Effective assessments to identify overuse injuries in unaffected limbs of persons with unilateral upper limb amputations.

STUDY DESIGN: Cross-sectional study. INTRODUCTION: Overuse injuries (OI) present major health problems and oftentimes, permanent disability. Persons with unilateral upper limb diagnoses, such as amputation, are at-risk for developing OI in their unaffected limbs. Measures to identify high-risk populations are needed. PURPOSE OF THE STUDY: Scores on 6 OI-assessments were compared for persons with unilateral upper limb amputations (UULA) and healthy participants. Cutoff values were proposed. METHODS: Sixty-two persons with UULA and 62 healthy controls completed this study. Scores for hand volume (HV), visual analogue scale (VAS), multi-site Semmes Weinstein Monofilament for median and ulnar nerves (SWM-M/SWM-U), torque range of motion for wrist/finger extension and flexion (TROM-E/TROM-F), intrinsic tightness (IT), and differential flexor tendon gliding (DFTG) were collected before and after 15 minutes of repetitive and resistive exercise. When analyzing collected data, descriptive statistics, and ANOVA were used to identify differences between groups. Receiver operating characteristic curves (ROC), area under the curve (AUC), sensitivity, and specificity were calculated to determine acceptable cutoff scores. Cutoff values with significant AUC ≥ 0.60 and sensitivity ≥ 0.80 were accepted. RESULTS: Statistically significant differences were found between HV by gender in both pre-exercise and post-exercise conditions. Gain scores for whole sample HV, female HV, and TROM-E were statistically different although differences were small and not meaningful. Significant AUC and acceptable pre-exercise cutoff values included 375 ml. for female HV (sensitivity 89%, specificity 87%), 505 ml. for male HV (sensitivity 81%, specificity 70%), 82 degrees for TROM-E (sensitivity 92%, specificity 71%), and 73 degrees of TROM-F (sensitivity 90%, specificity 89%). CONCLUSIONS: Potential at-risk OI-related populations, especially unaffected limbs of UULA persons, are best identified by pre-exercise cutoff values using HV by gender, TROM, and single-site SWM 2.83.

Upper limb casting in stroke rehabilitation: rationale, options, and techniques.

Upper limb casts have been recommended for stroke survivors with moderate to severe spasticity. The objective of this article is to (a) review the rationale of 2 theoretical models that address spasticity and its consequences, (b) describe 4 casting options reported in the literature, (c) present the evidence for each cast type, and (d) suggest techniques that ensure safe and efficient fabrication of casts. This review underscores the critical need for high-evidence research on the efficacy of casting and the potential long-term benefits to this population. Current evidence lacks controlled research designs, robust sample sizes, and sensitive outcome measures. However, selective groups of stroke survivors have benefited from each type of casting. Future studies are required to assess the impact of casting on upper limb function, especially for those persons with wrist and hand spasticity, and to evaluate the efficacy of those casts not widely adopted in current practice such as inhibitory and drop-out casts.

Preference of lid design characteristics by older adults with limited hand function.

INTRODUCTION: Although opening jars is problematic for older adults, little is known about the best interface design for jar lids. PURPOSE OF THE STUDY: To evaluate preferences in current and new lids for persons self-reporting difficulty with opening jars. METHODS: Participants were twenty-six older females with hand pain. Preference ratings were obtained for twenty-four current and forty-two new lid designs of different sizes, shapes, and textures. RESULTS: Current lids with taller heights, larger diameters, and textured sides were preferred. Texture compensated for limitations of shorter and smaller diameter lids. Preferred characteristics in new smaller diameter lids included taller height, non-circular top shapes, and concave side shapes. Taller height, regardless of shape, was preferred for new medium diameter lids. Least preferred for small and medium lids was the short height, traditional circular shape. CONCLUSIONS: The preferences of jar lids made by elderly females with hand pain support the recommendations commonly suggested by clinicians to increase the height, diameter, texture, and shape of jars, especially for lids smaller than 40 mm.

Evaluation of jar lid design characteristics by older women with hand use limitations.

The study evaluated several lid design characteristics (diameter, height, top shape, side shape, and surface texture) by means of controlled laboratory testing with older women with hand function limitations. A subjective evaluation process was applied to examine main effects and interactions of lid design characteristics on usability, determined by participants' perceptions of effort and discomfort. Results showed that lid height was the most important design characteristic associated with usability. For 42 mm diameter lids, designs perceived as best were ones with taller height, hexagonal top shape, and convex side shape. For 28 mm diameter lids, the best designs were ones with taller height and hexagonal top shape. Additionally, when the smaller lid's side shape was flat, a serrate surface texture provided some advantages, particularly for subjects with more severe hand dysfunction. This information could be used by package designers to improve jar lid usability for a growing sector of consumers.

Empowering elderly women with osteoarthritis through hands-on exploration of adaptive equipment concepts.

The study investigated the participation experiences of elderly women with hand limitations in a maketools-inspired activity for improving bottle openability and verified the usefulness of the results from this approach. Participatory design was used to stimulate participants' hands-on fabrication of new bottle lid concepts. Air-dry modeling clay, Crayola Model Magic® (Crayola LLC, 1100 Church Lane Easton, PA 18044-0431), clay modeling tools sets and empty bottles were the tools used to explore feasible and user-envisioned ideal lids that could potentially reduce hand pain and improve function when opening bottles. Twenty-five elderly women fully participated in the study. They generated 36 bottle lid design concepts. Qualitative analysis identified inclusion of four primary design features as follows: 1) surface texture; 2) increased leverage through lid shape or diameters; 3) increased contact surface with palm/fingers through lid shape or height; and 4) facilitation of alternative grip types. The major limitations of the study were inclusion of only women participants and healthier persons living in a retirement community. Future research is needed to investigate the bottle lid preferences of men and persons with more severe hand function living in places other than independent living communities.

Score reliability and construct validity of the Flinn Performance Screening Tool for adults with symptoms of carpal tunnel syndrome.

OBJECTIVE: We investigated the psychometric properties of the Flinn Performance Screening Tool (FPST) for people referred with symptoms of carpal tunnel syndrome (CTS). METHOD: An occupational therapist collected data from 46 participants who completed the Functional Status Scale (FSS) and FPST after the participants' nerve conduction velocity study to test convergent and contrasted-group validity. RESULTS: Seventy-four percent of the participants had abnormal nerve conduction studies. Cronbach's α coefficients for subscale and total scores of the FPST ranged from .96 to .98. Intrarater reliability for six shared items of the FSS and the FPST was supported by high agreement (71%) and a fair κ statistic (.36). Strong to moderate positive relationships were found between the FSS and FPST scores. Functional status differed significantly among severe, mild, and negative CTS severity groups. CONCLUSION: The FPST shows adequate psychometric properties as a client-centered screening tool for occupational performance of people referred for symptoms of CTS.