Hand dexterity in children: administration and normative values of the functional dexterity test.

PURPOSE: To document normative values from the Functional Dexterity Test (FTD) for typically developing children and to optimize test administration and interpretation. METHODS: A total of 175 typically developing children aged 3 to 17 years participated in the study. Children completed the 16-peg FDT with both hands, and elapsed time was recorded in seconds. Data were analyzed as 16/time, interpreted as speed (pegs per second). A linear regression analysis predicted speed from age and hand dominance. RESULTS: Functional Dexterity Test speed increased linearly in typically developing children by 0.04 pegs/s for each year of age. This rate of increase was the same for dominant and nondominant hands. Dominant hands were faster than nondominant hands by 0.09 pegs/s at all ages. There was no sex difference. CONCLUSIONS: This study provides age-specific normative values for functional dexterity in typically developing children in 2 formats: as a growth chart of FDT speed versus age and as a regression model that calculates expected speed given a child's age and tested hand dominance. Recommended pediatric modifications to the FDT are to use speed (pegs per second) instead of time (seconds) to report results, and to not assess penalties. The norms presented allow clinicians to compare both speed and rate of change over time of pediatric patients with typically developing children, which makes it possible to distinguish developmental change from intervention. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Peg Restrained Intrinsic Muscle Evaluator (PRIME): development, reliability, and normative values of a device to quantify intrinsic hand muscle strength in children.

PURPOSE: There is a need for objective measures of pediatric intrinsic hand muscle strength as the current standard, the manual muscle test, lacks sensitivity to clinically important changes in muscle strength. We report the development, reliability, and normative values of the Peg Restrained Intrinsic Muscle Evaluator (PRIME), a device that quantifies intrinsic hand muscle strength. METHODS: Typically developing children, ages 4 to 16 years (n = 119), established normative values of intrinsic strength for thumb palmar abduction, thumb opposition, and index and small finger abduction. A subset of 30 children (15 boys, 15 girls), ages 7 to 16 years, determined inter-rater and intra-rater reliability. We calculated mean, standard deviation, intraclass correlation coefficients, and smallest detectable differences. RESULTS: Normative results indicate that gender and age were significant predictors of strength. Although the dominant hand generated higher strength measurements on average, differences were not statistically significant. Mean index and small finger abduction strength was significantly lower than thumb abduction and opposition in both genders. Intraclass correlation coefficients ranged from 0.85 to 0.94 for inter-rater reliability and 0.88 to 0.98 for intra-rater reliability. Bland-Altman plots showed an even distribution across the zero line. CONCLUSIONS: The PRIME device is a reliable tool for the quantification of intrinsic hand muscle strength in children. Age-specific and gender-specific normative values in typically developing children can serve as a future resource for clinicians treating pediatric hand or neuromuscular conditions.

Post-exercise palpation of pulse rates: its applicability to habitual exercisers.

Despite the increased popularity of heart rate (HR) monitors, endurance-trained adults as well as habitual exercisers often use pulse rate palpation to periodically monitor exercise intensity. However, due to the rapid recovery of HR following exercise bouts, post-exercise palpation of pulse rates may underestimate exercise HR. To test this hypothesis, we studied 20 young physically active adults performing two sets of exercise for 5 min at 70% and 85% of maximal HR on the treadmill; one with carotid and another with radial pulse count. Post-exercise palpation of pulse rate was lower (P < 0.01) than the actual HR during exercise, underestimating exercise HR by 20-27 bpm (beats per min). Even when ECG tracings of HR were analyzed immediately after exercise (0-15 s), a significant underestimation of exercise HR (7-9 bpm) still persisted (P < 0.05). Following exercise, pulse rate obtained by carotid palpation at both intensities and radial palpation at the lower intensity was no different from the corresponding HR measured with ECG. In the radial artery trial at the higher exercise intensity, pulse rate following exercise was lower (10 bpm; P < 0.05) than ECG-derived HR. Arterial stiffness, which is closely associated with arterial baroreflex sensitivity, was not significantly related to the changes in HR with carotid palpation. We concluded that post-exercise pulse palpations may not be appropriate as an indicator of exercise intensity in habitual exercisers.

The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer.

BACKGROUND: Although the incidence of endometrial cancer increases with age, the effect of patient age on treatment selection and outcomes is unclear. In addition, although aging is associated with increased prevalence of comorbid conditions, the extent to which comorbidities influence endometrial cancer management is not well documented. METHODS: This population-based analysis evaluates the effect of age and comorbidity on endometrial cancer treatment and outcome in a cohort of 401 patients referred to the Vancouver Island Centre, British Columbia Cancer Agency from 1989 to 1996. Treatment and 5-year actuarial overall survival (OS) and disease-free survival (DFS) were compared by age at diagnosis (<65, 65-74, and > or =75 years) and comorbidity index (Charlson score 0-1 and > or =2). RESULTS: Median follow-up time was 7.8 years. In this cohort, 148 (37%), 152 (38%), and 101 (25%) were aged <65, 65-74, and > or =75 years, respectively. Charlson comorbidity scores > or =2 were found in 18% of patients. Distributions of disease stage, tumor characteristics, and surgical therapy were similar across age and comorbidity subgroups. Standard surgery in this cohort comprised hysterectomy without routine lymphadenectomy. In stage Ic disease, the use of postoperative RT declined with advanced age (96%, 97%, and 74% in patients aged <65, 65-74, and > or =75 years, respectively, P = 0.05) and with increased comorbidities (91% and 79% in patients with Charlson score 0-1 and > or =2, respectively, P = 0.07). Among stage Ic patients aged > or =75 years, pelvic/vaginal relapse occurred in 2 of 6 patients treated with hysterectomy alone compared with 0 of 20 patients treated with postoperative radiotherapy (P = 0.006). On multivariable Cox modeling, age at diagnosis, performance status, stage, grade, lymphovascular invasion, surgery, and radiotherapy use, but not Charlson comorbidity score, were significant predictors for overall survival. CONCLUSIONS: Although surgical therapy for endometrial cancer was not influenced by age or comorbidities, reduced use of postoperative radiotherapy in stage Ic disease was observed among women with advanced age and high comorbidity index. The associated pelvic/vaginal relapse rates were higher in elderly patients not treated with radiotherapy. Chronologic age alone should not preclude patients from consideration of optimal local therapy.