Hand function

Hand bone anatomy

Hand bones nomenclature
Joints of hand
 Muscles of hand
• Intrinsic muscles
• Extrinsic muscles
Muscles of hand
Sensory distribution of hand
 Functions of Hand
• Reach forward reach
sideward reach
backward reach

Forward reach sideward reach backward reach

• Grasp cylindrical – holding a glass
spherical – holding a ball
hook – carrying a bag

Cylindrical grasp spherical grasp hook grasp

• Prehension tip to tip / pulp to pulp-
picking a needle
lateral prehension –
turning a key
3-jaw chuck- holding a pencil
• Manipulation translation – finger to palm
or palm to finger
rotation- opening a bottle cap
shifting- one surface to another

rotation shifting
Translation
• Dexterity turning and placing

turning and placing

 HAND ASSESMENT
• Demographic data : name, age, sex,
occupation, hand dominance
• History : medical and surgical treatment taken
• On observation : position of the arm and
carrying posture, any evidence of laceration or
suture, swelling, trophic changes ( color)
• On examination :
1. Soft tissue tightness : intrinsic muscle
tightness / extrinsic muscle tightness
2. Edema assesment : pitting or non pitting
volumeter/ figure of 8
3. Sensory testing : sensory mapping
4. Nerve compression or regeneration : tinel’s
sign, touch pressure- semmes-weinstein
monofilaments, 2 point discrimination,
vibration
5. Range of motion of joints of hand:
goniometer
6. Strength of muscles of hand : MMT, Jamar
Dynamometer, Pinch gauge
STANDARDIZED TESTS FOR HAND FUNCTION

• What is a Standardized test ?

A standardized test is one whose administration
procedure has been written down, so that, by
following the directions exactly, the test is
administered the same each time.
Eg : what objects to use, what directions to give,
environment etc.
A standardized test should have a good
sensitivity, reliability and validity.
• What is reliability and validity?
RELIABILITY : reliability refers to the consistency
with which a test measures the phenomenon.
Test-retest reliability : refers to consistency from
time to time.
interrater reliability : refers to the consistency
across raters.
VALIDITY : validity refers to how well the test
measures what it is suppose to measure.
Eg : ADL test should include all those activities that
the person will be responsible for, at home, not
simply ‘hospital ADL’
• What is sensitivity?
Sensitivity denotes how well changes can be
captured to show progress. Tests with gross
sensitivity can measure large changes but will
miss small gains. The selected test should have
sensitivity necessary to document the size of
effect expected within time periods that re-
evaluation occur.
 JEBSON TAYLOR HAND FUNCTION TEST

• PURPOSE : to assess a broad range of uni-

manual hand functions required for activities of
daily living
• AREAS OF ASSESSMENT : activities of daily living
and upper extremity of hand function
• ASSESSMENT TYPE : performance measure
• ADMINISTRATION MODE : paper and pencil
• DESCRIPTIONS : 7 subtests performed on both
non-dominant and dominant hands
1. Writing a 24 letter, 3rd grade reading level
difficulty sentence
2. Card turning
3. Picking up small common objects (eg. pennies,
paper clips, bottle caps) and placing them in a
container
4. Stacking checkers
5. Simulated feeding
6. Moving light objects (eg., empty cans)
7. Moving heavy objects (eg., 1lb weighted cans)
• Subtest score = time (seconds) to complete task
• Total score = sum of times for each subtests
• Maximum time allotted per subtest is 120
seconds
• Lower score = greater function
• Each item performed with each hand
separately- non-dominant hand first
• Measures unilateral hand function
• Assesses speed, not quality of performance
• NUMBER OF ITEMS : 7
• EQUIPMENT REQUIRED :
 stopwatch
 Chair (18” seat height), desk/ table (30” high)
 Black ball point pen, four 8*11” sheets of
unruled white paper stacked and fastened to a
clipboard.
 Sentences typed in all capital letters and
centered on a 5*8” index card on a book stand.
 Five 3*5” index cards (ruled on one side only)
 Empty 1 pound coffee can
 Two 1” paper clips
 2 regular sized bottle caps (1” diameter)
 2 U.S. Pennies
 5 kidney beans (~5/8” long)
 1 regular teaspoon
 Wooden board (41½” long, 11¼ “ wide,
¾”thick), “C” clamp, plywood (20” long, 2”
wide, ½” thick) glued to the board
 Four standard size (1 ¼” diameter) red
wooden checkers
 Five no. 303 cans
• TIME TO ADMINISTER : 15 minutes
 PURDUE PEGBOARD
• PURPOSE : The Purdue Pegboard aids in the
selection and rehabilitation of employees for
various types of manual labor by measuring 2
types of dexterity.
a) Gross movements of the fingers, hands and
arms
b) Fine fingertip dexterity nacessary in assembly
tasks.
• AREA OF ASSESSMENT : coordination
dexterity
• KEY DESCRIPTIONS
 The Purdue Pegboard Test is a rectangular board
with 2 sets of 25 holes running vertically and 4
concave cups at the top. Small metal pegs are
placed in the cup on the side being tested, with
subjects asked to remove the pegs and place them
vertically in the holes as rapidly as possible. The
number of pegs placed in 30 seconds is scored.
 The original application for the test was for testing
the dexterity of industrial workers. It has since
been used for testing of dexterity within various
populations in the clinical setting including children
and adolescents.
• The test takes about 30 seconds per activity
for a total of 5-10 minutes including
instruction. The test administrator compiles 5
separate scores for the complete test
procedure, one for each battery:
a) Right hand (30 secs)
b) Left hand (30 secs)
c) Both hand (30 secs)
d) Right + left + both hands = total score
e) Assembly (60 seconds)
• EQUIPMENT REQUIRED :
 Purdue Pegboard Test
 Instruction Manual
 Test board
 Pins, collars, washers
 Score sheets
 At least one testing table approximately 30
inches tall. The subject must be seated
throughout the administration of the test.
 Stopwatch
 MMDT
• Purpose : the Minnesota Manual Dexterity Test
is used to measure a subject’s simple but rapid
eye hand coordination as well as arm- hand
dexeterity.
• Equipment required
 Instruction Manual
 1 test board
 60 black and red plastic disks
 Tablet of score sheets
• The MMDT includes instructions for 2 test
batteries :
1. Turning Test
2. Placing Test
Turning test : put the board on the table about 10
inches from the edge. Insert the disks into the hole
of the board. Now lift up the board, allowing the
disks to fall through the holes and remain in
straight rows and columns on the table. Now place
the board directly infront of the disks. The board
should now be about 1 inch from the edge of the
table closest to the subject. Pick up the bottom
disk and insert to the top hole. Move right to left.
Placing test : put the board on the table about 1
inch from the edge closest to the subject.
Insert all of the red disks into the black holes
in the board with either red or black side
facing up (the color must be consistent on the
whole board). Begin by asking the to “how fast
you can pick up the disks with one hand , turn
them with the other hand, and replace back
into the holes of the board.
• Scoring : total seconds required to complete
the test.
 Hand Therapy
Edema management
• Positioning : antigravity positioning(hand above wrist and
wrist above elbow and elbow above heart level) is essential
to avoid accumulation of liquid in distal part. This can be
achieved through splints, rolled towels, pillows,etc.
• Compression : edema can be controlled by compression
with elastic strip bandages or tubular bandages. Care must
be taken so that these are applied correctly and do not
constrict circulation.
• Passive & active range of motion : movement of the joints
through full range of motion is required. CPM
• Massage : edema massage distal to proximal
To increase Range of Motion
• Positioning : through splints to avoid
gravitational force causing any deformity
• Passive stretching : force applied by an
external source to elongate the muscles
• Active stretching : patient control the force,
speed, extent and direction of the stretch
• Active exercises : repetition of movement in
activities without weight. These can be
assistive or supportive.
To increase strength
• Isotonic active Exercise and activity : activities
requiring the movement in eliminated gravity
for grade 2 strengthening and against gravity
for grade 3 strengthening.
• Isotonic active resistive Exercise and activity :
activities increasing the strength in grade 4
and 5 with against gravity and weights applied
to activities or the affected parts of the hand.
Resistance is provided through weights,
resistive bands, velcro, springs etc.
To improve hand function
• Positioning : through splints
• Activities : various activities requiring the hand
functions that is deficit.