Role of physical performance component evaluations in occupational therapy functional assessment.

In the 1970s, occupational therapy assessments tended to focus on physical performance component (PPC) evaluations such as strength and range of motion; assessment of occupational performance played a secondary role. Given changes within and outside the profession of occupational therapy, it is time for the assessment of occupation and role performance to assume a primary role, while PPC evaluation should shift to a secondary role. Although PPC evaluations may be less prominent than in the past, they will continue to play an important role in occupational therapy practice and research. Therapists need to be critical consumers of PPC measurement tools because many require further development to validate their use for occupational therapy purposes.

Motor behavior research: implications for therapeutic approaches to central nervous system dysfunction.

This article reviews the models and theories of motor behavior that are the foundation for the traditional approaches to central nervous system (CNS) dysfunction and presents a new theoretical model and approach that are beginning to influence practice. Reflex, hierarchical, and systems models of motor control and developmental and motor learning theories are discussed. The relationships of these models and theories to past, present, and future treatment approaches to CNS dysfunction are explored. The assumptions and limitations of the muscle reeducation, neurodevelopmental, and motor relearning approaches are discussed. A contemporary task-oriented approach based on the systems model is proposed and contrasted with traditional neurodevelopmental approaches.

Soft versus hard resting hand splints in rheumatoid arthritis: pain relief, preference, and compliance.

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.

Grip and pinch strength: norms for 6- to 19-year-olds.

The purpose of this study was to establish normative data for 6- to 19-year-olds on four tests of hand strength. The Jamar dynamometer was used to measure grip strength and a pinch gauge was used to measure tip, key, and palmar pinch. A sample of 231 males and 240 females from the seven-county Milwaukee area was tested, using standardized positioning and instructions. Results of this study indicate that increases in grip and pinch strength coincide with increases in chronological age, that males are stronger than females in all age groups, and that hand dominance does not significantly affect hand strength scores. Normative data collected in this study were slightly higher than norms from previous American and Australian studies.

Adult norms for the Box and Block Test of manual dexterity.

The Box and Block Test, a test of manual dexterity, has been used by occupational therapists and others to evaluate physically handicapped individuals. Because the test lacked normative data for adults, the results of the test have been interpreted subjectively. The purpose of this study was to develop normative data for adults. Test subjects were 628 Normal adults (310 males and 318 females) from the seven-county Milwaukee area. Data on males and females 20 to 94 years old were divided into 12 age groups. Means, standard deviations, standard error, and low and high scores are reported for each five-year age group. These data will enable clinicians to objectively compare a patient's score to a normal population parameter.

Immediate effects of positioning devices on the normal and spastic hand measured by electromyography.

There is a continuing controversy in the literature and in clinical practice about whether positioning devices are effective in decreasing spasticity and, if so, which type is most effective. In this study, the immediate effects of a volar resting splint, a finger spreader, a firm cone, and no device were compared on eight normal and four hemiplegic subjects. Electromyography (EMG) was used to measure flexor muscle activity of the tested forearm while the subjects squeezed a grasp meter with the contralateral hand and during the following relaxation period. Results showed significantly greater EMG activity for the finger spreader compared to no device in the flexor carpi radialis of normal subjects during the grasping period. Hemiplegic subjects did not show significantly less EMG activity when using positioning devices compared to no device. In fact, the volar splint appeared to increase the EMG activity while the subjects were grasping.

The Purdue Pegboard: norms for 14- to 19-year-olds.

The purpose of this study was to collect normative data on the Purdue Pegboard, a test of finger dexterity, for individuals aged 14 to 19 years. Three trials were administered to 176 subjects from the seven-county Milwaukee area. Results indicated that females performed better than males on three out of four subtests, suburban subjects scored better than urban subjects on two of four subtests, and scores increased with age. The normative data collected provide a means of comparing a patient's score with normal individuals of the same sex and age and aid in determining a patient's need for therapy and in setting appropriate treatment goals.

Effect of elbow position on grip and key pinch strength.

Twenty-nine college women participated in a study to investigate the effect of elbow position on grip and key pinch strength evaluations. Standardized instructions and positioning were followed with the exception of the two elbow positions. The elbow was flexed to 90 degrees in one test condition and it was fully extended in the other. The results showed a significantly stronger grip strength measurement in the 90 degree elbow flexed position than in the fully extended position. For evaluation of key pinch strength, both hands were stronger in the elbow flexed position, but only the right hand was significantly stronger. This study supports the use of the elbow flexed position in standardized grip and key pinch evaluations.

Reliability and validity of grip and pinch strength evaluations.

Twenty-seven college women participated in a study to evaluate the reliability and validity of four tests of hand strength: grip, palmar pinch, key pinch, and tip pinch. Standardized positioning and instructions were followed. The results showed very high inter-rater reliability. Test-retest reliability was highest in all tests when the mean of three trials was used. Lower correlations were shown when one trial or the highest score of three trials were utilized. The Jamar dynamometer by Asimow Engineering and the pinch gauge by B&L Engineering demonstrated the highest accuracy of the instruments tested.

Efficacy of an energy conservation course for persons with multiple sclerosis.

OBJECTIVE: To evaluate the efficacy of an energy conservation course on fatigue impact, self-efficacy, and quality of life (QOL) for persons with multiple sclerosis (MS). DESIGN: Repeated measures with control and experimental interventions conducted during a 19-week study. SETTING: Community-based treatment center. PARTICIPANTS: A convenience sample of 54 individuals from 79 community-dwelling volunteers with fatigue secondary to MS. INTERVENTION: A 6-session, 2-hr/wk energy conservation course taught by occupational therapists for groups of 8 to 10 participants. MAIN OUTCOME MEASURES: Fatigue Impact Scale (self-report measure of fatigue impact on cognitive, physical, social functions), Self-Efficacy Gauge (self-report measure of confidence in ability to perform specific behaviors), and Medical Outcomes Study Short-Form Health Survey (QOL measure). RESULTS: Participants reported, as predicted, significantly less fatigue impact, increased self-efficacy, and improved QOL (ie, 3 of 4 subscales expected to improve). There were no significant differences, as predicted, in any of the dependent variables after the control (ie, support group) and no intervention periods. CONCLUSION: Results provide strong evidence for the efficacy of this energy conservation course for persons with MS.

Grip and pinch strength: normative data for adults.

The primary purpose of this study was to establish clinical norms for adults aged 20 to 75+ years on four tests of hand strength. A dynamometer was used to measure grip strength and a pinch gauge to measure tip, key, and palmar pinch. A sample of 310 male and 328 female adults, ages 20 to 94, from the seven-county Milwaukee area were tested using standardized positioning and instructions. Right hand and left hand data were stratified into 12 age groups for both sexes. This stratification provides a means of comparing the score of individual patients to that of normal subjects of the same age and sex. The highest grip strength scores occurred in the 25 to 39 age groups. For tip, key, and palmar pinch the average scores were relatively stable from 20 to 59 years, with a gradual decline from 60 to 79 years. A high correlation was seen between grip strength and age, but a low to moderate correlation between pinch strength and age. The newer pinch gauge used in this study appears to read higher than that used in a previous normative study. Comparison of the average hand strength of right-handed and left-handed subjects showed only minimal differences.

Muscle tone: objective evaluation of the static component at the wrist.

A device measuring the flexion of the hand from an extended position was evaluated as a technique for assessing the passive component of muscle tone. Wrist measurements of 23 individuals, ten able-bodied, eight with spastic and five with flaccid wrists, were collected for three days of each week for three weeks, to determine the interrater, test-retest reliability, and construct validity of the device. Findings demonstrated high interrater reliability, inadequate test-retest reliability for single daily score comparisons, but an acceptable level of test-retest reliability for composite weekly score comparisons. Construct validity was supported since measurements of the involved limbs of individuals with spastic and flaccid wrists and the able-bodied group were significantly different from each other. This technique may provide useful objective information for therapists.