Analyzing finger interdependencies during the Purdue Pegboard Test and comparative activities of daily living

Writing in two different scripts promotes fine motor control

Biscriptuality is the ability to write in two different scripts. Achieving handwriting expertise in a single script demands years of intensive practice, and these demands are even stronger when two scripts must be mastered. Biscriptuality could thus impact the cognitive and motor skills underlying graphomotor control. Here, we aimed at establishing that biscriptuality enhances graphomotor control, and at testing whether biscriptuals have better fine motor skills and working memory performance compared to Latin monoscriptuals. We found that biscriptuals perform better than monoscriptuals on graphomotor tasks, and on 3 types of fine motor control tasks indexing dexterity, motor timing under spatial constraints, and spontaneous motor tempo; the two groups did not significantly differ in their working memory performance. These results demonstrate that writing expertise widely impacts the organization of the motor system.

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.

Study of the Correlation between the Motor Ability of the Individual Upper Limbs and Motor Imagery Induced Neural Activities

Motor imagery based brain-computer interfaces (MI-BCIs) have excellent application prospects in motor enhancement and rehabilitation. However, MI-induced electroencephalogram features applied to MI-BCI usually vary from person to person. This study aimed to investigate whether the motor ability of the individual upper limbs was associated with these features, which helps understand the causes of inter-subject variability. We focused on the behavioral and psychological factors reflecting motor abilities. We first obtained the behavioral scale scores from Edinburgh Handedness Questionnaire, Maximum Grip Strength Test, and Purdue Pegboard Test assessments to evaluate the motor execution ability. We also required the subjects to complete the psychological Movement Imagery Questionnaire-3 estimate, representing MI ability. Then we recorded EEG signals from all twenty-two subjects during MI tasks. Pearson correlation coefficient and stepwise regression were used to analyze the relationships between MI-induced relative event-related desynchronization (rERD) patterns and motor abilities. Both Purdue Pegboard Test and Movement Imagery Questionnaire-3 scores had significant correlations with MI-induced neural oscillation patterns. Notably, the Purdue Pegboard Test of the left hand had the most significant correlation with the alpha rERD. The results of stepwise multiple regression analysis showed that the Purdue Pegboard Test and Movement Imagery Questionnaire-3 could best predict the MI-induced rERD. The results demonstrate that hand dexterity and fine motor coordination are significantly related to MI-induced neural activities. In addition, the method of imagining is also relevant to MI features. Therefore, this study is meaningful for understanding individual differences and the design of user-centered MI-BCI.

Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs

BACKGROUND

Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity.

PURPOSE

This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions.

STUDY DESIGN

Scoping review, with qualitative content analysis.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function.

RESULTS

Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks.

CONCLUSIONS

Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.

Active versus resting neuro-navigated robotic transcranial magnetic stimulation motor mapping

Transcranial magnetic stimulation (TMS) motor mapping is a safe, non-invasive method that can be used to study corticomotor organization. Motor maps are typically acquired at rest, and comparisons to maps obtained during muscle activation have been both limited and contradictory. Understanding the relationship between functional activation of the corticomotor system as recorded by motor mapping is crucial for their use clinically and in research. The present study utilized robotic TMS paired with personalized neuro-navigation to examine the relationship between resting and active motor map measures and their relationship with motor performance. Twenty healthy right-handed participants underwent resting and active robotic TMS motor mapping of the first dorsal interosseous to 10% maximum voluntary contraction. Motor map parameters including map area, volume, and measures of map centrality were compared between techniques using paired sample tests of difference and Bland-Altman plots and analysis. Map area, volume, and hotspot magnitude were larger in the active motor maps, while map center of gravity and hotspot locations remained consistent between both maps. No associations were observed between motor maps and motor performance as measured by the Purdue Pegboard Test. Our findings support previous suggestions that maps scale with muscle contraction. Differences in mapping outcomes suggest rest and active motor maps may reflect functionally different corticomotor representations. Advanced analysis methods may better characterize the underlying neurophysiology of both types of motor mapping.

Use of mobile applications in hand therapy

INTRODUCTION

Mobile devices can be incorporated into therapy as an engaging alternative to traditional therapy options. The use of mobile devices and smartphone applications can enhance the quality of care provided by health care professionals.

PURPOSE

To find mobile apps that can be incorporated into hand therapy practice.

METHODS

Hand therapy evaluation, interventions, proprioception, laterality, and home exercise program applications can be incorporated into practice. Patient education can also be provided via the use of mobile applications.

CONCLUSION

Smartphone applications can be a valuable intervention and impact performance in individuals with impaired hand function. Smartphone applications offer a client-centered, and potentially motivating, activity option that can be utilized to aid the hand therapist.

Determination of the optimal cutoff values and validity of the Purdue Pegboard Test

Introduction

The Purdue Pegboard Test (PPT) is crucial for assessing fine dexterity of patients with hand injury. Determining the PPT cutoff value is needed to distinguish patients with impaired hand dexterity from those with unimpaired hand dexterity. The aim of this article is to examine the construct validity of PPT and to determine its cutoff values for patients with hand injuries.

Method

The PPT and Disabilities of Arm Shoulder and Hand Questionnaire Turkish version (DASH-T) were used to measure hand dexterity. To examine construct validity, we measured the correlation between PPT and DASH-T. The cutoff values were determined using the receiver operating characteristic (ROC) curve generated with sensitivity and 1-specificity. We recruited 101 patients with hand injury and 162 healthy participants.

Results

Correlation between all subtests of PPT and DASH-T were weak ( r = −0.282; −0.473: p<0.05). The cutoff value for the assembly subtest of PPT was 24.5. The range of area under the curve (AUC) values for PPT subtests was good to excellent (AUC: 0.82–0.92).

Conclusion

The current study demonstrates that PPT is a valid instrument for measuring hand dexterity in patients with hand injury. Results also suggest that PPT distinguished the patients with impaired hand function from those with unimpaired hand dexterity.

Plasma luteinizing hormone level affects the brain activity of patients with polycystic ovary syndrome

OBJECTIVE

Cognitive function has been reported to be impaired in women with polycystic ovary syndrome (PCOS). This study aimed to investigate the effect of PCOS on brain activity and explore the relationship between brain activity and sex hormone levels in women with PCOS (WPCOS).

METHODS

Twenty-one women aged 18-45 years old with new-diagnosed PCOS were enrolled. Plasma levels of six sex hormones including luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were tested during the 2-5 days of their menstrual periods. Twenty-seven healthy controls (HC) were recruited. Every subject underwent a resting-state functional magnetic resonance imaging (fMRI). The amplitude of low-frequency fluctuation (ALFF) of the whole brain was evaluated followed by the functional connectivity (FC) analysis. Finally, the correlation between the ALFF, FC of the significant areas and the plasma hormone levels were analyzed.

RESULTS

The patients showed increased ALFF value in the left inferior temporal gyrus (ITG.L) and decreased ALFF value in the left inferior occipital gyrus (IOG.L) as well as the superior frontal gyrus (SFG.R, P < 0.005). For the FC analysis, patients showed decreased FC in SFG.R with the right middle frontal gyrus (MFG.R, P < 0.05). The FC between SFG.R and MFG.R was negatively correlated with LH level (R=-0.594, P = 0.005) and with the LH/FSH ratio (R=-0.521, P = 0.015).

CONCLUSION

PCOS can induce changes in activities of brain regions responsible for visuospatial working memory, face processing and episodic memory. The reduced functional connectivity within the right frontal lobe is related with the high LH level in WPCOS.

Bimanual task performance: Adults who do and do not stutter

Research has demonstrated children who stutter score significantly lower than children who do not stutter on the Purdue Pegboard Test. Past data also suggest performance on this task may be associated with stuttering frequency (Choo et al., 2016; Mohammadi et al., 2016). The purpose of this study was to explore whether these performance differences and the relationship to stuttering frequency are present in adults who stutter (AWS). Forty-eight participants (AWS = 24, and AWNS = 24) matched for age, gender, education, and handedness completed all four tasks of the Purdue Pegboard Test. There were no significant between group differences and stuttering frequency did not predict performance. These findings suggest previous differences may only be applicable to subgroups and/or that, with development, the manual tasks unique to the Purdue Pegboard Test may not be sensitive enough to reveal differences.

The suitcase packing activity: A new evaluation of hand function

STUDY DESIGN

Prospective, repeated-measures study.

INTRODUCTION

Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic therapeutic outcomes. At this point in time, a composite test that assesses both unilateral and bimanual hand function in relation to a functional activity is not available.

PURPOSE OF THE STUDY

To establish the reliability and validity of the suitcase packing activity (SPA).

METHODS

An expert panel established face and content validity. Eighty healthy, English-speaking volunteers aged between 18 and 45 years were randomly assigned to either 1 or 2 sessions (test-retest reliability). Relative agreement between 2 examiners using an intraclass correlation coefficient (ICC)_3,1 determined interrater reliability. Test-retest reliability was determined by using a repeated-measures analysis of variance and an ICC_3,2. Concurrent validity was evaluated against 2 well-established hand evaluations using separate tests of correlational coefficients.

RESULTS

Face and content validity were established across 4 focus groups. Our results demonstrate good to excellent interrater reliability (ICC_3,1 ≥ 0.93) and good to excellent test-retest reliability (ICC_3,2 ≥ 0.83). SPA scores were moderately correlated with the 2-hand evaluations.

DISCUSSION

Through evaluating hand function during participation in a goal-directed activity (eg, packing a suitcase), the SPA exhibits promise in usefulness as a future viable outcome measure that can be used to assess functional abilities following a hand injury.

CONCLUSION

The SPA is a valid and reliable tool for assessing bimanual and unilateral hand function in healthy subjects.

LEVELS OF EVIDENCE

Diagnostic level II.

Evaluating Hand Function in Clients with Trigger Finger

Background

Trigger finger (TF) is a common hand pathology frequently encountered in hand clinics. Occupational therapists predominantly assess TF symptoms as opposed to using standardized hand functioning assessments. The purpose of this study was to assess the construct validity of dexterity and grip strength assessments for clients with TF.

Method

Sixty-three participants with TF and 66 healthy controls were administered the Functional Dexterity Test (FDT), Purdue Pegboard Test (PPT), and Jamar® Hydraulic Hand Dynamometer (JD) and completed the Disabilities of Arm Shoulder and Hand questionnaire (DASH). TF symptoms were graded using the Quinnell classification.

Results

Statistically significant differences were found between the groups in dexterity and grip strength. A statistically significant difference between the three TF grades was found on the PPT. All three test scores were moderately correlated with the DASH scores.

Conclusion

This study provides innovative evidence for the validity of common hand function assessments for individuals with TF and recommends incorporating these tools in clinical practice. Further research is needed with larger samples and better representation of each TF clinical grade.