Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The goal of the study was to examine the implications of a variety of hand-related diagnoses using the broad prospective of the International Classification of Functioning, Disability and Health. The hand-condition group reported significantly (p < .05) lower perceived quality of life (QoL), higher levels of disability, and reduced hand strength and dexterity in comparison with a healthy control group. Personal factors, hand function, and pain explained 29% of the variance in QoL. The results support the application of a broader biopsychosocial approach in hand therapy practice. Primary Author and Speaker: Danit Langer Contributing Authors: Avigayil Horwitz, Hanna Melchior, and Adina Maeir

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Repetitive wrist and hand movement is a risk factor for carpal tunnel syndrome. During daily functional hand use, some people develop carpal tunnel syndrome. However, the exact mechanism of injury remains unknown. We evaluated the effect of functional hand use on the median nerve and assessed the compression and displacement of the median nerve using state-of-the-art sonography. Primary Author and Speaker: Buwen Yao Contributing Authors: Shawn C. Roll

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The health and safety of OT clientele demand students' proficiency in a multitude of evaluation and intervention approaches. Subsequently, educators must use evidence-based instructional approaches to facilitate efficient high-quality learning. In this research presentation, we discuss a randomized controlled educational intervention designed to train entry-level OT students how to evaluate the accessibility of community spaces. Primary Author and Speaker: Jaclyn K. Schwartz Additional Authors and Speakers: Roger O. Smith, Suzanne Burns, Rochelle Mendonca, and Ingris Treminio Contributing Authors: Alyssa Jindracek, Tori Stokes, and Jordann Young

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Regaining adequate hand function for participation is a challenge for many stroke survivors. Eleven participants completed 12 grasp–transport–release training sessions with a user-driven hand robot that provides active assist for finger extension. A mean gain of 2.64 points (p = .03) on the Fugl–Meyer was observed, with most gains on the distal subscale (2.27 points, p < .001). This intervention is a promising adjunct to conventional therapy to promote typical grasp patterns and functional use. Primary Author and Speaker: Michaela Fraser Additional Authors and Speakers: Daniel Geller Contributing Authors: Sangwoo Park, Lynne Weber, Cassie Meeker, Lauri Bishop, Joel Stein, and Matei Ciocarlie

Importance: Self-management programs (facilitated by mobile devices) may improve health and prevent secondary complications for older adults with diabetes. However, older adults may have difficulties using mobile devices because of neuropathy or cognitive dysfunction. Objective: To identify sensorimotor and cognitive abilities associated with touchscreen tablet app performance to support self-management of diabetes in older adults. Design: Cross-sectional study. Setting: Outpatient Center for Successful Aging With Diabetes. Participants: Forty-five older adults with Type 2 diabetes. Outcomes and Measures: Dexterity (Purdue Pegboard Test), touch sensation (Semmes–Weinstein monofilaments), pinch strength (pinch gauge), cognition (Montreal Cognitive Assessment), and executive functioning (Trail Making Test) were assessed. Two apps were then used: Dexteria and SuCare. Demographic data, prior mobile device use, and diabetes severity (hemoglobin A1C [HbA1C]) were collected. Results: Age and HbA1C accounted for 29.8% and 9.7%, respectively, of the total variance of Dexteria performance time (dominant hand). Dexterity (dominant hand) accounted for an additional 5.4% of the total variance of 45.1%, F(4, 40) = 10.021, p < .001. Prior mobile device use, age, and diabetes severity accounted for 6.4%, 11.8%, and 26.4%, respectively, of the total variance of SuCare performance time. Executive functioning and dominant-hand dexterity accounted for an additional 9.5% and 9.4%, respectively, of the total variance of 61.0%, F(5, 39) = 14.75, p < .001. Conclusions and Relevance: Beyond age and diabetes severity, executive functioning and dominant-hand dexterity contributed to app performance, highlighting the importance of diabetes self-management. These findings may help determine suitable candidates for tablet use for self-management. What This Article Adds: App performance is explained by the executive functioning and dexterity of older adults with Type 2 diabetes. These factors, in addition to age and diabetes severity, should be taken into consideration by occupational therapy practitioners in future mobile self-management programs.

Importance: To develop a practical program in the early phase after nerve repair for more rapid return of function. Objective: To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair. Design: An assessor-blinded study with a randomized controlled design. Setting: University hospital. Participants: We recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons. Intervention: The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk. Outcomes and Measures: The Semmes–Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after treatment, and 12 wk after the last treatment. Results: The experimental group showed greater improvements in the results of the pinch-holding-up activity test and the PPT Unilateral Pin Insertion, Bilateral Pin Insertion, and Assembly subtests. However, change on the SWM test revealed no significant difference between the two groups. Conclusions and Relevance: Touch-observation and task-based mirror therapy is an effective but low-cost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury.

OBJECTIVE. The dart-throwing motion (DTM) is a multiplane wrist motion that is needed for many daily occupations. Mobilization along the DTM plane may be essential for rehabilitation after wrist injury, but DTM angles are reported for the dominant hand alone, so their relevance to injury in the nondominant hand cannot be surmised. The aim of this study was to quantify the DTM plane angles for both hands during different activities of daily living (ADLs). METHOD. Forty-three healthy participants wore a twin-axis electrogoniometer during ADLs. RESULTS. No significant differences were found between the DTM plane angles of the dominant (20°–45°) and nondominant (15°–40°) hands. These angles varied by task and across participants. CONCLUSION. The DTM plane is a functional motion used by both hands during ADLs. Because the DTM plane angle differs among hands, tasks, and individual clients, wrist rehabilitation involving the DTM plane should not be limited to a singular DTM plane angle.

The Jebsen Hand Function Test (JHFT) is a standardized assessment that has been used as a clinical outcome measure. To appropriately interpret the effects of an intervention on hand function (as measured by the JHFT), the extent to which this instrument shows significant practice effects must be quantified. The purpose of this study was to determine whether the JHFT is susceptible to within-session practice effects. The results showed that the dominant and nondominant hands significantly improved on the JHFT and many of its subtests over six consecutive trials. Although practice effects might complicate the interpretation of change due to intervention, we briefly relate our findings to emerging neuropsychological evidence that practice effects may indicate a person’s motor learning potential or treatment responsiveness.

To clarify expectations for mature cutting skills and investigate the influences of cutting task and scissor type, we videotaped 60 typical adults cutting three shapes with two different types of scissors. The videotapes were reviewed, and 38 aspects of grasp and cutting motions were rated. Percentages of participants who used a particular grip or cutting motion for each shape with each scissor type were reported and compared. Findings included variations in grasp that depended on the scissor type used and variations in cutting motions that depended on the shape being cut. Improved understanding of mature scissor skills and the effect of variations in the cutting task and scissor type used will allow more effective assessment of and intervention for children and adults with cutting difficulties. Specific implications for practice are discussed.

The investment of time and self to develop therapeutic relationships with clients appears incongruent with today’s time-constrained health care system, yet bridging the gap of these incongruencies is the challenge therapists face to provide high-quality, client-centered, occupation-based treatment. This case report illustrates a shift in approach from biomechanical to occupational adaptation (OA) in an orthopedic outpatient clinic. The progress of a client with lupus-related arthritis who was 6 days postsurgery is documented. The intervention initially used a biomechanical frame of reference, but when little progress had been made at 10 weeks after surgery, a shift was made to the more client-centered OA approach. The Canadian Occupational Performance Measure was administered, and an OA approach was initiated. On reassessment, clinically important improvements were documented in all functional tasks addressed. An OA approach provides the bridge between the application of clinical expertise, client-centered, occupation-based therapy and the time constraints placed by payer sources.

OBJECTIVE. We examined the efficacy of a remotely based arm rehabilitation regimen. A 62-year-old man participated in occupation-based, task-specific practice of activities of daily living (ADLs) >3 years after stroke. The entire regimen was administered over the Internet using personal computer–based cameras and free network meeting software. METHOD. Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), and Canadian Occupational Performance Measure (COPM) were administered before intervention. One week after treatment, FM, ARA, and COPM were readministered. RESULTS. The participant exhibited reduced impairment and reduced functional limitation. He also expressed enhanced satisfaction with his ability to perform ADLs and rated his ADL performance better after intervention. The participant could now drive using both hands, use eating utensils, and catch and throw a ball. CONCLUSION. Data suggest feasibility and efficacy of a remotely based, inexpensive approach using functional electrical stimulation for affected arm rehabilitation after stroke.

OBJECTIVE. We sought to analyze the interrater reliability of occupational therapy students using standard hand-strength instruments. METHOD. Seventy-three healthy students, faculty, and staff members from a midwestern university participated in this study. Each participant completed three trials for both grip and pinch strength bilaterally. Two student raters independently scored each trial. RESULTS. The interrater reliability of the grip and pinch strength trials was determined using an intraclass correlation coefficient (ICC) one-way random effects model (1,1). The ICC for the Jamar dynamometer ranged from .996 to .998 (p < .05). The ICC of the pinch gauge ranged from .949 to .990 (p < .05). CONCLUSION. This study demonstrated that occupational therapy students can be reliable raters after being trained and tested for competency. To improve psychometric properties for instruments commonly used in the profession, students can participate in collecting normative data for hand-held dynamometry.

The Test of In-Hand Manipulation (TIHM; Case-Smith, 2000) is a five-task test that uses a 9-hole pegboard to examine 2 key components of in-hand manipulation: rotation and translation with stabilization. The authors used Rasch modeling to examine the TIHM’s construct validity, interrater reliability, and test–retest reliability in 45 typically developing children ages 5.5 years to 6.5 years. A version of the test, revised using Rasch modeling, was found to have evidence for adequate construct validity and excellent interrater reliability. However, test–retest reliability over a 2-week retest period was not supported. The TIHM demonstrates potential as a clinically useful assessment of in-hand manipulation. The test does not examine all aspects of in-hand manipulation, however, and it may have limited sensitivity to the performance of finger-to-palm and palm-to-finger translation. Further validation of the test is needed before the TIHM can confidently be used in occupational therapy practice.

OBJECTIVE. The aim of this study was to evaluate interrater and intrarater reliability for the Assisting Hand Assessment. METHOD. For interrater reliability, two designs were used: 2 occupational therapists rated the same 18 children, and 20 occupational therapists rated the same 8 children. For intrarater reliability, 20 raters each rated one child twice. Both English and Swedish versions of the instrument were used. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) were calculated. RESULTS. ICCs for the sum score for the interrater were 0.98 (two raters) and 0.97 (20 raters) and for the intrarater 0.99. SEM was 1.5 for interrater and 1.2 for the intrarater study, which gave an error interval of ± 3 raw scores for interrater and ± 2.4 raw scores for intrarater. CONCLUSION. This study shows excellent interrater and intrarater reliability for sum scores.

Although infrequently discussed in the professional literature, visionary language and visual imagery are identifiable elements within occupational therapy’s culture. They seem part of the profession’s desire to characterize, affirm, and renew itself. One early vision of practice, that of reaching for heart as well as hands, is the subject of this inquiry that extends a prior discussion of visions in occupational therapy. Central to the inquiry are the early vision’s (a) origin, exemplification, and clarity of meaning within one autobiographical text and (b) merits for the profession’s characterization, affirmation, and renewal. The early vision of reaching for heart as well as hands may benefit the profession today by characterizing the ethos of occupational therapy as integrative, affirming its practice as occupational, and inspiring its practitioners to renew a commitment to caring.

OBJECTIVE. This study examined differences between the dominant and nondominant hands of children during an object release task under various accuracy and speed constraints. METHOD. Fifteen children 7 to 14 years of age who were typically developing released an instrumented object held with a precision grip onto a stable or unstable surface at a self-paced or quick speed while temporal and force measures were recorded. RESULTS. Few differences were found between the two hands under stable, self-paced conditions. However, given accuracy constraints, object replacement with the nondominant hand took longer than the dominant hand. The nondominant hand exhibited different force coordination patterns than the dominant hand when both accuracy and speed constraints were imposed. CONCLUSION. Task constraints differentially affected the performance of the dominant and nondominant hands during this object release task. The results suggest that clinicians should incorporate various task constraints into hand preference evaluations and during “dominance retraining.”

OBJECTIVE. This study compared the total wrist range of motion permitted by four different styles of wrist extension orthoses and the free hand. METHOD. Using a repeated-measures, counterbalanced design, 40 healthy female volunteers 20 to 39 years of age shot a basketball while free handed and while wearing each of four wrist extension orthoses: AlignRite; Rolyan D-Ring Long; Rolyan D-Ring Short; and a custom-made, thumb hole design orthosis. The motion at the wrist was measured by an electrogoniometer. RESULTS. No significant differences were found in total wrist motion permitted among the four orthotic conditions. Analyses revealed that the custom-made orthosis allowed significantly less palmar flexion and significantly more dorsiflexion than the three commercially available orthoses. All orthoses significantly restricted wrist movement compared with the free hand. CONCLUSION. The commercially available wrist extension orthoses offered little difference in the amount of restriction they provided. The custom orthosis restricted movement to a different portion of the available range than did the commercial orthoses. Future research should examine how different strapping techniques on custom-made orthoses affect total range of motion permitted at the wrist. Knowledge of patterns of restriction among various styles of orthoses will help therapists to select the most appropriate orthosis for a client‘s individual needs.

Objective. Hands-on learning has been an important aspect of the profession of occupational therapy since its founding. The purpose of this study was to determine whether children engaged in hands-on learning would be able to recall more of the steps and more of the correct order of the steps of an occupation than children engaged in a demonstration teaching method. Method. After being randomly assigned, 73 healthy third-graders (42 girls and 31 boys) either participated in making a model of a volcano or observed the making of a model of a volcano. Following task completion, both groups were asked to recall and state as many of the 41 syntactical units as possible in their proper order. The children’s responses were audiotaped and scored in a blind fashion according to predetermined criteria. Interrater reliability was excellent. Results. A t-test revealed a significant difference between conditions in terms of free recall scores, with children in the hands-on condition having a greater recall score, t (71) = 2.63, p < .005. The effect size d equaled .62. A MannWhitney U Test revealed no significant difference between conditions in terms of remembering the steps in proper order (the lack of a significant difference may have been due to a problem of measurement). Conclusion. The results of this study demonstrated that participants were able to recall more information when engaged in a hands-on teaching method as compared with a demonstration method. It is suggested that the learning advantages of hands-on occupation are related to the enhanced sensory/perceptual experiences and the feelings of success that are characteristic of hands-on learning, as opposed to passive forms of learning.