Tyrimo tikslas: įvertinti kineziterapijos taikymo efektyvumą rankų funkcijoms sergant reumatoidiniu artritu. Tyrimo objektas: pacientai sergantys reumatoidiniu artritu tiriant jų rankų funkcinę būklė, sąnarių skausmą, plaštakų raumenų jėga ir judesių amplitudes. Tyrimo uždaviniai: 1. Nustatyti tiriamųjų sergančių reumatoidiniu artritu rankų funkcinę būklę, naudojant Keitel indekso rodiklius, prieš ir po kineziterapijos. 2. Nustatyti tiriamųjų sergančių reumatoidiniu artritu plaštakų raumenų jėgą prieš ir po kineziterapijos. 3. Nustatyti kineziterapijos efektyvumą tiriamųjų sergančių reumatoidiniu artritu rankų sanarių skausmui. 4. Nustatyti tiriamųjų sergančių reumatoidiniu artritu rankų sąnarių judesių amplitudes prieš ir po kineziterapijos. Rezultatai: tyrimo rezultatai parodė, kad po kineziterapijos (KT) taikymo rankų funkcijos pagal Keitel indeksą pagerėjo 2,8 balo. Plaštakos raumenų jėgą tiriamiesiams KT pagerino dešinėje rankoje 3,9 kg, o kairėje rankoje 3,3 kg. Skausmo stiprumas sąnariuose po KT tiriamiesiams sumažėjo 2,9 balo. Judesių amplitudės peties, alkūnės ir riešo sąnariuose po KT padidėjo statistiškai patikimai (p<0,001), lyginant rodiklius prieš KT ir po KT. Tyrimo išvados: kineziterapija pagerino rankų funkcinę būklę (Keitel indeksas), sergantiems reumatoidiniu artritu. Kineziterapija pagerino tiriamųjų plaštakų raumenų jėgą, sergančių reumatoidiniu artritu. Kineziterapija sumažino rankų raumenų skausmus, tiriamiesiams, sergantiems reumatoidiniu artritu... [toliau žr. visą tekstą] / The aim of the research: evaluate the effectiveness of physiotherapy for hand functions in patients with rheumatoid arthritis. Object of the research : patients with rheumatoid arthritis analyzing their hand functional condition, pain in the joints, palm muscle strength and range of motion. The goals of the research: 1. Set of subjects with rheumatoid arthritis hand functional condition using Keitel index indicators before and after physiotherapy. 2. Set of subjects with rheumatoid arthritis hand muscle strength before and after physiotherapy. 3. Determine the effectiveness of physiotherapy for subjects with rheumatoid arthritis to their hand joint pain. 4. Set of subjects with rheumatoid arthritis in hand joints range of motion before and after physiotherapy. Results: the results showed that after physiotherapy, both hand functions by Keitel index improved 2.8 points. Hand muscle strength for subjects after physiotherapy increased 3.9 kg in the right hand and 3.3 kg in left hand. The severity of pain in joints after physiotherapy for subjects decreased by 2.9 points. Range of motion of the shoulder, elbow and wrist joints after physiotherapy increased significantly (p <0.001) compared to rates before physiotherapy and after physiotherapy. Research conclusions: for the purposes of physiotherapy for subjects with rheumatoid arthritis improved hand function condition (Keitel index). For the purposes of physiotherapy for subjects increased hand muscle strength. For the purposes... [to full text]

Stipinkaulio distalinės dalies lūžiai yra vienas iš dažniausių kaulų ir raumenų sistemos pažeidimų. Literatūroje nurodoma, kad distalinės stipinkaulio dalies lūžiai yra 1/10 visų lūžių, kuriuos patiria vyresni nei 35 metų amžiaus asmenys. Apie 3 % pacientų, po šios traumos išlieka ilgalaikė negalia. Siekiant optimizuoti stipinkaulio distalinės dalies lūžių gydymą, buvo atliktas tyrimas, kuriame buvo iškelti trys uždaviniai. Vertinome 2 savaičių imobilizacijos įtaką rankos funkcijai, po stipinkaulio distalinės dalies lūžio ir osteosintezės delnine rakinama plokštele. Taip pat vertinome,radiologinio lūžio tipo, pagal AO klasifikaciją, įtaką rankos funkcijai. Sugijus kaului, tirta metalinių konstrukcijų pašalinimo įtaka rankos funkcijai. Vertinant rezultatus, nustatyta, kad riešo judesių amplitudė ir rankos funkcija tarp pacientų, patyrusių stipinkaulio distalinės dalies lūžį su poslinkiu ir operuotų delnine rakinama plokštele, kuriems buvo taikyta pooperacinė 2 savaičių riešo imobilizacija ir kuriems pooperacinė riešo imobilizacija nebuvo taikyta, nesiskyrė. Tiriamiesiems, patyrusiems C tipo lūžį pagal AO radiologinę klasifikaciją nustatyta prastesnė funkcija. Riešo judesių amplitudė ir rankos funkcija po delninės rakinamos plokštelės pašalinimo nepakito. / Distal radius fracture is one of the most common injuries of the skeletal and muscular system. It has been reported in literature that distal radius fractures account for one-tenth of all the fractures experienced by people older than 35 years. Long-term disability remains in approximately 3% of patients after a distal radius fracture. In order to optimise treatment of distal radius fractures, a study with three objectives was performed. We evaluated the effect of immobilisation for the period of 2 weeks on the hand function after a distal radius fracture and osteosynthesis with a volar locking plate. The effect of the fracture type according to the AO classification on the hand function was also assessed. After the bone has healed, the effect of the removal of metal constructions on the hand function was evaluated. The analysis of the results demonstrated that there were no differences in the range of wrist motions and the hand functionbetween the patients after a displaced distal radius fracture operated with a volar locking plate and post-surgery immobilisation of the wrist applied for the period of 2 weeks and the patients who did not have post-surgery wrist immobilisation applied. A worse function was determined in the patients after type C fracture according to the AO radiological classification. The range of wrist motions and the hand function after the removal of a volar locking plate did not differ.

Attention uses sensory inputs and goals to select information from our environment. Monkey electrophysiological literature demonstrates that visuo-tactile bimodal neurons (respond to visual and tactile stimuli presented on/near the hand) facilitate multisensory integration. Human behavioral studies show that hand position/function bias visual attention. Event-related potentials (ERPs) reveal the cortical dynamics coordinating visual inputs, body position, and action goals. Early, sensory ERPs (N1) indicate multisensory integration. Later, cognitive ERPs (P3) reflect task-related processing. Study 1 investigates a discrepancy between monkey and human literatures. Monkey studies demonstrate bimodal neuron responses equidistantly around the whole hand, but human studies demonstrate attentional bias for grasping space. In a visual detection paradigm, participants positioned their hand so target and non-target stimuli appeared near the palm or back of the hand; ERPs were measured. N1 components indicated no amplitude differences between Palm vs. Back conditions, but P3 components revealed greater target vs. non-target differentiation for Palm conditions. Results suggest cortical timing underlies grasping vs. whole hand bias differences: early processing does not differentiate using hand function, but cognitive processing does when stimuli are discriminated for action. Study 2 investigates whether proprioceptive inputs facilitate visual processing. In a visual detection paradigm, participants viewed stimuli presented between occluders blocking view of a hand positioned either near or far from the stimuli. N1 amplitudes were similar for near and far conditions, but P3 amplitudes for target/non-target differences were accentuated for near conditions. Proprioceptive effects emerge later in processing. ERP reveals the cortical dynamics underlying hand position effects on vision.

In der vorliegenden Arbeit wurde eine vergleichende Analyse der Hand- und Armfunktion von gesunden rechtshändigen alten und jungen Personen vorgenommen und dabei insbesondere der modulare Aufbau von Greifmustern analysiert. Es wurden vier Handfunktionstests durchgeführt: eine Tapping-Aufgabe an einer Computertastatur, eine Handkraftmessung mit dem Martin-Vigori-meter, der Jebsen-Taylor Test of Hand Function und eine standardisierte Greifaufgabe nach vier Greifobjekten (Münze, Kronkorken, kleine Dose, große Dose) mit Aufzeichnung der Handbewe-gungen mit einem Sensorhandschuh (Wü-Glove) und der Armbewegungen mit ultraschallemittierenden Markern. Die Auswertung der Greifaufgabe erfolgte zum einen nach kinematischen Aspekten (Dauer, maximale Geschwindigkeit, maximale Beschleunigung), zum anderen wurde mittels Hauptkomponentenanalyse der modulare Aufbau von Greifmustern untersucht und mittels Ähnlichkeitsanalysen (u.a. Mahalanobis-Distanz) die Finger- und Armkonfigurationen bei Objektkontakt verglichen. Daten von 66 Probanden wurden ausgewertet. Vollständige Datensätze lagen von 10 jungen (20-33 J.) und 10 alten (61-85 J.) Probanden vor. Junge Probanden zeigten erwartungsgemäß eine größere Handkraft und Fingerschnelligkeit und eine bessere Leistung im Jebsen-Taylor Test of Hand Function. Die Greifmuster der älteren Probanden waren verglichen mit den jungen Probanden interindividuell variabler, gleichzeitig aber ökonomischer organisiert. Diese ökonomischere Organisation kann als Folge impliziter Lernprozesse bei individuell unterschiedlichen Greiferfahrungen in Abhängigkeit des Alters gedeutet werden. Zunehmendes Lebensalter muss somit nicht nur mit einer Abnahme motorischer Funktionen verbunden sein, sondern kann auch positive Auswirkungen auf die Steuerung der Handfunktion in Form einer Optimierung von Greifmustern durch implizite Expertise haben.

Title: Developmental coordination disorder - literature review Objectives: The theoretical part talks about developmental coordination disorder, its diagnosis, investigations, etiology and division during the different ages of the child. The practical part compares the studies relating to atypical development of motor skills in children with developmental coordination disorder. In diploma thesis was often used shortcut CKP and DCD, depending on the source from which it was drawn. DCD is the English equivalent of the shortcut CKP. Methods: This diploma thesis has both descriptively - analytical character. It will be treated as a literature review. Results: On the basis of the researched literary sources, this thesis provides a comprehensive picture on the topic of developmental coordination disorder. This thesis evaluated the atypical motor skills in school and preschool age children with developmental coordination disorder from the perspective of different authors. It has been found, which diagnostic procedures are used and which difficulties are most limiting for the children. Keywords: developmental coordination disorder, fine motor skills, hand function, gross motor skills

Purpose Conventional arm-prosthesis are expensive to make and therefore limit the availability for users on the geographical locations there the user pays for it. This study compares the hand function of a 3D-printed prosthesis with lower production cost with a traditional prosthesis. Method A test person performed two different tests of hand function (Box and Block test and Nine-hole peg test) with a myoelectric trans radial prosthetic arm and a body powered 3D printed trans radial prosthetic arm. The test person also answered two parts of the orthotics and prosthetics users’ survey (OPUS) considering both prosthetic arms. Result The 3D-printed prosthesis performed worse than the traditional prosthesis in the two tests of hand function and generally worse in the questionnaire about the function of the prosthesis. Though it got higher values in comfort and affordability. Conclusion There was a significant difference in function between the 3D-printed prosthesis and the myoelectric prosthesis but the printed prosthesis could perform many activities in daily living. Whether the 3D-printed prosthetic device is priceworthy or not is hard to measure because of different criteria, therefore a conclusion is hard to reach.

Hand function is of great importance in the many daily activities that require well-coordinated hand and arm movements. Measurement of hand function is an essential element in the rehabilitation process, in order to facilitate medical diagnosis and determine developmental stages, functional levels, and the efficacy of treatment interventions. Basic requirements for any measurement used in clinics are that they are easy to use, relevant to the function being assessed, and valid and reliable. When scrutinizing the literature on hand function, important gaps were found with regard to measurement. For example, the reliability of grip strength with the Grippit in children has yet to be determined, and there are few evaluations of hand function measurements in Charcot-Marie-Tooth disease (CMT). Furthermore, laboratory measurements of hand function, which have the potential to provide more detailed information and insight into hand control, such as the role of the cerebellum in reactive grip control – have not been fully explored. The overall aim of the thesis was to achieve more knowledge on hand function; on the evaluation of measurements in different target populations; and on movement control of the hand. In the first study, the aim was to evaluate the test-retest reliability of the peak and sustained grip strength with Grippit in a sample of healthy children (n=58, 6-, 10- and 14-y-olds). This was followed by two studies examining hand function in an adult sample (n=20) diagnosed with CMT. The test-retest reliability of grip and pinch strength using Grippit, sensation with the Shape Texture Identification test (STI) and dexterity with the Box and Block Test (BBT) and Nine-Hole Peg test (NHP) were studied. The impact of the disease on daily life, measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH), and correlations between disability and various aspects of hand function, were also explored in this condition. The aim of the fourth study was to examine grip force response to unpredictable loadings of an object held in a pinch grip in subjects (n=9, 22-48 yrs) who had been diagnosed with a cerebellar lesion, compared with a healthy control group (n=11). The first study showed that test-retest reliability was good for both peak and sustained grip strength in healthy children. The mean and best of three trials were equally reliable, but differences in reliability were detected within different age groups. For example, the peak grip strength, best of three trials, was more reliable for the 6-y-olds (intraclass correlation coefficient (ICC)=0.96, standard error of measurement in percentage (SEM%)=6.3) and 14-y-olds (ICC=0.96, SEM%=5.2) compared with the 10-y-olds (ICC=0.78, SEM%=12.5). In the second study, evaluating measurements of hand function in subjects with CMT, grip strength proved to be reliable (ICC=0.99, coefficient of repeatability (CR)=26.7 N, coefficient of variation (CV)=6.6 %), but pinch strength was less reliable. The reliability was also good for the BBT (ICC=0.95, CR=11.5 blocks/min, CV=8.4%) and the NHP (ICC=0.99, CR=4.3 s, CV=3.9 %). However, a bias towards higher values was noted on the second test occasion with the BBT. The reliability of the STI test (kappa=0.87) was also very good in subjects with CMT. A limitation in this latter test was noted in terms of its ability to describe subjects either performing very well or very poorly. The results of the third study showed that hand function in CMT was reduced (p&lt;0.001) to about 60% of that in healthy controls in each of the separate outcome measures, as well as by a constructed summary index of hand function. The median DASH score was 38.8 (range 0-66.7) and was clearly related to hand function (r=0.64-0.83). The results of the final study in subjects with cerebellar lesions showed that the ipsilateral hand had delayed and more variable response latencies e.g. 278±166 ms for loads delivered at 2 N/s, compared with healthy subjects (HS) 80±53 ms (p=0.005). The cerebellar subjects also used a higher pre-load grip force with the ipsilateral hand (1.6±0.8 N) than the HS (1.3±0.6 N (p=0.017)). Even the contralateral hand in subjects with unilateral cerebellar stroke showed a delayed onset of the grip response. In conclusion: Grip strength assessment in children with Grippit results in good reliability for peak and sustained grip strength, although the 10-y-olds were less reliable. In CMT the tested instruments can all be used to evaluate hand function, but certain factors, such as the number of trials used should be taken into consideration. The CMT subjects’ hand function was reduced and correlated with their self-experienced disability. However, clinicians should be aware that patients might score lower than expected on DASH, possibly due to a long process of adaptation. Cerebellar lesions can impair the reactive grip control in both the ipsilateral and the contralateral hand. These investigations have thus, as intended increased the knowledge of hand function. The studies have evaluated some measurements in different samples, which will help clinicians testing hand function.

The thesis deals with with handwriting in adult patients after stroke. The main aim is to design and evaluate a therapeutic program for stroke patients focused on hand function and handwriting. The secondary aims are to translate Handwirting Assessment Battery for Adults into the Czech language by the method of back translation and to determine patient satisfaction with the program. The theoretical part of the thesis briefly summarizes the issue of stroke. General knowledge about handwriting is followed by a summary of handwriting difficulties of stroke patients. The theoretical part is concluded by available handwriting examinations and different ways of occupational therapy intervention. The practical part of the thesis was a case study. Five patients participated in the four- week therapeutic program. The designed program includes task-specific training and Constraint Induced Movement Therapy (CIMT) elements. The tools of the Jebsen Taylor Hand Function Test, the Frenchay Arm Test and Score for Visual Evaluation of Functional Task of the Hand were used to assess the effect of the program on hand function. The practical part mentions the back translation of the handwriting tool Handwriting Assessment Battery for Adults, which was used to evaluate the effect of the program on handwriting...

Introduction: Dexterity impairments are common and disabling. Measuring the extent of these impairments is important for care and service provision. Despite this, dexterity is poorly operationalized in the management of persons with hand and wrist conditions (HWC). Thesis purpose: To understand: 1) how dexterity is defined in the management of persons with HWC and 2) how therapists working with persons with HWC perceive/understand the concept and measurement of dexterity and use of performance-based outcome measures of dexterity (PBOMD). Methods: In study one, Interpretive Description was used to understand the perceptions and measurement practices of occupational therapists working with persons with HWC in Singapore. Study two involved a content analysis of the literature outlining the constructs measured by PBOMD that were validated for use in persons with HWC. Results: Both studies highlighted the lack of conceptual clarity around ‘dexterity’ that is reflected in therapists’ and tool developers’ discourse. Many of the therapists we interviewed, perceive PBOMD to lack clinical value. Studies from this thesis suggest that identified PBOMD do not adequately cover dexterity. Conclusion: Findings highlight the challenges surrounding the construct of dexterity and provide clinical practice recommendations. / Thesis / Master of Science Rehabilitation Science (MSc) / Dexterity is the ability to do tasks, successfully, quickly and accurately. Loss of dexterity is common and affects our ability to do our tasks of daily life and work. Unfortunately, there is a lack of agreement on the best way to measure dexterity. Our study aims to explore what dexterity means to health professionals. We focused on occupational therapists seeing persons with hand and arm injuries. In the first study, we interviewed therapists to understand how they measured dexterity. In the second study, we searched for dexterity tests used with persons with hand injuries. Then, we compared the tests we found to dexterity theories. We found that dexterity is measured in different ways. Therapists faced many barriers to using dexterity tests. Current dexterity tests are an incomplete reflection of a person’s dexterity. The information gained from these studies could be used to inform future research on the measurement of dexterity.

Résumé : Dans la sclérodermie systémique (ScS), les contractures aux mains, pour lesquelles il n'existe aucun traitement prouvé, sont courantes et associées à de l'incapacité de la main, globale et au travail. Toutefois, quelques études sur les effets d'interventions comprenant des techniques manuelles ont montré des résultats prometteurs. Ainsi, le but de l'étude était d'explorer les effets d’un traitement ostéopathique sur la fonction de la main, des symptômes globaux de la maladie et le statut fonctionnel de personnes atteintes de ScS. Une série d'études à cas uniques (A[indice inférieur 1]-B-A[indice inférieur 2]) fut réalisée. Six participantes atteintes de ScS ont été recrutées parmi la cohorte du Groupe de recherche canadien sur la sclérodermie à deux sites (Hôpital général juif de Montréal et Centre hospitalier universitaire de Sherbrooke). Les participantes ont reçu neuf séances hebdomadaires d’ostéopathie semi-standardisées, ciblées sur les membres supérieurs, le thorax et la base du crâne. Des mesures répétées pendant les trois phases de l'étude ont été prises à une fréquence bihebdomadaire pour la raideur aux mains (RM) et les symptômes de douleur, dyspnée et fatigue; et hebdomadaire pour l'amplitude de mouvement des doigts (AMD), la fonction de la main (FM) et l'incapacité globale (IG). L'épaisseur/rigidité de la peau main/avant-bras (ÉPMA), l'incapacité au travail (IT) et la qualité de vie reliée à la santé (QVS) ont été mesurées à trois temps (avant et après l'intervention, ainsi qu'au suivi à un mois). Les variables à mesures répétées ont été représentées sur des graphiques linéaires soumis à des analyses visuelles, complétées du test Sheward's two Standard Deviation Band. Les différences ont été calculées pour les variables mesurées à trois temps. Toutes les participantes (n=6) ont montré une amélioration des variables reliées à la fonction manuelle (RM, AMD et FM), sauf pour l'ÉPMA (n=4). La majorité des participantes ont montré une amélioration des symptômes (douleur n=6, fatigue n=4 et dyspnée n=3/4) et des variables reliées au statut fonctionnel (IG n=5/5, IT n=4, score résumé physique n=6 et mental n=4 de la QVS). La plupart des effets se sont maintenus au suivi à un mois. Lorsque la comparaison était possible, presque toutes les améliorations observées ont été supérieures aux différences minimales cliniquement importantes suggérées pour cette population. Ces résultats suggèrent que l'ostéopathie pourrait être efficace pour réduire l'incapacité découlant des contractures aux mains de personnes souffrant de ScS, et devraient être vérifiés dans un essai clinique randomisé. // Abstract : In systemic sclerosis (SSc), hand contractures are common and associated with hand, global and work disability. There are no known effective treatments, although there have been a few promising studies with manual therapies. Our aim was to explore the effects of osteopathy on hand function, disease symptoms and functional status in SSc patients. A series of single case studies (A[subscript 1]-B-A[subscript 2] was undertaken. Six female SSc patients with hand contractures were recruited among subjects enrolled in the Canadian Scleroderma Research Group cohort at 2 sites (Jewish General Hospital, Montreal and Centre hospitalier universitaire de Sherbrooke, Sherbrooke). Participants received 9 weekly semi-standardized sessions of osteopathy targetted on upper limbs, thorax and cranial base. Repeated measures were taken during the three phases of the study, twice a week for hand stiffness and disease symptoms of pain, dyspnea and fatigue; and once a week for range of motion of fingers, hand disability and global disability. Upper limbs skin score, work disability and health-related quality of life were measured at baseline, after treatments and at 1-month follow-up. Data for each variable with repeated measures were represented on simple line graphs and visually interpreted, completed by the Sheward's two Standard Deviation Band test. Differences were calculated for variables measured at 3 time points. All participants (n=6) showed improvement in variables related to hand function (hand stiffness, range of motion of fingers and hand disability), except for upper limbs skin score (n=4). The majority of participants showed improvement in disease symptoms (pain n=6, fatigue n=4, et dyspnea n=3/4) as well as variables related to functional status (global disability n=5/5, work disability n=4, physical n=6 and mental n=4 component summary of health-related quality of life). Most improvements were maintained at 4 week follow up. When the comparison was possible, almost all observed improvements were higher than the minimal clinically important differences suggested for this population. These findings suggest that osteopathy may be effective in reducing disability from hand contractures in SSc. A randomized controlled trial is needed to confirm these results.