Hand Osteoarthritis (HOA) is the most common joint disease that affects the finger joints of older adults. Individuals with HOA have decreased handgrip strength and hand function. People with this condition have difficulties in grasping, gripping, twisting, and turning objects in daily living. As the disease advances structural changes such as loss of normal joint space, osteophyte formation, and bony nodules in people with HOA are common. Several investigators have examined the relationship between hand or body anthropometrics and handgrip strength and hand function in healthy diverse populations; however, no previous studies have investigated this association in people with HOA. The purpose of this thesis was to investigate the relationship between body and hand anthropometrics with hand strength and function in people with HOA, encompassing 2 papers. The first manuscript in this thesis was to describe the relationship between body and hand anthropometric variables with hand strength in people with HOA. In addition, it sought to establish the relative contribution among those variables for hand grip and pinch strengths in people with HOA. The second manuscript in this thesis was to describe the relationship between body and hand anthropometric variables with hand function in people with HOA. Further, it examines how anthropometric and demographic factors in combination explain hand function and health status in people with HOA. Finally, the thesis addresses the implications for the studies, limitations, and conclusions. / Thesis / Master of Science (MSc)

Motor skills disorder of upper limb motor disorders is currently a frequent reason for large population disability. That is why it is necessary to adress this issue and look for possibilities of proper evaluation and therapy. One of the standard methods is Jebsen- Taylor test (JTT). This thesis deals with theoretical aspects of the Jebsen-Taylor test and presents results of the research verifying psychometric characterictics of the test as well as influence of demografic characteristics on the performance in the test. The theoretical part deals with motor skills disorder that are closely related with the test. The practical part presents results of the research using the sample of nonrandomised Czech non-clinical population. The aim is to create basic norms of the Jebsen-Taylor test and this particular population.The norms were created on a sample of 180 persons separately for men and women divided into three age groups (20-59, 60-75, 76-99). The age of the participants influences the results in most subtests of the Jebsen-Taylor test. With the increasing age, an average time of particular subtests increases, too. The gender influence was not notably manifested in most subtests. In the group of men the performance of the upper limb showed significant difference. On the other hand, in the group of...

Associative plasticity, which involves modification of synaptic strength by coactivation of two synaptic inputs, has been demonstrated in many species. Here I explore whether it is possible to induce associative plasticity within a corticocortical pathway in the human brain using a novel protocol that activates two brain areas repeatedly with double-site transcranial magnetic stimulation (TMS). The pathway between ventral premotor cortex (PMv) and primary motor cortex (M1) which computes hand movements for precision grasp was manipulated. First, I selectively potentiated physiological connectivity between the stimulated brain areas. The effects as assessed with paired-pulse TMS were in accordance with principles of spike timing-dependent plasticity (STDP), pathwayspecific and showed a different pattern of expression during rest and during performance of a naturalistic prehension task. Furthermore, I demonstrated that effects evolved rapidly, lasted for up to three hours and were reversible. In a follow-up study, the protocol‘s effects on network interactions were investigated using functional magnetic resonance imaging (fMRI), specifically focussing on functional connectivity of network nodes within the wider parietofrontal circuit controlling reaching-and-grasping. The study demonstrated that functional connectivity was causally modified between stimulated nodes and that those changes in coupling also affected parallel, functionally-related pathways. Comparison of neurophysiological (paired-pulse TMS) and functional (fMRI) connectivity between individuals revealed a linear relationship of these connectivity indices; the first can assess the physiological nature of the interaction, whereas the latter can elucidate global network effects, making the techniques complementary. Neurophysiological interactions of ipsilesional and contralesional PMv-M1 were tested in chronic subcortical stroke patients during grasping. Patients showed a diminished facilitatory influence of ipsilesional PMv on M1 compared to healthy controls which might contribute to their motor disability. Application of paired-associative TMS “normalised“ the reduced effective influence of ipsilesional PMv on M1 and this effect correlated with the patient‘s potential to improve their dexterity.

This thesis focuses on assistive and rehabilitation technology for restoring the function of the hand. It presents three different approaches to assistive technology: one in the form of an orthosis, one in the form of a brain-computer interface combined with functional electrical stimulation and finally one totally aiming at rehabilitating the nervous system by restoring brain function using the concept of neuroplasticity. The thesis also includes an epidemiological study based on statistics from the Swedish Hospital Discharge Register and a review on different methods for assessment of hand function. A novel invention of an orthosis in form of a light weight glove, the SEM (Soft Extra Muscle) glove, is introduced and described in detail. The SEM glove is constructed for improving the grasping capability of a human independently of the particular task being performed. A key feature is that a controlling and strengthening effect is achieved without the need for an external mechanical structure in the form of an exoskeleton. The glove is activated by input from tactile sensors in its fingertips and palm. The sensors react when the applied force is larger than 0.2 N and feed a microcontroller of DC motors. These pull lines, which are attached to the fingers of the glove and thus work as artificial tendons. A clinical study on the feasibility of the SEM glove to improve hand function on a group of patients with varying degree of disability has been made. Assessments included passive and active range of finger motion, flexor muscle strength according to the Medical Research Council (MRC) 0-5 scale, grip strength using the Grippit hand dynamometer, fine motor skills according to the Nine Hole Peg test and hand function in common activities by use of the Sollerman test. Participants rated the potential benefit on a Visual Analogue Scale. A prototype for a system for combining BCI (Brain-Computer Interface) and FES (Functional Electrical Stimulation) is described. The system is intended to be used during the first period of recovery from a TBI (Traumatic Brain Injury) or stroke that have led to paresis in the hand, before deciding on a permanent system, thus allowing the patients to get a quick start on the motor relearning. The system contains EEG recording electrodes, a control unit and a power unit. Initially the patients will practice controlling the movement of a robotic hand and then move on to controlling pulses being sent to stimulus electrodes placed on the paretic muscle. An innovative electrophysiological device for rehabilitation of brain lesions is presented, consisting of a portable headset with electrodes on both sides adapted on the localization of treatment area. The purpose is to receive the outgoing signal from the healthy side of the brain and transfer that signal to the injured and surrounding area of the remote side, thereby having the potential to facilitate the reactivation of the injured brain tissue. The device consists of a control unit as well as a power unit to activate the circuit electronics for amplifying, filtering, AD-converting, multiplexing and switching the outgoing electric signals to the most optimal ingoing signal for treatment of the injured and surrounding area. / <p>QC 20130403</p>

Dental hygiene students may struggle in dental hygiene curriculum in regards to hand function. Currently, this is not an aspect dental hygiene programs screen for or have protocol in place to help students. The research in the study examined if hand function could improve with hand function exercises and if exercises improved instrumentation scores. During a 6-week pilot study, an occupational therapist tested the hand function of a cohort of dental hygiene students. The results were recorded and the students began a 6-week hand function exercise regimen. After 6 weeks the same evaluations were preformed and the pre- and posttest data were compared. Statistical tests showed a significant improvement in hand function. After the hand function testing was complete, the scores of the cohort on the periodontal probe and 11/12 explorer were compared to students in the previous 5 cohorts. No significant improvement was made on the instrumentation scores.

The work presented in this dissertation was focused on developing an affordable, automated, upper extremity exercise system suitable for individuals with stroke and spinal cord injury (SCI). The three studies presented in this thesis demonstrated the efficacy of functional electrical stimulation-assisted exercise therapy (FES-ET). Furthermore a protocol was developed to implement FES-ET in participants homes via tele-rehabilitation. The protocol included the use of an improved version of the bionic glove, an FES device that enhanced hand grasp and release in SCI individuals in combination with a custom-built workstation that enabled task-oriented rehabilitation in the home setting, supervised over the Internet. In the course of these studies, an objective hand function assessment tool was developed to complement tele-supervised FES-ET and provide the therapist with an unbiased evaluation of the participants impairment. A major section of this dissertation is concerned with the development and testing of a novel exercise workstation named the ReJoyce (Rehabilitation Joystick for Computer Exercise), that can assess hand function electronically. The ReJoyce is an instrumented workstation that provides standardized upper extremity rehabilitation based on ADLs, in the guise of computer games played by manipulating attachments on the device. The three studies presented in this thesis focus on the scientific merits and the logistics of providing tele-supervised FES-ET with this workstation. The first study demonstrated the feasibility of treating and assessing individuals on the workstation who had recently suffered a stroke. The second study explored the relationship between the quantitative assessment of hand function with the workstation and two widely-used clinical tests. The last study involved daily, tele-supervised FES-ET or conventional exercises and therapeutic electrical stimulation (TES), maintained for 6 weeks, with SCI participants spread out over a large geographical area. FES-ET performed with the workstation resulted in statistically significant and clinically important improvements in hand function that were greater than those produced by the more conventional protocol. The results demonstrated the importance of including a range of exercises aimed at improving both strength and dexterity. It is concluded that tele-supervised FES-ET on a standardized workstation is feasible, effective and affordable in the current healthcare settin

Injury to the cervical spinal cord results in complete or partial loss of arm and hand function, severely limiting the performance of daily activities. Deficits in hand function in individuals with cervical spinal cord injury (SCI) are primarily due to a loss of descending motor pathways that are vital for fine control of the hand and fingers. In addition to these deficits, secondary plastic reorganization may create further loss of function. This thesis will explore the following questions: 1. What are the similarities and differences between cortical organization of muscles affected by a cervical SCI to those not affected by the injury?; 2. Do individuals with cervical SCI improve in hand function and cortical organization after an intensive hand training intervention?; 3. Which physical therapy intervention provides the optimal conditions by which to improve hand function following cervical SCI? In chapter 2 we compare cortical motor maps of transcranial magnetic stimulation (TMS) evoked responses of muscles rostral and caudal to the injury to those of ND individuals. The cortical maps of the biceps brachii or the thenar muscles were constructed, and compared between ND individuals and individuals with SCI. The motor threshold (MT) for the thenar muscles in individuals with SCI was significantly higher than ND individuals. The purpose of the study described in chapter 3 was to compare the functional and cortical changes associated with two different interventions: unimanual or bimanual massed practice training, both combined with somatosensory stimulation. There was a significant difference between pre- and post-intervention scores on tests measuring unimanual hand function, bimanual hand function, and sensory function. This difference was associated with a difference between pre- and post-intervention cortical map area. The purpose of the study described in chapter 4 was to compare clinical and cortical changes associated with either a delayed intervention control period or a combined intervention of massed practice training with electrical stimulation. Participants were randomly assigned to one of two groups: delayed intervention control group or immediate intervention group. Participants were also randomly assigned to one of four groups: unimanual training with somatosensory stimulation, bimanual training with somatosensory stimulation, unimanual training with functional electrical stimulation, or bimanual training with functional electrical stimulation. There was a significant difference between the control and immediate intervention group on the test measuring unimanual hand function. Participants in the bimanual group performed significantly better on the test measuring bimanual hand function. There was a significant difference between the control group and immediate intervention group in cortical map area. In chapter 5 we discuss the clinical relevance of the results of the studies described in three prior chapters. Conclusions drawn include the idea that cortical maps of muscles caudal to the level of injury in individuals with SCI have higher motor thresholds than ND participants. Individuals with tetraplegia can improve in hand function and sensation with a physical therapy intervention of massed practice training combined with somatosensory stimulation. Finally, the type of training (unimanual massed practice or bimanual massed practice) influences the type of improvements gained, however the type of electrical stimulation does not influence the clinical outcome.

Background: A computer game based Telerehabilitation platform has been developed to provide a seamless system for hand exercise and assessment in home settings for people with arthritis. The exercise program involves task-oriented training of real life object manipulation tasks performed with computer gaming. The platform will also be integrated with a telemonitoring, computer game based hand function assessment application. Objectives: 1) To determine test-retest reliability and convergent validity of the assessment application protocol in people with rheumatoid arthritis or hand osteoarthritis, 2) To conduct a pilot randomized controlled trial for assessing the feasibility, and therapeutic effects of the task-oriented training compared to conventional hand exercises, and 3) To qualitatively evaluate participants’ experiences on their respective exercise programs. Methods: Performance during three different object manipulation tasks was evaluated by the assessment application protocol on 40 people with arthritis. The performance measures were correlated with other common hand function measures. A six-week pilot randomized trial was conducted on 16 individuals with arthritis. The Arthritis Hand Function Test (AHFT), the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, exercise compliance and task performance during three object manipulation tasks were the clinical outcomes. Focus group interviews were conducted on seven participants who had before received their home exercise programs. Results: The protocol demonstrated moderate to high test-retest reliability (ICCs between 0.5-0.84) of performance measures. Spearman correlation coefficients (rho) between task performance measures and other measures of hand function were low to moderate (0.4 < rho < 0.5 to 0.7). The pilot trial was not successful in terms of participant recruitment but demonstrated feasibility of study procedures, resources, and management. Except for two dexterity sub-scales of the AHFT, there were no significant differences in other clinical measures. Exercise compliance was >85% in both groups. The qualitative study provided initial evidence on the appropriateness, acceptance, perceived benefits, and a few practical difficulties in performing each exercise program. Conclusions: The hand function assessment application warrants validation in a variety of object manipulation tasks and in different patient populations. In order to proceed to a full-fledged trial, additional recruitment strategies, and revisions in the inclusion criteria must be considered. / February 2015

Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents. This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients. For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

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