Importance: People with Parkinson’s disease (PD) experience motor and functional impairment that can negatively affect daily living and participation. Objective: To examine the occupational performance and hand function outcomes of people with PD who participated in a Lee Silverman Voice Treatment (LSVT) BIG^® program. Design: Retrospective record review. Setting: Outcomes were extracted from patient charts at a hospital outpatient clinic. Participants: Sixty-six clinic outpatients with PD who completed the LSVT BIG program. Intervention: An occupational therapist and a physical therapist who were certified in LSVT BIG administration delivered the 16-session LSVT BIG program. Outcomes and Measures: The Canadian Occupational Performance Measure (COPM), grip strength, and Minnesota Manual Dexterity Test (MMDT) were administered before and after participation in LSVT BIG training. Results: For participant-identified COPM goals, pre–post changes were significant, ranging from 3 to 6 points for performance and satisfaction (p < .001). Grip strength in both hands showed significant gains; median scores for the right hand increased from 55.0 lb (interquartile range [IQR] 41.0, 70.0) to 64.0 lb (IQR 46.0, 80.0; p < .001) and for the left hand from 52.0 lb (IQR 39.0, 64.0) to 63.0 lb (IQR 44.5, 79.5; p < .001). MMDT median scores for right to left also significantly improved, from 124.0 s (IQR 113.0, 181.0) to 119.5 s (IQR 105.5, 163.5; p = .014). Conclusions and Relevance: Participation in the LSVT BIG program can improve perceived occupational performance and satisfaction and produce gains in hand strength and dexterity for people with PD. What This Article Adds: This study is the first retrospective review of data on occupational performance and hand function outcomes after participation in the LSVT BIG program. The findings of beneficial outcomes support the use of LSVT BIG in occupational therapy services to increase functional abilities among people with PD.

Date Presented 04/13/21 Children with unilateral cerebral palsy participating in repeat doses of pediatric constraint-induced movement therapy camp augmented with the Hocoma Armeo®Spring demonstrated significant improvements in hand function and bimanual performance for both doses and showed a generalized upward trend in hand function over time. Primary Author and Speaker: Heather Roberts Additional Authors and Speakers: Sara P. Johnston, David Plutschack

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A quantitative study was conducted to determine if a correlation existed between dynamic grip strength and hand function in healthy subjects across the life span. Outcomes were measured using the Baltimore Therapeutic Equipment grip tool and the Jebsen Hand Function Test. An insufficient statistical correlation existed between timed Jebsen Hand Function results and dynamic hand strength values to support the use of test results as a clinical indicator of functionality or intervention planning. Primary Author and Speaker: Cindy W. Poole

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

Importance: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. Objective: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. Design: Randomized, crossover-controlled, assessor-blinded study. Setting: Rehabilitation clinic. Participants: Patients (N = 24) with moderate motor and sensory deficits. Intervention: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. Outcomes and Measures: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment–Upper Extremity (FMA–UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes–Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. Results: RT resulted in significantly improved FMA–UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants’ EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). Conclusions and Relevance: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. What This Article Adds: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Importance: Spasticity is one of the most common and disabling motor impairments after stroke. Objective: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity. Data Sources: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017. Study Selection and Data Collection: Following PRISMA guidelines, we included articles describing Level I–III studies with participants who were adults with upper extremity spasticity and received a stretching intervention. Findings: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria. Conclusion and Relevance: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. What This Article Adds: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.

Date Presented 04/04/19 This study examined whether sleep quality is associated with hand function above and beyond what can be explained by pain and carpal tunnel syndrome (CTS) severity to hand function in clients with CTS. Manual Ability Measure-20, Pittsburgh Sleep Quality Index, Pain Visual Analogue Scale, and Electromyography for CTS diagnosis and severity level were measured outcomes in 53 participants. Sleep quality was significantly associated with manual ability after controlling for CTS severity and pain. Primary Author and Speaker: Angela Goorman Additional Authors and Speakers: Colleen Schneck, Doris Pierce Contributing Authors: Spencer Dawson

OBJECTIVE. To examine the relationships between self-reported and performance-based hand function. METHOD. Thirty participants with hand function limitations completed the Manual Ability Measure (MAM–36) and the Upper Extremity Performance Test for the Elderly (TEMPA). Participants were categorized into two groups: (1) Dominant Hand Affected and (2) Nondominant Hand Affected. Correlations between the two assessments were examined. The speed of task execution and TEMPA scores were compared between the two groups. RESULTS. A significant correlation was found between the MAM–36 and TEMPA Total Functional Rating (ρ = 0.79, p < .05). Significant differences were found in the speed of execution of unilateral tasks and the Unilateral Functional Ratings between the two groups. CONCLUSION. The MAM–36 is a promising assessment tool for measuring a client's perceived hand function. However, a performance-based assessment can supplement information about the quality and speed of hand-task performance.

Objective. A commonly adhered to operating principle in occupational therapy clinics is that a person must exhibit 20 lb of grip strength before his or her hand is considered “functional” This study examined the relationship between hand and finger grip performances with the forces required to open common household containers. Method. The grip and pinch strengths of 49 college students were obtained using dynamometry. The forces required to open six common household containers were measured using Force Sensing Resistors^® attached to each container. Results. Weak correlations were found (r = −.179 to r = .333) between grip and pinch strength performances and the forces used to operate the accessing mechanisms of the containers. Analyses of variances demonstrated significantly greater grip and pinch strength performances in men than in women (ps < .05) but no significant difference between the genders in the forces generated to open the containers (ps > .05). Conclusions. In a normal population of college students, the premise that greater hand strength affords greater performance in accessing everyday household containers was not supported. Implications suggest that grip and pinch dynamometry are not conclusive evaluative tools for predicting hand function while opening a select group of containers. The relationship between traditional dynamometry and hand performance during a variety of functional tasks needs to be examined in clinical populations as well.

Objective. This study determined which object characteristics had an effect on grasp when adult women took a drink from a cup. Method. Thirty women aged 20 to 45 years (M = 27.6years) were randomly assigned to a sequence for each of three experiments. The first experiment tested the grasp pattern used for cups of same height and weight but with different-sized handles. The second experiment tested the grasp pattern for cups of varied height but with same-sized handles and same weight. The third experiment tested the grasp pattern for cups of varied weight but with same-sized handles and same height. The grasp patterns were recorded by a videocamera placed across from the subjects. Results. The number of fingers placed through the handle was found to be significantly greater for the cup with a larger handle than for the cups with the smaller handles when cup size and weight were held constant, X²(2) = 49.8, P < .001. No significant difference was found in the number of supporting fingers for varying cup heights or weights. Conclusion. The results support other research that has stated that handle size accounted for the change in grasp pattern. Because motor performance is affected by the object characteristics as well as personal abilities, adaptation of characteristics, such as handle size, for persons with limited hand use may provide an environment that evokes more optimal performance.

Objectives. This study compared soft versus hard resting hand splints on pain and hand function in 39 persons with rheumatoid arthritis. Splint preference was also evaluated to determine its effects on splint wear compliance. Method. A repeated measures research design was used to compare the two experimental conditions, wearing a soft splint versus a hard splint on the dominant hand for 28 days at night only, and an unsplinted control period of 28 days. Results. Arthritis pain was considerably less during both splinted periods when compared with the pretest. Subjects identified fewer joints as being painful during the soft splint condition than during the unsplinted condition. There were no significant differences among conditions on hand function measures. Splint preference was 57% for the soft splint, 33% for the hard splint, and 10% for no splint. Splint wear compliance was significantly better with the soft splint (82%) than with the hard splint (67%). Conclusion. The findings indicate that resting hand splints are effective for pain relief and that persons with rheumatoid arthritis are more likely to prefer and comply with soft splint use for this purpose. Individualized splint prescription that focuses on client comfort and preference may enhance splint wear compliance.

Objectives. Much has been written about the use of static orthoses to maintain proper position and prevent deformity, but there are few empirical data to determine whether static orthoses improve function, maintain range of motion, or prevent deformity in the hand. Method. This study measured gains in hand function during a 3-month rehabilitation period in 13 persons with sixth cervical (C-6) level complete quadriplegia, 7 of whom wore a static orthosis at night (experimental group) and 6 who did not wear the orthosis (control group). Hand function, range of motion and strength were measured in all subjects 4 weeks and 8 weeks after the study commenced, and again after 12 weeks in only 69% of the subjects. Results. No significant differences were found in hand function between control and experimental groups; hand function had improved significantly in all 13 subjects. Conclusion. As the effects of deformity have been clinically observed, future studies should examine the effects of static orthoses with increased daily wear or wear over a longer period of time.

The effects that normal aging have on adult hand function and functional performance are not well understood. An empirical study was conducted examining relationships between prehension pattern type and frequency, hand strength, and performance time in functional tasks. Four groups of 10 adults were selected by age and gender, ranging from 24 to 87 years. Subjects were asked to pour milk into a cup and remove money from a wallet while being videotaped. Prehension patterns were identified with a functionally based classification system. Grip and three types of pinch were measured with a dynamometer and a pinch gauge. Prehension pattern selection did not seem to differ with age. Statistically significant differences in age were found for prehension pattern frequency, hand strength, and performance time. Nondysfunctional older subjects were observed resetting identical prehension patterns secondary to lateral pinch weakness, which contributed to increased prehension pattern frequency and performance time. Hand function seemed to remain stable until age 65 years, after which it diminished slowly. After age 75 years, age differences in performance were most apparent.

During the course of their education, occupational therapy students learn to administer complex structured assessments. For easier administration of these assessments, students design note cards, which then replace cumbersome test manuals during administration. This study considered whether students could learn test administration with equal efficiency and efficacy if given test administration note cards rather than having to design their own. The results showed that the subjects using instructor-designed cards earned written test and practical examination scores similar to those of the subjects using self-designed cards. The subjects using instructor-designed cards spent significantly less (p = .003) total time in study than did the subjects using self-designed cards. The difference in time between the two groups was attributable to the time spent designing note cards. Therefore, distribution of instructor-designed note cards appears to offer equally effective and significantly more efficient learning when compared with that produced when students design their own cards. The differences in efficacy and efficiency were found to be similar for students of different learning styles.