HAND EVALUATION KIT-

RELIABILITY AND
VALIDITY AND PROTOCOL
M. Mangala Prema,
M.P.T. IIISemester-Orthopaedics and Traumatology
INTRODUCTION
• Hand assessment is a process of examination by which the quality of a
patient's hand function is quantified and judged.
• The assessment helps to define the patient's problem and is the foundation
for selecting and directing treatment.
• Evaluation of the hand through precise measurement will decrease subjective
judgments and increase the therapist's ability to obtain reproducible findings
and meaningful results.
• The clinical decision-making process relies on objective, valid, and reliable
data.
• We are alerted, however, to resist the tendency to reject information about
the patient that is not quantifiable.
• To date, no standardized, universally accepted hand evaluation
battery is available.
• The selection of the hand-assessment tools to be used, the art of
human interaction between the therapist and the patient, the art of
evaluating the patient's hand as a part, but also as an integrated
whole, are part of the subjective processes involved in hand
assessment.
• Regardless of the statistical support provided for the validity and
reliability of the hand-assessment tools, hand therapy remains an art
as well as a science.
• Therapists are required to objectively evaluate the patient's function
and dysfunction to minimize the cost of therapy.
• A therapist using valid and reliable assessment tools will increase the
mathematical probabilities of making correct clinical decisions.
HAND EVALUATION KIT- LIST
• Finger Goniometer and Regular Goniometer
• Jamar Hand Grip Dynamometer
• Pinch Gauge Meter
• Semmes-Weinstein Monofilament Test (SWMT)
• Pin wheel
• Finger Circumference Gauge
• Baseline functional finger motion gauge
GONIOMETER-ROM
• In addition to individual joint ROMs, many clinicians have begun to
record the total ROM values of each digit that is, the total active and
passive ROM values for the metacarpophalangeal and the proximal
and distal interphalangeal joints.
• This method is quite conducive to both graphical representation and
statistical analysis of the digit's goniometric recordings over time.
• This amalgamated value alone, however, may not be valid in terms of
localizing the physical deficit for impairment ratings.
• Research in goniometric reliability has been in two main areas:
1) device reliability and 2) intertester and intratester reliability.
• Agreement exists in device reliability among different sizes and scales
of goniometers. Of the studies that examined goniometric intertester
and intratester reliability, only a few focused on the joints of the
hand.
• In hand goniometry, a ± 5-degree margin of error is accepted even for
experienced examiners adhering to standardized protocols.
• Cambridge concludes that goniometric assessment can be an
accurate, reproducible means of evaluation.
• We investigated interrater reliability of motion (ROM) measurement
in the finger joints of people with Dupuytren's disease. Eight raters
measured flexion and extension of the three finger joints in one
affected finger of each of 13 people with different levels of severity of
Dupuytren's disease, giving 104 measures of joints and motions.
• Reliability measures, represented by intraclass correlation coefficient
(ICC), standard error of the mean (SEM), and differences between
raters with the highest and lowest mean scores, were calculated. ICCs
ranged from .832 to .973 depending on joint and motion.

I
• The SEM was ≤3° for all joints and motions. Differences in mean
between highest and lowest raters were larger for flexion than for
extension; the largest difference was in the distal interphalangeal
joint. The results indicate that following these standardized
guidelines, the interrater reliability of goniometer measurements is
high for digital ROM in people with Dupuytren's disease.

Interrater Reliability in Finger Joint Goniometer Measurement in

Dupuytren's Disease-January 2012
The American journal of occupational therapy.: official publication of the
American Occupational Therapy Association 66(1):98-103
PROTOCOL FOR GONIO MEASURE
• Measurements were performed over the dorsal midline of the
metacarpals or phalanges with a plastic goniometer
• The position for measurement of flexion in the MCP and PIP joints
was as follows: elbow placed on table and forearm in neutral position,
wrist in 30 degree extension, and fingers in full flexion making a fist.
For measurement of flexion in the DIP joint, raters instructed patients
to extend the MCP joint as much as possible and keep the PIP and DIP
joints in flexion, attempting to make a hook fist.
 • The position for measurement of
finger extension was as follows:
elbow placed on table and
forearm in neutral position, wrist
in neutral position, and fingers in
full extension

Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytren's

Disease
Article  in  The American journal of occupational therapy.: official publication of the American Occupational Therapy Association · January 2012
FINGER ROM NORMATIVE VALUES
•Metacarpophalangeal (MCP)
•Abduction: 25 degrees
•Adduction: 20 degrees
•Flexion: 80 degrees
•Extension: 30 degrees
•Interphalangeal Proximal (PIP) Joint of the Finger
•Flexion: 120 degrees
•Extension: 120 degrees
•Interphalangeal Distal (DIP) Joint of the Finger
•Flexion: 80 degrees
•Extension: 80 degrees
• Metacarpophalangeal Joint of the Thumb
• Abduction: 50 degrees
• Adduction: 40 degrees
• Flexion: 60 degrees
• Extension: 60 degrees

• Interphalangeal Joint of the Thumb

• Flexion: 80 degrees
• Extension: 90 degrees
JAMAR HAND GRIP DYNAMOMETER
• Generally, the next step after the administration of the MMT is to
document the patient's achievement on the hand grip and pinch
strength tests.
• Both tests are measures of muscle strength using a standardized
instrument. The most common grip strength-assessment tool is the
Jamar adjustable dynamometer and the pinch meter is used for a
variety of prehension patterns. Most instruments are designed to
allow readings in imperial (pounds) or metric (kilograms) units. The
Jamar dynamometerhas been shown to be a reliable test instrument.
• There is some question as to whether or not a goniometer is a
sufficiently valid and reliable instrument to determine whether an
intervention has been effective[2]. Some research argues that the
reliability of the measurement gotten from a goniometer depends on
the type used[3][4] while some did not see any significant difference
between some instruments[5][6]

• (https://www.physio-pedia.com/Goniometer)
• The literature, however, shows a wide variety of procedural
differences regarding posture,handle level, number of trials, score
documentation, and normative data sources. There is variation as to
whether the patient should be positioned standing or seated.

• There has been recent acceptance of positioning the upper extremity

in shoulder adduction with neutral humeral rotation, the elbow flexed
to 90 degrees, and the forearm and wrist in neutral.
• Healthy adults' grip strength values for the five handle positions (first
position = smallest; fifth position = widest) using the Jamar
dynamometer consistently present a normal, bellshaped curve.
• The first position is least advantageous because it relies primarily on
the force of the intrinsic musculature. The most advantageous
position, when both the intrinsic and extrinsic muscles contribute to
the voluntary effort, is either the second or the third handle-spacing
position,depending on hand size. There is no uniform agreement as to
the handle placement of the Jamar dynamometer during testing.
• Mathiowetz and colleagues used the second handle position for all
subjects, whereas Kellor et al did not specify the handle position and
Fess advocated the middle range.
• Overall, two different methods are used to record grip strength
values:
• 1) the Kellor et al method, which uses the highest measurement of
two successive trials and 2) the Mathiowetz et al method, which uses
the averaged value of three trials.
• Both Kellor et al and Mathiowetz et al have contributed normative
tables for grip function, based on their own methods. Intertester
reliability may be increased if follow-up measurements are taken
using the same procedure.
• With adherence to an accepted procedure for test administration, both
intertester and intratester reliability show promise. The Jamar
dynamometer's capacity to test different muscle groups, intrinsic versus
extrinsic, suggests concurrent validity in testing muscle strength.
• The five level testing method suggested by Stokes offers a possible
method of distinguishing between patients who demonstrate a maximal
voluntary effort and those who demonstrate a submaximal effort. The
assumption is that when there is no neural or tendon damage, grip
strength recordings from maximal voluntary efforts may produce a bell-
shaped curve but those from submaximal efforts will demonstrate a
flatter curve.
 • Background: To evaluate the test-retest reliability of Jamar hand held
dynamometer for measuring handgrip strength (HGS) in patients with
acute and chronic cervical radiculopathy and to find out the difference
in measurement of the handgrip strength between acute and chronic
cervical radiculopathy.
• Methods: A prospective, observational and non-experimental, the
comparative study design was used.

TEST-RETEST RELIABILITY OF HAND GRIP STRENGTH MEASUREMENT USING

A JAMAR HAND DYNAMOMETER IN PATIENTS WITH ACUTE AND CHRONIC
CERVICAL RADICULOPATHY
DOI https://doi.org/10.15621/ijphy/2017/v4i6/163928
• A sample of 72 subjects (37 women and 35 men) suffering from
cervical radiculopathy were divided into two groups i.e., Group
A(acute) and Group B(chronic), handgrip strength was measured
using Jamar hand held dynamometer on two occasions by the same
rater with an interval of 7-days.
• Data collection was based on standard guidelines of American Society
of Hand Therapists. Three gripping trials (measured in Kg) with
patient’s arm in standardized arm position were recorded. The data
was analyzed from the mean score obtained from the sample.
• Result: One-way Analysis of Variance(ANOVA) was used to evaluate
test-retest reliability and Tukey-Kramer Multiple Comparison Test used
to find the difference between handgrip strength among acute and
chronic Cervical radiculopathy cases. Greater P-value (>0.05) in both
testing session, as well as 95% of the confidence interval, shows the
reliability of the instrument and lesser p-value (<0.05) in male subject
shows a significant difference in handgrip strength and greater p-
value (>0.05) in female subjects shows no significant difference in
handgrip strength between the two groups.
• Conclusion: Excellent test-retest reliability for hand grip strength
measurement was measured in patients with acute and chronic
cervical radiculopathy shows that the equipment could be used as an
assessment tool for this patient and significant difference exists
among male handgrip strength between acute and chronic cervical
radiculopathy cases whereas no difference exists among female
handgrip strength between acute and chronic cervical radiculopathy
cases.
HAND DYNAMOMETER-PROTOCOL

• Using the hand dynamometer is easy enough. The patient holds the
dynamometer in the hand being tested, with the arm at right angles
with the elbow by the side of the body. Adjust the handle of the
dynamometer as necessary, making sure that the base rests on the
first metacarpal (heel of the palm), while the handle rests on the
middle of the four fingers. The patient then squeezes the hand
dynamometer with maximum isometric effort for at least 5 seconds.
The patient is required to not move any other part of the body and is
encouraged to use maximum effort.
Testing Norms for Hand Grip Dynamometers

https://www.prohealthcareproducts.com/blog/hand-dynamometer-how-it-works-and-why-its-important/
PINCH GAUGE METER
• Much of the functional capacity of the hand is derived from the
specialized abilities of the thumb.
• Many classifications are used to describe the great variety of
postures that the hand can assume in carrying out activities. The most
common pinch posture classification has been described by Flatt.
• It includes three types of pinch:
• 1) tip
• 2) palmar
• 3) lateral-key
• The pinch tests frequently used in hand therapy clinics measure these
three forms of pinch.
• The palmar pinch, sometimes called "three-jaw chuck," uses the
thumb, index finger, and middle fingers.
Reliability and validity of grip and pinch strength
evaluations J Hand Surg Am-1984 Mar;9(2):222-6.
doi: 10.1016/s03635023(84)80146-x.

• 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.
Reliability and Validity of Pinch and Thumb
Strength Measurements in de Quervain's Disease-
Journal of Hand Therapy Volume 19, Issue 1,
January–March 2006,
• The purpose of this study is to evaluate the test–retest reliability and
construct validity of pinch and thumb strength measurements in
subjects with de Quervain's disease. Maximal palmar pinch and
thumb strength (adduction, extension, abduction, and flexion) were
measured using, respectively, a pinch gauge and a biaxial
dynamometer.
• The reliability was estimated using the generalizability theory.
• The validity hypotheses were as follows:
1) the pinch and thumb strength of the symptomatic side would be
significantly lower than that of the asymptomatic side, and
2) the strength loss would be greater for thumb extension and abduction. The
reliability was high for all strength measurements, pinch strength being the
more reliable one.
• The pinch and thumb strength in all directions evaluated was significantly
decreased on the symptomatic side (p < 0.003); no direction showed a
greater decrease than the others.
• The results suggest that pinch and thumb strength measurements are
reliable and able to show a decreased strength on the symptomatic side in
this population.
PINCH METER-PROTOCOL

https://www.prohealthcareproducts.com/pinch-gauge-norms-and testing-protocols/
Pinch-Gauge-N
orms-for-Adults.pdf
SENSATION
• The hand is a complex organ whose function depends on the harmony
between sensory and motor abilities.
• Sensory testing can frequently identify sensorineural changes earlier than
traditional motor examinations.
• In some conditions, such as median nerve entrapment in the carpal tunnel,
sensory changes precede motor changes, and sensory studies are more
sensitive in quantifying these changes.
• Moran et al have shown the Semmes Weinstein pressure esthesiometer test
to be more sensitive when compare with the 2PD (Two Point Discrimination)
and other clinical sensory tests in assessing diminished sensibility with
carpal tunnel syndrome.
• In this study, the Semmes-Weinstein Monofilament Test (SWMT) was used
to examine light touch sensation of the UE, and the Thumb Localizing Test
(TLT) was used for proprioception.
• The SWMT is considered a simple and inexpensive touch threshold test and
is widely used by clinicians to evaluate sensory disturbances of neuropathic
diseases, such as diabetes mellitus and carpal tunnel syndrome.
• Its reliability and validity in patients with those diseases have been
confirmed in previous research , but in patients with stroke, those of the
SWMT as an index of light touch sensation are poorly documented.
• However, it is easy to quantify sensory disturbances in detail with the
SWMT, so it has often been used as a follow-up index for patients with
stroke in the latest studies

https://www.frontiersin.org/articles/10.3389/fneur.2020.625917/full
 • Semmes Weinstein Monofilament Test is a neurological test that is used
in sensory loss of the skin.
• In Semmes Weinstein Monofilament Test, the palm of the hand is
divided into several areas, and only one point (usually in the center) is
tested in each area:
• Between the fingertip and DIP joint.
• Between the DIP joint and PIP joint.
• Between the PIP joint and finger web.
• Between the finger web and the distal anterior (palmar) crease.
• Between the distal anterior (palmar) crease and the central palm.
• Base of palm and wrist.
• Superficial radial nerve distribution.
https://orthofixar.com/special-test/semmes-weinstein-monofilament-test/
• The clinician applies a monofilament perpendicular to the surface,
and the pressure is increased until the monofilament begins to bend.
Filament 2.83 MN is considered the “Normal” filament and indicates
normal light touch perception. A positive test for CTS is when the
patient with eyes closed cannot report which digit is receiving
pressure at 2.83 mg.
• Diagnostic Usefulness of the Semmes Weinstein Monofilament Test in
one study by Koris et al found that this test has a Sensitivity of 82%
and a Specificity of 86%.

• Another study by Pagel et al. found the Sensitivity of 98% and a

Specificity of 15% for the Semmes Weinstein Monofilament Test.

• In a study on 36 hands with carpal tunnel syndrome, the

Interexaminer Reliability was κ = .22 (.26, .42).
Validity and Reliability of the Semmes-Weinstein
Monofilament Test and the Thumb Localizing Test in
Patients With Stroke
2021 Jan 27;11:625917.
doi: 10.3389/fneur.2020.625917. eCollection 2020.

• Conclusion of study:
• The reliability and validity of the SWMT and the TLT were verified.
These tests can be used as reliable sensory examinations of the UE in
patients with chronic stroke, and especially for the SWMT, it is more
reliable for screening.
https://musculoskeletalkey.com/sensibility-testing-with-the-
semmes-weinstein-monofilaments/Sensibility Testing with the
Semmes-Weinstein Monofilaments
• Instrument Reliability
• An instrument has to be shown to have instrument reliability before it
can be considered valid and used in clinical studies. The repeatability
of an instrument is related to its validity. If an instrument is shown not
to be repeatable (i.e., in its strength of application), then its validity is
nonexistent. One cannot use human performance alone to prove
reliability of an instrument that measures in units defined by the
National Institute of Standards and Technology (NIST).
• The monofilaments clearly have been shown to be accurate and
repeatable as an instrument if calibrated correctly, and they have the
unique ability to dampen the vibration of the examiner’s hand that
occurs with hand-applied devices that do not control for this
vibration.
• It is true that some closeness in force of application is produced by
the monofilaments in the long kit and occasions may occur when
forces overlap. This simply means that not all the monofilaments
available for testing need to be used.
• For the sake of time, it is more expedient to use those monofilaments
determined most critical for identification of “normal versus
abnormal” and changes in “functional discrimination and
recognition.”
• This is why certain monofilaments are specifically selected for the
minikit, and in most cases, these are all that is needed for screening
or full mapping of sensibility. The forces of application of the
monofilaments in the minikit never overlap; thus the minikit is
actually more sensitive as an instrument than the long kit. The long kit
does include additional monofilaments needed for testing within
normal subjects. In normative studies, inclusion of the lighter above-
threshold monofilaments is critical for accurate measurement.
Validity

• When calibrated and applied correctly, the monofilaments are a valid

test for testing sensibility detection thresholds. Studies have clearly
demonstrated their ability to accurately detect the clinical condition
intended. * Used in standard protocols, the monofilament test is
being used to compare patient data in multicenter studies and is
providing information regarding peripheral nerve changes with
treatment not previously available with less sensitive and
uncontrolled instruments.
WEBER TWO POINT
DISCRIMINATION TEST
• The Weber Two Point Discrimination Test were first introduced by Weber in1953 using
calipers and by Moberg in 1958 using a paper clip.

• Today it is recommended that a two-point aesthesiometer tool such as a Disk Criminator be

used. The instrument is explained and demonstrated to the patient until an appreciation
can be made between one and two points in an area of normal sensibility.

• The instrument is applied, in a perpendicular fashion, to all of the fingertips in a mixed

series of two and one points for five consecutive applications. The patient should be able to
recognize at least four out of the five or seven out of ten. The clinician repeats the tests in
an attempt to find the minimal distance at which the patient can distinguish between the
two stimuli, decreasing or increasing the distance between the points depending on the
response by the patient.
• This distance is called the threshold for discrimination: Normal discrimination
distance is less than 6 mm, although this can vary between individuals, and in the
area of the hand, with normal fingertip scores between 2 and 5 mm and finger
surface scores between 3 and 7 mm.

• Studies investigating the sensitivity and the specificity of the Weber Two Point
Discrimination Test indicate that the test has a high specificity but low sensitivity.

• Buch-Jaeger and Foucher found the test to have a sensitivity of 6 % and a specificity of
99 %. Another study by Gellman and colleagues found the sensitivity to be 33 % and
the specificity to be 100 %. These findings suggest that the Weber Two Point
Discrimination Test is useful for ruling in CTS.
WEBER TWO POINT
DISCRIMINATION-PROTOCOL
• The examiner uses a paper clip, two point discriminator, or calipers[4]
to apply pressure on two adjacent points in longitudinal direction or
perpendicular to the long axis of the finger.[5]
• The minimal distance with which the patient can distinguish between
two stimuli is found by moving from proximal to distal. This distance is
called threshold for discrimination. The area being tested must not be
seen by the patient and the patient must concentrate on feeling the
points. For accurate results, the hand must be immobile on a hard
surface and it must be ensured that the two points are simultaneously
touching the skin. The patient is asked to report whether one or two
points was felt.
https://www.physio-pedia.com/Weber_Two-Point_Discrimination_Test
• The smallest distance between two points that still results in the
perception of two distinct stimuli is recorded as the patient's two-
point threshold.[6] Performance on the two extremities can be
compared for discrepancies. Although the test is still commonly used
clinically, it has been roundly criticized by many researchers as
providing an invalid measure of tactile spatial acuity, and several
highly regarded alternative tests have been proposed to replace it.
• There must be no skin blanching as it indicates too much pressure being
applied. There may be an increase or decrease in the distance between
the points depending on the patient's response. Starting distance between
the points can be easily distinguished. If the patient is hesitant to respond
or becomes inaccurate, the patient is required to respond accurately on
several trials before the test can be repeated.

• Normal discrimination distance recognition is less than 6mm, but it varies

from person to person. This test is best for hand sensation involving the
static holding of an object between the finger and thumb requiring pinch
strength
 Two Point Discrimination Value

Normal <6mm

Fair 6-10mm

Poor 11-15mm

Protective where only one point is

perceived.

Anesthetic where points are not

perceived.
• Weber's two-point discrimination test is the most common method
used to of assess sensibility of the upper extremity. The amount of
force applied between one and two points easily exceeds the
resolution or sensitivity threshold for normal sensation.
• Tremendous variance in pressures applied resulted in poor levels of
interrater reliability. This perhaps explains some of the lack of
agreement in reporting discriminatory function. The number of
correct responses required may vary slightly from examiner to
examiner.
Reliability of two-point discrimination
measurements- SEPTEMBER 01, 1987
• Both moving and static two-point discrimination are valid
measurements of functional sensibility in the hand. The present study
investigated the interobserver variability of these measurements
when two observers used the same testing instrument and the same
definition of the testing procedure's end point.
• In testing 30 nerve-injured patients, interobserver variability was
found to vary within 1 mm, or less, for moving two-point
discrimination in 93.3% of the measurements and for static two-point
discrimination in 86.8% of the measurements.
• In only two of the 30 measurements of moving two-point
discrimination and in four of the measurements for static two-point
discrimination were interobserver differences equal to 2 mm.
Measurements for both moving and static two-point discrimination
were analyzed statistically by linear regression and correlation co-
efficient techniques.
• The measurements for two-point discrimination obtained with the
protocol employed in this study were found to have an interobserver
reliability at the p < 0.00001 level.
A PINWHEEL FOR NEUROLOGIC EXAMINATION
Robert Wartenberg, M.D.

• Pin wheel has been used in testing the sensibility of the skin to pain,
both for the first gross orientation and for exact determination of the
boundaries of hypalgesia or analgesia, it is essential to apply on an
extensive area of the skin a series of stimuli which should be as much
as possible equal with regard to time, distance and strength.
• The handling of this pin wheel is easy and convenient
• It is rolled under light pressure on the skin or permitted to work with
its own weight
• It is also useful for comparison of sensibility to pin prick on two
symmetrical places of the body
 • In this manner it is easy to
achieve equal stimuli
• The use of this pin is preferrable
for determination of hypoalgesic
or analgesic boundaries on the
small surfaces of the ends of the
extremities

JAMA. 1937;109(16):1294. doi:10.1001/jama.1937.02780420054022

 EDEMA
• Following hand trauma or hand surgery, there is frequently an abnormal
accumulation of fluid in interstitial spaces of tissues, resulting in increased
hand size.
• This edematous state limits ROM and ultimately hand function. Edema
documentation can be compiled by measuring the circumference of the
edematous part.
• To allow for more valid comparison of sequential measurements, anatomic
landmarks are used as reference points for placement of the tape measure.
• The placement and tension applied on the tape measure affects the
intertester and intratesterreliability of these measurements.
• Another method involves the use of jeweler's rings, which reduce the
measurement error produced by thetension of the tape-measure method
FINGER CIRCUMFERENCE GAUGE

• Measure the circumference of a

joint or digit
• Wrap webbing around the finger
and read circumference
• Measures inches and
centimeters
Finger circumference measurements: inter- and intra-rater
reliability,First published online August 26, 2010
Abstract
• Background
• Finger oedema can occur for a variety of reasons, including traumatic injuries to
the fingers and as a consequence of stroke or diabetes. The purpose of this study
was to determine the intra- and inter-rater reliability for finger circumference
measurements.
• Methods
• Eight hand therapists assessed the middle finger circumference of 11 healthy
adults using the Richardson Products finger circumference device for three trials
over two testing days. Intraclass reliability analysis and analysis of variance were
used to assess the consistency and stability of measures. Level of significance was
set at P ≤ 0.05.
• Results
• Significant differences (P < 0.001) were found between raters for
circumference measurements with a range difference of 0.5 cm.
Intrarater reliability was 0.98–0.99 (single measure intraclass
coefficient). Inter-rater reliability coefficients ranged from 0.94 to 0.95.
• Conclusions
• These results provide clinicians with evidence for using a specific
finger circumference device and issues associated with various
therapists assessing finger circumference. A device with a way of
assessing tension at the end of the tape measure or cloth pulled
around the finger is warranted.
FUNCTIONAL FINGER MOTION
GAUGE
• Baseline Functional Finger Motion Gauge is a clear plastic gauge
that simplifies and speeds measurement of composite finger
flexion and finger-thumb opposition measurement. Scales
measure up to 10 centimeters.
• Composite finger flexion: Place the flat end of the plastic gauge
on the subject'spalmer crease and have the subject flex his/her
fingers.
• Read the composite flexion of each finger directly from the
gauge(distance from the palmer crease to the fingertips of the
maximally flexed fingers.)
• Thumb and finger opposition: Have the subject grasp the
smallest step possible between the thumb and finger.
• Repeat for each finger (index, middle, ring and pinky.)
SUMMARY
• Hand-assessment instrument reliability and validity studies are
limited.
• As a result, the hand therapist is challenged to provide objective data,
obtain reproducible findings, and produce meaningful results.
• Instruments that produce reliable and valid data will assist in the
accountability for hand therapy.
• The art of practice, however, requires awareness and documentation
of the patient's qualitative hand dysfunction characteristics.