Research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the Master of Science in Occupational Therapy, Johannesburg, June 2013 / The effectiveness of the Stetro pencil grip in 45 Grade 2 learners with handwriting difficulties was investigated. Monthly assessments considered descriptors including the position joints when writing, the position of the pencil in the hand, hand and arm movements, arm position and posture when writing as well as pencil grasp, the speed and quality of handwriting and tripod pinch strength. The experimental participants used a Stetro pencil grip for two months after which it was removed for one month. The control participants wrote without a pencil grip. Statistically significant improvement was found for the experimental group in the efficiency of their pencil grasps and their use of their fingers when writing. The quality and speed of writing and the pinch strength improved in both groups with the experimental group showing significant change in their index finger DIP position. The use of the Stetro pencil grip was effective in resolving inefficient pencil grasps in 70% of the experimental group.

Paul Wittgenstein (1887-1961) made significant contributions to the piano literature for the left hand through numerous commissioned works as well as his own transcriptions. In the transcriptions, Wittgenstein preserved the texture of two-hand music, aiming for the simulation of the original works. This requires special techniques in the performance by the left hand alone. This dissertation investigates technical means and performance problems associated with the transcriptions as well as Wittgenstein's own recordings of selections from his works.

by Ho Kim Kong Enoch. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references (leaves 98-102). / ABSTRACT --- p.I / ACKNOWLEDGMENT --- p.IV / TABLE OF CONTENTS --- p.V / LIST OF TABLES --- p.VIII / LIST OF ILLUSTRATIONS --- p.X / Chapter CHAPTER 1 - --- INTRODUCTION --- p.1-5 / Chapter 1.1 --- Introduction / Chapter 1.2 --- Questions address / Chapter 1.3 --- Definition / Chapter CHAPTER 2 - --- LITERATURAL REVIEW - DEVELOPMENT OF HAND FUNCTION TESTS --- p.6-14 / Chapter 2.1 --- Introduction / Chapter 2.2 --- Trends of studies of hand injury in Hong Kong / Chapter 2.3 --- Previous studies to compare and relate physical and functional impairment / Chapter 2.4 --- Conclusion / Chapter CHAPTER 3 - --- FUNCTION ASSESSMENT - CRITERIA FOR THE EVALUATION --- p.15-28 / Chapter 3.1 --- Introduction / Chapter 3.2 --- Functional Anatomy / Chapter 3.3 --- Grip force study / Chapter 3.4 --- Sensation / Chapter 3.5 --- Functional assessment / Chapter 3.6 --- Conclusion / Chapter CHAPTER 4 - --- METHODOLOGY --- p.29-43 / Chapter 4.1 --- Subject selection / Chapter 4.2 --- Organization / Chapter 4.3 --- Physical assessment / Chapter 4.4 --- Functional assessment / Chapter 4.5 --- Evaluation of loss of earning capacity / Chapter 4.6 --- Control group / Chapter 4.7 --- Statistical analysis / Chapter CHAPTER 5 - --- RESULT --- p.44-57 / Chapter 5.1 --- Introduction / Chapter 5.2 --- Subject characteristics / Chapter 5.3 --- Result of individual tests / Chapter 5.4 --- Assessment of loss of earning capacity / Chapter 5.5 --- Hand function assessment after return to work / Chapter 5.6 --- Effect of severity of injury / Chapter CHAPTER 6 - --- DISCUSSION --- p.58-67 / Chapter 6.1 --- Introduction / Chapter 6.2 --- Impairment of hand function in finger amputation / Chapter 6.3 --- The effect of return to work / Chapter 6.4 --- Official schema for assessment of percentage of loss of earning capacity / Chapter 6.5 --- Severity of injury and the outcome / Chapter 6.6 --- The hand assessment protocol / Chapter CHAPTER 7 - --- CONCLUSION --- p.68-70 / APPENDIX --- p.71-90 / ILLUSTRATIONS --- p.91-97 / REFERENCES --- p.98-102

In this thesis, the synthesis of a grasping and manipulation controller of the Barrett hand, which is an archetypal example of a multi-fingered robotic hand, is investigated in some detail. This synthesis involves not only the dynamic modelling of the robotic hand but also the control of the joint and workspace dynamics as well as the interaction of the hand with object it is grasping and the environment it is operating in. Grasping and manipulation of an object by a robotic hand is always challenging due to the uncertainties, associated with non-linearities of the robot dynamics, unknown location and stiffness parameters of the objects which are not structured in any sense and unknown contact mechanics during the interaction of the hand’s fingers and the object. To address these challenges, the fundamental task is to establish the mathematical model of the robot hand, model the body dynamics of the object and establish the contact mechanics between the hand and the object. A Lagrangian based mathematical model of the Barrett hand is developed for controller implementation. A physical SimMechanics based model of the Barrett hand is also developed in MATLAB/Simulink environment. A computed torque controller and an adaptive sliding model controller are designed for the hand and their performance is assessed both in the joint space and in the workspace. Stability analysis of the controllers are carried out before developing the control laws. The higher order sliding model controllers are developed for the position control assuming that the uncertainties are in place. Also, this controllers enhance the performance by reducing chattering of the control torques applied to the robot hand. A contact model is developed for the Barrett hand as its fingers grasp the object in the operating environment. The contact forces during the simulation of the interaction of the fingers with the object were monitored, for objects with different stiffness values. Position and force based impedance controllers are developed to optimise the contact force. To deal with the unknown stiffness of the environment, adaptation is implemented by identifying the impedance. An evolutionary algorithm is also used to estimate the desired impedance parameters of the dynamics of the coupled robot and compliant object. A Newton-Euler based model is developed for the rigid object body. A grasp map and a hand Jacobian are defined for the Barrett hand grasping an object. A fixed contact model with friction is considered for the grasping and the manipulation control. The compliant dynamics of Barrett hand and object is developed and the control problem is defined in terms of the contact force. An adaptive control framework is developed and implemented for different grasps and manipulation trajectories of the Barrett hand. The adaptive controller is developed in two stages: first, the unknown robot and object dynamics are estimated and second, the contact force is computed from the estimated dynamics. The stability of the controllers is ensured by applying Lyapunov’s direct method.

Photocopy of typescript. / Digitized by Kansas Correctional Industries

With the increase of hand pathologies in the last decade, the need to better understand the anatomy of the hand is becoming more vital. The cutaneous innervation of the hand is classically described to be supplied by palmar cutaneous branch of the median nerve (PCBMN), common digital nerves (CDNs), ulnar nerve (UN), palmar cutaneous branch of the ulnar nerve, dorsal branch of the ulnar nerve (DBUN), superficial branch of the radial nerve (SBRN) and occasionally the lateral antebrachial cutaneous nerve (LABCN). Although the sensory distribution of the hand has been described in the literature, reports have often shown contradicting views and occasionally different or incomplete descriptions. Furthermore, clinical procedures in the hand and wrist can result in painful and/or disabling postoperative complications. This thesis outlines, categorizes and describes the distribution and branching patterns of cutaneous branches supplying the palmar and dorsal surface of the hand and their relationship to the distal area of the forearm and wrist. It also investigates the palmar and dorsal communicating branches, their patterns and common locations. Moreover, the project discusses the impact of the distribution and branching patterns of the cutaneous nerves on surgical and diagnostic procedures performed in the hand, wrist and distal forearm. 160 cadaveric hands were dissected in the Centre for Anatomy and Human Identification (CAHID), University of Dundee. All cadavers were musculoskeletally mature adults with mean age of 82.5±9.4 (range: 53-101) years. Skin was removed from the distal half of the forearm to the metacarpophalangeal joints. Nerves under investigation were identified, dissected, and traced. Sketches, photographs, and measurements to predefined landmarks including the wrist crease (WC), bistyloid line (BSL) and the third metacarpophalangeal (MCP) joint were taken and results expressed as means, standard deviations and ranges. Patterns are classified and expressed with frequencies. The PCBMN was found to originate from the main trunk of the median nerve (MN) 54.1±15.7 mm proximal to the WC and course distally between flexor carpi radialis and palmaris longus (if present) to innervate the proximal palmar surface of the hand by branching into one of three types identified. Furthermore, two PCBMN were found in 8.9% of cases. The second, third, fourth CDNs were found to divide into proper digital nerves at a point located distal to the 70% of the distance between the third MCP joint and the BSL in 88% of cases. The cutaneous innervation of the palm was found to be relatively constant with the lateral 3½ digits being supplied by the MN and the medial 1½ being supplied by the UN. A palmar CB was found between the third CDN-MN and fourth CDN-UN in 86.9% of the cases coursing in different patterns and changing the palmar sensory innervation of that previously described. The sensory innervation of the dorsum of the hand was variable. The most common pattern was being supplied by the SBRN innervating the lateral dorsal skin and the skin covering the lateral 2½ digits and the DBUN innervating the medial dorsal skin and the skin covering the medial 1½ digits found in 37.3%. All radial supply to the dorsum of the hand with the absence of the DBUN was found in 6.7%. The SBRN connected with the LABCN in 30.7% and with the DBUN in 26.4% complicating the sensory innervation in the dorsum of the hand. Understanding the cutaneous innervation of the hand, appreciation of the possible variations and presence of communicating branches will result in a better evaluation of signs and symptoms, establishing a proper therapeutic plan, avoiding iatrogenic injuries during surgical interventions, and properly diagnose postoperative complications leading to an increased quality of medical service and patient satisfaction.

MSc, Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand, 2008 / Purpose of this study was to develop an appropriate and valid hand function assessment: the Steinmann-Obermeyer questionnaire (SOQ) for clients attending the Rheumatology Clinic at Kalafong Hospital. To achieve this • the construct validity of the SOQ had to be examined by assessing the face and content validity. • the criterion –related validity of the SOQ was assessed using convergent, concurrent and discriminative validity compared to pain, severity of deformity and disease severity. • the criterion –related validity of the SOQ was further assessed using the predictive validity by assessing normal subjects with the SOQ. Objective: The objective of this study was to test the following null hypotheses: 1.4.1 The SOQ is not a valid method of evaluating the functional ability of rheumatology clients treated at Kalafong hospital out patient clinic. 1.4.2 There is no correlation between the severity of the rheumatic disease and the score obtained by the SOQ. 1.4.3 There is no correlation between the disease activity and the score obtained by the SOQ. 1.4.4 There is no correlation between the client’s assessment of their level of pain and the score obtained by the SOQ. Method. The SOQ consisted of 48 questions, was translated into Sotho and Zulu and was administered and analysed on 96 arthritic clients between 18 and 69 years of age. An occupational therapy assistant (OTA), who spoke both the tribal languages fluently, completed the questionnaire with each client. An interviewer-administered format was used because many of the clients were illiterate. Results. After the analyses were completed, three questions were excluded and the final questionnaire consisted of 45 questions. This questionnaire was found to be a valid method of evaluating the functional ability of rheumatology clients treated at Kalafong hospital. Clients with severe functional limitations scored high on the questionnaire and those with minimal functional difficulty scored low on the questionnaire. The questionnaire scores correlated significantly with the pain levels experienced by the clients and their disease activity. The statistical analyses also showed that there is no correlation between the questionnaire score and the deformities of the clients. Inter-rater reliability was established. Conclusion. The 45-question occupational performance evaluation was developed, analysed and proven to be valid and sensitive for use with rheumatology clients with hand function difficulties at the Kalafong rheumatology clinic.

Development of an Open Source Prosthetic Hand Platform Scott Garrett In the field of upper extremity prosthetic devices, advancements in technology drive the design of products which are becoming capable of restoring the lost functions of the native hand. While several dexterous devices have been developed to serve this purpose, they remain prohibitively expensive and thus are not a viable option for many upper extremity amputees. To address this problem a prosthetic hand platform was developed utilizing the open source Arduino microcontroller and off-the-shelf electrical components. Using these resources, a novel finger actuation mechanism was developed to show how a prosthetic hand platform could be developed which is capable of individual finger actuation, multiple actuation modes, sensing of forces at the individual fingers, providing force feedback to the user, and control of finger actuation through a variety of control inputs. After going through several iterations of hand’s mechanical components, electronics, and firmware a final prototype was built to showcase the possible capabilities of the open source prosthetic hand platform. This prototype consisted of several groups of subcomponents including an auto-flexing / extending finger design, a modular palm/ servo attachment base, and a wrist section which housed the hand’s electronic components, power supplies, force feedback system. The open source prosthetic hand platform was then verified using a series of tests to quantify several performance characteristics of the final prototype. Battery life and grip strength during continuous use were evaluated and demonstrated that the hand could provide consistent grip force during up two hours of initial continuous use. Also, the grip performance of the hand was assessed through the grasping of spherical objects with varying surface textures, diameter, and weight. Furthermore the hand was tested in various “real life” applications including manipulating and sorting small objects, opening doors, grasping moderately heavy objects such as water bottles, and sensitive objects such as an egg. Lastly, the platform was connected to a myoelectric input circuit to demonstrate compatibility with advanced electro-physical inputs. These tests demonstrated that the platform was capable of performing some of the dexterous tasks performed by prohibitively expensive available robotic upper extremity prosthetic devices. Further developments could be made to the open source prosthetic hand platform including enhancements to the platform’s finger force sensing and feedback mechanisms, consolidation of the electronics, refinement of the auto-flexing / extending fingers, and integration with a silicone covering and patients residual limb socket. These future iterations of this platform could help provide a dexterous prosthetic hand platform at lower cost to a wider patient base.

Philosophiae Doctor - PhD / The fluoride release and chemical adherence to tooth structure remain the most desirable features of glass ionomer restorative cements (GICs). Although the physical properties for multi-surface restorations are well-defined, even with the introduction of newer GICs not all demands have been met. Yet, increased use of GICs will only be possible if clinicians change their perceptions of the low survival rate of GICs. The lower clinical success rate of GICs is partly due to the marginal integrity and wear over time, which has often been recorded in the literature as restoration failure. The current, well-established restorative options for the primary dentition are Resin Modified Glass Ionomers (RMGICs) and Compomer resins. There is a paradigm shift towards materials that are more biologically favourable. Areas of research for dental materials include antibacterial properties in conjunction with ion release to maintain healthy restored teeth. If a GIC can provide adequate physical properties with the inclusion of the aforementioned features, GICs might become a more viable permanent restorative solution.

Age related cataracts are one of the major causes of loss of vision worldwide. Approximately 20 million people in the United States have their vision obstructed by cataracts and 500,000 new cases are diagnosed annually. The treatment for cataract is surgical extraction. The surgery is more than 95% successful in significantly improving vision. Because of continual advancements in cataract surgery, it is almost exclusively performed as an outpatient procedure and involves the administration of local anesthesia. For the most part patients are fully conscious during the procedure and it is imperative that they remain still. In the elderly, fear of loss of vision related to cataract surgery is second only to the fear of death. Although studies have shown that the average cataract patient is not unduly anxious regarding cataract surgery, anxiety is a known entity. An increase in anxiety can cause a patient to be restless, jittery, and agitated, all of which can cause unanticipated movement and hence a deleterious outcome. People are social beings. Interaction with and among other people provides and conveys support, comfort, and reassurance. Touch, specifically hand holding, has been shown to decrease anxiety and stress in multiple situations. It is minimally invasive, safe, reassuring and could allow patients to communicate during procedures where verbal communication, if done without parameters, as in cataract surgery, could be devastating. The findings of this study failed to reveal a significant difference in post op anxiety scores in either the treatment group or the non treatment group. However, subjectively, those people who received hand holding strongly agreed that hand holding helped to decrease anxiety during the procedure. The physician rating for patient compliance did not reveal a significant level of increase with the intervention during surgery. Again, subjectively, the majority of patients strongly agreed that hand holding did help them to be more compliant to the surgeon’s request. None of the participants that received hand holding felt an intrusion of personal space during the treatment. Results strongly suggest, at least subjectively, that hand holding is beneficial in decreasing anxiety, increasing compliance to intraoperative request, and is much welcomed, beneficial nursing intervention. / Thesis / Master