Hand grip function assessed by the box and block test is affected by object surfaces

Movement analysis of the distal transverse arch of the dominant hand while grasping and pinching objects: A descriptive, correlational research study

BACKGROUND

The distal transverse arches obtained from active and passive motions of the hand and the used range of motion (u-ROM) of the hand arch in activities of daily living have rarely been reported.

PURPOSE

This study aimed to investigate the distal transverse arch angle of the dominant hand, the influence of age, and the u-ROM of the arch when grasping and pinching objects.

STUDY DESIGN

Descriptive and correlational research design.

METHODS

The active and passive distal transverse arches of the dominant hand of 104 healthy subjects were measured using a goniometer. Additionally, the hand arch was measured when the subjects grasped and pinched objects. These data were used to analyze the correlation with age and to calculate the u-ROM (u-ROM %) rate of the distal transversal arch. Furthermore, the u-ROM% between the ring and fifth finger components of the hand arch was compared.

RESULTS

The active and passive dorsal arch angles were 135.8 (10.0°) and 169.9 (11.5°), respectively. The distal transverse arch angle tended to decline with age (active: r = -0.18, p = 0.07, 95% confidence interval = -0.36 to 0.02; passive: r = -0.40, p ≤ 0.001, 95% confidence interval = -0.55 to -0.23). The u-ROM% of the hand arch in grasping and pinching ranged from 65.5 (9.8)% to 84.6 (11.6)% and from 52.1 (7.9)% to 67.4 (9.1)%, respectively, against active and passive motions. The ring finger component was significantly higher than the fifth finger component (active: p = 0.08 to <0.001, effect size = -0.17 to -0.69; passive: p ≤ 0.001, effect size= -0.71 to -0.86). A similar trend was observed in both men and women.

CONCLUSIONS

Therapists should evaluate the movement of the distal transverse arch of the injured hand in detail and consider the age, sex, and component of the hand arch when intervening.

A smart tablet application to quantitatively assess the dominant hand dexterity

BACKGROUND AND OBJECTIVE

The Nine-Hole Peg Test (NHPT) is the most used test to assess hand dexterity in clinical practice and is considered the gold standard but only evaluates the time needed to complete the task. The aim of this work is to describe a graphic test on a smart tablet to assess in a quantitative as well qualitative way the dominant hand dexterity and to validate it in a cohort of neurological subjects and healthy controls.

METHODS

The task consists in asking the subject to connect with a graphic line the start and the end point of a pre-defined path, with two different widths, in the most precise and fastest way possible. The path is constituted by a 'meander' and a 'spiral' part. The subjects perform the task on a smart tablet with a capacitive pen four times. The three parameters of interest considered at each trial are the execution time, length path, and number of interactions with the border. The app automatically computes these three parameters and stores the completed test files. The results of the digital graphic test are compared to the NHPT results. Healthy and pathological subjects are compared to each other, and performances obtained in different repetitions are compared to assess the learning effect in each population.

RESULTS

53 subjects with a definitive diagnosis of neurodegenerative/genetic neurological disorders (34 men, mean age 59.1 ± 16.1) and 78 healthy controls (33 men, mean age 42.5 ± 16.3) were recruited. Among the pathological subjects, 31 also performed the NHPT. The graphic test clearly distinguish between the two populations for all parameters of interest. Moreover, compared to the gold standard NHPT, time has a moderate positive correlation (r = 0.57, p ≤ 0.001), whereas interactions and length have a strong positive correlation (r = 0.81, p ≤ 0.001) and (r = 0.69, p ≤ 0.001), respectively.

CONCLUSIONS

The proposed digital test can measure in an accurate, quantitative and qualitative way dominant hand disability and can result more informative with respect to the gold standard NHPT. In homogeneous cohort of subjects (for example affected by multiple sclerosis or Parkinson disease), the digital test can be used as an outcome measure in clinical trials as well as a tool for monitoring disease progression at the dominant hand level.

Validation of a graphic test to quantitatively assess the dominant hand dexterity

Dexterity dysfunction is a key feature of disability in many neurological and non-neurological diseases. The Nine-Hole Peg Test (NHPT) is the most used test to assess hand dexterity in clinical practice but presents limitations. A new graphic test to enhance objective evaluation of the of the dominant hand dexterity is proposed. The task consists in drawing a continuous line in paths composed by a part with multiple orthogonal changes of direction ('meander'), and a second part derived from the Archimedean spiral ('spiral'). The test was validated in 200 healthy controls and 93 neurological patients. 48 patients performed also the NHPT. Several parameters were analyzed, among which total time, total length, number of touches and number of crossings. Healthy subjects display statistically significant differences with respect to pathological subjects in the case of total time, number of touches, and number of crossings (p<0.001), but not in the case of total length (p = 0.27) needed to complete the second sheet. Moreover, healthy controls display a learning effect, the time needed to complete the second sheet was significantly lower than for the first sheet (p<0.001), and an inverse correlation with age was observed (r = 0.56, p<0.001). The comparison between the NHPT and the new test showed a strong positive correlation (r = 0.71, p<0.001) whereas touches and crossing a weak positive one (r = 0.35, p = 0.01). The new test distinguishes between a slow but precise performance and a fast but imprecise performance, thus providing additional information with respect to NHPT.

Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

Background

Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone.

Methods

A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication.

Discussion

This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden.

Trial registration

NCT04569123. Registered on September 29, 2020

Evidence of Motor Skill Learning in Acute Stroke Patients Without Lesions to the Thalamus and Internal Capsule

Background:

It is currently unknown whether motor skill learning (MSkL) with the paretic upper limb is possible during the acute phase after stroke and whether lesion localization impacts MSkL. Here, we investigated MSkL in acute (1–7 days post) stroke patients compared with healthy individuals (HIs) and in relation to voxel-based lesion symptom mapping.

Methods:

Twenty patients with acute stroke and 35 HIs were trained over 3 consecutive days on a neurorehabilitation robot measuring speed, accuracy, and movement smoothness variables. Patients used their paretic upper limb and HI used their nondominant upper limb on an MSkL task involving a speed/accuracy trade-off. Generalization was evaluated on day 3. All patients underwent a 3-dimensional magnetic resonance imaging used for VSLM.

Results:

Most patients achieved MSkL demonstrated by day-to-day retention and generalization of the newly learned skill on day 3. When comparing raw speed/accuracy trade-off values, HI achieved larger MSkL than patients. However, relative speed/accuracy trade-off values showed no significant differences in MSkL between patients and HI on day 3. In patients, MSkL progression correlated with acute motor and cognitive impairments. The voxel-based lesion symptom mapping showed that acute vascular damage to the thalamus or the posterior limb of the internal capsule reduced MSkL.

Conclusions:

Despite worse motor performance for acute stroke patients compared with HI, most patients were able to achieve MSkL with their paretic upper limb. Damage to the thalamus and posterior limb of the internal capsule, however, reduced MSkL. These data show that MSkL could be implemented into neurorehabilitation during the acute phase of stroke, particularly for patients without lesions to the thalamus and posterior limb of the internal capsule.

Registration:

URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01519843.

Object shape affects hand grip function for heavy objects in younger and older adults

Hand-grip function while lifting objects is essential for performing everyday tasks. The Box and Block Test (BBT) has been used to assess hand-grip function and dexterity, but only light objects have been used. The purpose of this study was to investigate the effects of block surface, shape, age, and sex on hand dexterity during the movement of heavy blocks in the BBT. Forty healthy participants comprised of a younger group of 10 males (M =  22.50 years, SD = 2.01) and 10 females (M  =  22.20 years, SD = 2.66) between 20 and 30-years-old, and an older group of 10 males (M = 55.80 years, SD = 3.19) and 10 females (M = 55.90 years, SD = 2.56) between 50 and 60-years-old, performed the BBT using steel objects of different shapes (cylindrical and cubic) and different surfaces (plain steel, black spray-painted steel, and yellow non-slip spray-painted steel). The results indicated that repetition and shape had significant effects on the BBT score. Previous researchers have found that surface textures, age, and sex influenced hand dexterity for light objects, but these effects were not discovered in the current study. These findings suggest that shape should take priority over age, sex, and surface texture when designing tools to improve user handling. Practitioner Summary: Hand-grip function is critically important when performing daily grip tasks such as picking up a writing utensil, using a toothbrush, or twisting a hand tool. The shape should be considered during the design process of tools and equipment used in industry so that handling can be made for the user. Abbreviations: BBT: box and block test; COF: coefficient of friction; BPS: blocks per second.

Clip-On IMU System for Assessing Age-Related Changes in Hand Functions

Hand functions affect the instrumental activities of daily living. While functional outcome measures, such as a targeted box and block test, have been widely used in clinical settings and provide a useful measure of overall performance, the advent of a wearable Inertial Measurement Unit(IMU)-based system enables the examination of the specific performance and kinematic parameters of hand movements. This study proposed a novel clip-on IMU system to facilitate the clinically fitted measurements of fine-motor finger and wrist joint movements. Clinical validation was conducted with the aim of characterising age-related changes in hand functions, namely grasping, transporting, and releasing blocks. Eighteen young (age 20–31) and sixteen healthy older adults (age 75–89) were evaluated during the box and block test. The results demonstrated that an older age was characterized by slower movements and higher variations and kinematic alterations in the hand functions, such as a larger range of motions at the fingers as well as kinematic trajectories. The proposed IMU system and subsequent validations highlight the value of the performance and kinematics parameters for a more comprehensive understanding of fine-motor finger and wrist movements that could shed light on further implementations in clinical and practical settings.

Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson's Disease

In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation; however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user’s hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson’s Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system, separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.

Spiral tracing on a touchscreen is influenced by age, hand, implement, and friction

Dexterity impairments are well documented in older adults, though it is unclear how these influence touchscreen manipulation. This study examined age-related differences while tracing on high- and low-friction touchscreens using the finger or stylus. 26 young and 24 older adults completed an Archimedes spiral tracing task on a touchscreen mounted on a force sensor. Root mean square error was calculated to quantify performance. Root mean square error increased by 29.9% for older vs. young adults using the fingertip, but was similar to young adults when using the stylus. Although other variables (e.g., touchscreen usage, sensation, and reaction time) differed between age groups, these variables were not related to increased error in older adults while using their fingertip. Root mean square error also increased on the low-friction surface for all subjects. These findings suggest that utilizing a stylus and increasing surface friction may improve touchscreen use in older adults.

Force fluctuations while pressing and moving against high- and low-friction touch screen surfaces

The purpose of this study was to identify the influence of a high- and low-friction surface on the ability to maintain a steady downward force during an index finger pressing and moving task. Fifteen right-handed subjects (24-48 years) performed a static force pressing task and a hybrid pressing and moving task on the surface of an iPad mini while holding a steady 2-N force on high- and low-friction surfaces. Variability of force was quantified as the standard deviation (SD) of normal force (F z) and shear force (F xy) across friction conditions and tasks. The SD of F z was 227 % greater during the hybrid task as compared to the static task (p < .001) and was 19 % greater for the high- versus low-friction condition (p = .033). There were positive correlations between SD of F z and F xy during the hybrid force/motion tasks on the high- and low-friction conditions (r (2) = 0.5 and 0.86, respectively), suggesting significant associations between normal and shear forces for this hybrid task. The correlation between the SD of F z for static and hybrid tasks was r (2) = 0.44, indicating that the common practice of examining the control of static tasks may not sufficiently explain performance during hybrid tasks, at least for the young subjects tested in the current study. As activities of daily living frequently require hybrid force/motion tasks (e.g., writing, doing the dishes, and cleaning counters), the results of this study emphasize the need to study motor performance during hybrid tasks in addition to static force tasks.

The extent of altered digit force direction correlates with clinical upper extremity impairment in chronic stroke survivors

Many stroke survivors suffer from impaired hand function. Biomechanics of hand grip suggests that abnormally directed grip force can hamper gripping abilities and hand function. This study examined the relation between the ability to precisely direct fingertip force and clinical hand function scores among individuals affected by stroke. Specifically, clinical hand function tests of the Fugl-Meyer, Chedoke McMaster, and Box and Block Test were used, since they involve various hand movements required for activities of daily living. Digit force direction during static grip was recorded using multiaxial load cells. Data for 59 chronic stroke survivors were analyzed. We found that larger angular deviation of digit force from the normal direction was significantly associated with lower hand functional levels (p<.001 for all three clinical tests). Particularly, stroke survivors whose digit force deviated more than 21° from the normal direction could not achieve the normal level of Fugl-Meyer or Chedoke or move more than 4 blocks in a minute. The biomechanics of the way digit force direction affects hand grip function is described. In addition, underlying mechanisms for altered digit force direction post stroke are postulated, including impaired somatosensation and abnormal neural input to muscles. In summary, this study identifies a new biomechanical marker for hand functional level and recovery. Future interventions may focus on correcting digit force direction to improve hand functional outcome.

Improvement of hand function using different surfaces and identification of difficult movement post stroke in the Box and Block Test

This study determined the impact of changing block surfaces on hand function, as well as identified particularly time-consuming movement components post stroke, measured by the Box and Block Test (BBT). Eight chronic stroke survivors and eight age- and gender-matched control subjects participated in this study. The BBT score (number of blocks moved) and time for seven movement components were compared for three different block surfaces (wood, paper, and rubber). The rubber blocks improved BBT scores 8% (compared to all other conditions) not only for control subjects but also for the paretic and non-paretic hands of stroke survivors, by reducing movement time for finger closing and contact-to-lift. Modifying daily objects' surfaces with rubber could help stroke survivors' hand function. The paretic hand displayed notably slower movement for contact-to-lift, transport-release, reach before barrier, and reach after barrier suggesting that therapies may focus on goal directed reaching and object grasping/releasing.