=693). Questions were framed around frequency and perceived effectiveness of interventions, examination techniques, outcome measures, and prognostic factors. More than 80% of therapists use education/activity modification, home exercise, LE orthoses, and stretching for both the acute and chronic LE. Therapists perceive education, orthoses and home exercise are the most effective for acute cases, whereas in chronic cases, orthoses dropped to ninth in ranked perceived effectiveness. Grip strength (80%) and numeric pain rating (71%) were the most commonly used outcome measures. Most (>70%) therapists perceived occupation and duration of symptoms are prognostic in terms of resolution of symptoms, whereas compliance with exercise (78%) and work factors are important for return to work. Therapists rely on impairment measures to evaluate hand therapy outcomes in patients with LE. Hand therapists are aligned with a number of recommendations from the available systematic reviews, although the use of outcome measures and optimal definition of education and exercise exhibit evidence to practice gaps. Level of evidence: Level 5.

A Comparison of the Ability of Two Upper Extremity Assessments to Measure Change in Function

2009-11-30

Abstract: Study Design: Retrospective Measurement Comparison.Introduction: Upper extremity musculoskeletal disorders affect millions, thus, discerning optimal assessments for measuring change in upper extremity function is critical.Purpose of the Study: To compare responsiveness (ability to measure change) of the Disabilities of Arm, Shoulder, and Hand (DASH) and Upper Extremity Functional Index (UEFI).Methods: Statistical analyses included Rasch analysis to place the instruments on the same scale, analysis of variance to compare change scores, correlations to compare change scores with global ratings, and the use of receiver operating characteristic (ROC) curves to determine meaningful change scores and overall error.Results: Change scores on the DASH and UEFI and correlations between change scores and global ratings were similar. Areas under the ROC curves for the DASH and UEFI were 67% and 65%, respectively.Conclusions: Neither assessment has a clear advantage over the other when measuring clinical change.Level of Evidence: Not applicable.

Modification of the Upper Limb Functional Index to a Three-point Response Improves Clinimetric Properties

Charles Philip Gabel, Lori A. Michener, Markus Melloh, Brendan Burkett — 2009-12-07

Abstract: Study Design: Observational two-stage.Introduction: To achieve optimal clinimetric properties for outcome measures, both practical and psychometric, ongoing improvements are required.Purpose of the Study: To evaluate if the Upper Limb Functional Index (ULFI) clinimetric properties are improved by modification to a three-point response option and to verify the factor structure.Methods: Stage 1, calibration (n=139) used ULFI dichotomous responses, and stage 2, validation (n=117) used a three-point response option. The clinimetric properties were compared in physical therapy outpatients with the QuickDASH as the reference standard. Repeated measurements were made at two to four weekly intervals.Results: The ULFI three-point response option improved reliability [intraclass correlation coefficient (2,1)=0.98], internal consistency (α=0.92), QuickDASH concurrent validity (r=0.86), and responsiveness. Minimal detectable change (90% confidence interval) was 7.9%, and factor structure was unidimensional. Missing responses were <0.5%, and practical characteristics were unchanged.Conclusions: The enhanced reliability and reduced errors with unchanged practicality demonstrate the ULFI improvements through modification to a three-point response option.Level of Evidence: 2c.

Hand-injured Patients' Experiences of Cold Sensitivity and the Consequences and Adaptation for Daily Life: A Qualitative Study

Ingela K. Carlsson, Anna-Karin Edberg, Christine Wann-Hansson — 2009-09-18

Abstract: Study Design: Qualitative descriptive.Introduction: Cold sensitivity is a common and persistent complaint after hand injuries.Purpose of the Study: To explore the experiences of severe cold sensitivity, its consequences for daily life, and the strategies for enduring and enabling occupation.Methods: Fifteen hand-injured patients with abnormal cold sensitivity were interviewed. The transcribed text was analyzed using manifest and latent content analysis. Experiences of triggering factors, symptoms, and relieving strategies were described.Results: The consequences and adaptation in daily life entailed a change in life roles, a struggle to maintain self-image and changed occupational performance and/or occupational patterns.Conclusions: Our findings highlight the importance of a holistic approach, including a screening of patients' occupational roles and patterns as well as psychosocial needs, to obtain the information needed to support patients with severe cold sensitivity to achieve a sense of control and self-mastery.Level of Evidence: not applicable.

Training Grip Control with a Fitts' Paradigm: A Pilot Study in Chronic Stroke

Nam Hun Kim, Michael Wininger, William Craelius — 2010-01-01

Abstract: Study Design: A clinical measurement study.Purpose: To test the applicability of Fitts' paradigm to grasping tasks in individuals with chronic stroke.Introduction: Fitts' Law relates the time of target achievement to task difficulty in repetitive motor tasks.Methods: Six male chronic stroke patients performed repetitive actuation of a grip force dynamometer with their affected hands for 12 sessions over four to six weeks.Results: Movement times followed Fitts' behavior with correlations of R2>0.8 for all subjects. Grasp control improved during training, as indicated by an average decrease in Fitts' slope of 26% at high difficulty levels (p<0.05), and decreases in the number of force corrections and in jerkiness, both at p<0.001 level.Conclusions: The Fitts' grip force targeting protocol provides an objective standardized instrument for grasp proficiency quantification and a potentially efficacious platform for hand training for persons with stroke.Level of Evidence: N/A.

The Hand Arc—A Hand-based Splint Design for Intraarticular Fractures

Sarah Baier, Mike Szekeres — 2009-11-02

When a fracture of the finger is intraarticular in nature, it adds another dimension to the rehabilitation program, as the joint space is affected and subsequently gaining motion can be a challenge. Traction splinting has been reported in the literature as one way to manage intraarticular finger fractures in an attempt to provide stability while allowing motion. These authors have modified some of the original traction splints to create a hand-based version to use for the patients with an intraarticular, proximal interphalangeal joint fracture.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor

Treatment of Grade III Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries with Early Controlled Motion Using a Hinged Splint

Ernest J. Michaud, Sharon Flinn, William H. Seitz — 2010-01-01

Ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal (MCP) joint are some of the more common injuries to the thumb and are usually treated with immobilization. There are benefits, however, to early active motion for healing ligaments. Therefore, these authors incorporated some of the concepts related to early controlled motion and its role in healing, and created a hinged thumb MCP radial and ulnar deviation restriction splint for use with Grade III UCL injuries.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor

Can we talk? Discussing “Cases” Amongst ourselves

Annette Leong — 2009-10-19

Having read your recent editorial “Can we talk? Discussing “Cases” Amongst ourselves,” I echo your concern about the nonattendance at the “bring your case” breakout session at the annual Philadelphia meeting. It is disappointing, not only for yourselves as the organizers, but for the profession, that hand therapists are not recognizing the value of these sessions as a forum to connect continuing education and professional accountability with improving patient care outcomes.

Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation

Charles Philip Gabel, Markus Melloh, Lori A. Michener, Brendan Burkett — 2009-11-30

We wish to commend your journal on the recent publication of the article by Schoneveld et al. and the supplementary commentary by Powell and Wietlisbach. However, we would like to bring your readers' attention to three points that are potentially unclear: 1) Did one measure fare better?; 2) Inclusion criteria; and 3) Acceptable clinimetric properties.

A Review of Clinical Tests and Signs for the Assessment of Ulnar Neuropathy. Goldman SB, Brininger TL, Schrader JW, Koceja DM. J Hand Ther. 2009;22:209–19

J.W. Brandsma — 2010-01-01

I have read this thorough review article with great interest. Having worked for many years with people affected by leprosy, I have considerable experience with ulnar neuropathy, an often-seen complication of leprosy. It is from this experience with thousands of these patients and my PhD work in the area of intrinsic muscle paralysis that I would like to make some comments.

A Rebuttal

2010-01-01

The authors would like to thank Dr. Brandsma for his insightful comments and for stimulating a thought-provoking discussion about clinical testing for ulnar neuropathy. All comments are well received and we have the utmost respect for his work with individuals affected by leprosy.

The Hand Owner's Manual

Greg Hritzo — 2010-01-01

The Hand Owner's Manual: A Hand Surgeon's Thirty-Year Collection of Important Information and Fascinating Facts is a book written in reader-friendly language that is worth a prominent place on the bookshelves of patients, hand therapists, and surgeons.

Thumb Mechanics

David Levy — 2010-01-01

Judy Colditz's “Thumb Mechanics: Linking Anatomy & Treatment of CMC Osteoarthritis” was published in 2009 and can be purchased as a set or individually at www.handlab.com. Each includes a DVD and CD with supplemental materials including relevant articles, study notes, self-study exercises (including splint patterns), a list of references, and clinical pearls. The CD materials are printable for use while viewing the DVD. After completion of the course work, there are 100 self-study questions to assess comprehension of the materials included in each disc.

Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture

Greg Hritzo — 2010-01-01

The authors investigated an alternative treatment of chemical lysis of the Dupuytren's cords compared with a placebo injection as an alternative to surgical excision. The procedure is an office-based treatment that aims to prevent the need for surgery and correct the flexion deformities at the MP, PIP, and DIP levels.

Needle Aponeurotomy for Dupuytren's Contracture

Russell Blau — 2010-01-01

Purpose: To review the effectiveness and safety of needle aponeurotomy for Dupuytren's contracture in a Chinese population. Methods: Seven males and one female, age range 50–80 underwent needle aponeurotomy for Dupuytren's contracture. Needle aponeurotomy was performed under local anesthesia using a 23-gauge hypodermic needle. The cord is placed on tension and the needle is inserted in the same local anesthetic injection sites. The needle is then rotated and the sharp bevel edge is used to make small perpendicular cuts in the fibers of the cord a few millimeters in depth. The needle is then rotated and swiped transversely. Other punctures were administered in the same manner along the cord until the desired extension was gained. After the procedure was complete, the finger was splinted in an extended position. Dressing changes were allowed three to seven days postoperative. Active mobilization was undertaken at that time. Splinting continued for eight to twelve weeks, depending on patient need.

ASHT President's Lecture: Making Decisions Using Values, Experience, and Evidence

Joy C. MacDermid — 2009-11-30

Be willing to make decisions. That's the most important quality in a good leader.General George S. Patton In taking on the role of 2009 President of the American Society of Hand Therapists (ASHTs), I was concerned about providing leadership to the society. As indicated by General George Patton, leadership requires making decisions. Some are easy, some are hard—none are simple. We are all familiar with making decisions, because it is required in our personal lives and our career choices. We know that clinical decision making is critical in our roles as health-care providers. When we take on professional leadership roles, we need to use and extend our skills as decision makers. So it is, that year has caused me to reflect on my own decision making and has become the focus of this lecture.

Erratum to “A Review of Clinical Tests and Signs for the Assessment of Ulnar Neuropathy” [J Hand Ther 2009;22(3):209–220]

Sarah B. Goldman, Teresa L. Brininger, John W. Schrader, David N. Koceja — 2010-01-01

In the above-mentioned article, the authors have noted that two figures were not printed in the final version: (Spurling's test) and (combined pressure and flexion test). This resulted in the incorrect numbering of all subsequent figures; therefore, Figure 3 in the original article should be listed as Figure 5, Figure 4 should be Figure 6, Figure 5 should be Figure 7, Figure 6 should be Figure 8, Figure 7 should be Figure 9, Figure 8 should be Figure 10, and Figure 9 should be Figure 11.

2010-01-01

Editorial Board/Masthead/ASHT Officers

2010-01-01

Contributors

2010-01-01

Sarah Baier, MScOT, BSc, BPHE, CHT, a therapist in the Hand the Upper Limb Center in London, Ontario has consummated her interest in problem-solving splinting challenges with this, her first contribution to the Journal of Hand Therapy (JHT).

Instructions for Authors

2010-01-01

Journal of Hand Therapy

Gateway to the World of Hand Therapy

Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist

Hand Therapist Management of the Lateral Epicondylosis: A Survey of Expert Opinion and Practice Patterns

A Comparison of the Ability of Two Upper Extremity Assessments to Measure Change in Function

Modification of the Upper Limb Functional Index to a Three-point Response Improves Clinimetric Properties

Hand-injured Patients' Experiences of Cold Sensitivity and the Consequences and Adaptation for Daily Life: A Qualitative Study

Training Grip Control with a Fitts' Paradigm: A Pilot Study in Chronic Stroke

The Hand Arc—A Hand-based Splint Design for Intraarticular Fractures

Treatment of Grade III Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries with Early Controlled Motion Using a Hinged Splint

Can we talk? Discussing “Cases” Amongst ourselves

Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation

A Review of Clinical Tests and Signs for the Assessment of Ulnar Neuropathy. Goldman SB, Brininger TL, Schrader JW, Koceja DM. J Hand Ther. 2009;22:209–19

A Rebuttal

The Hand Owner's Manual

Thumb Mechanics

Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture

Needle Aponeurotomy for Dupuytren's Contracture

ASHT President's Lecture: Making Decisions Using Values, Experience, and Evidence

Erratum to “A Review of Clinical Tests and Signs for the Assessment of Ulnar Neuropathy” [J Hand Ther 2009;22(3):209–220]

Table of Contents

Editorial Board/Masthead/ASHT Officers

Contributors

Instructions for Authors