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At least 595 records · Page 33Linked to original sources
PubMed1985

Hand function in children with myelomeningocele.

Hand function in 33 patients with myelomeningocele, aged from 4 to 17 years, was investigated by clinical examination and formal tests of co-ordination and dexterity. The average score for hand function was 59% of normal and only two children had clinically normal upper limbs. Twenty-eight patients (85%) had cerebellar ataxia, either alone or combined with other abnormal signs, most commonly upper motor neuron lesions. Hand function was significantly better in children of 11 years and older, in children under 11 with milder degrees of hydrocephalus, and in the younger children who were right-handed. Function was not shown to be better in those with lesions lower in the spine, nor in those with stable spines as has been previously reported. When co-ordination of the upper limb, manual dexterity and simultaneous movements of both arms were examined separately, these three were affected equally. Some abnormalities of hand function could be overcome by encouraging affected children to sit up and to practise skillful use of their hands as early in life as possible.

Adolescent↗
PubMed2001

Virtual reality bronchoscopy simulation: a revolution in procedural training.

BACKGROUND: In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. METHODS: We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used. RESULTS: Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. CONCLUSION: A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.

Bronchoscopy↗
PubMed1999

Divided vertical banded gastroplasty either for correction or as a first-choice operation.

BACKGROUND: Staple-line disruption may occur after vertical banded gastroplasty (VBG). METHODS: Since May 1996, the authors have performed the gastric restrictive procedure divided VBG, as described by MacLean, as a first-choice operation and not only as correction for staple-line breakdown. Divided VBG was done in 111 patients, 32 as correction after staple-line disruption and 79 as a first choice, 29 of them by hand-assisted laparoscopy with the dexterity pneumosleeve. RESULTS: Weight loss and nutritional status have been very satisfactory. Operating time for the standardized operation has been no longer than 60 minutes. CONCLUSION: Divided VBG, especially if done by hand-assisted laparoscopy using the dexterity pneumosleeve, is a valid restrictive procedure.

Adult↗
PubMed2006

Development of hand function and precision grip control in individuals with cerebral palsy: a 13-year follow-up study.

OBJECTIVE: Although children with cerebral palsy display large developmental differences in hand function from that of typically developing children by the age of 6 to 10 years, little is known about the developmental processes underlying hand function during subsequent development. In this study we investigated the development of manual dexterity in a timed motor task, the timing and amplitude of fingertip-force application during a precision grasping task, and the relationship between changes in these measures. We applied highly quantitative analytical approaches to determine if the fingertip-force application pattern and trial-to-trial variation of fingertip-force application change during development. METHODS: Twelve subjects with cerebral palsy (aged 6-8 years) participated in the first data-collection session conducted between 1989 and 1990. Ten of these subjects (5 with hemiplegia and 5 with diplegia, aged 19-21 years) returned between 2002 and 2003. Manual dexterity was measured by using timed tasks of the Jebsen-Taylor test of hand function. Subjects also lifted an object instrumented with force transducers while we measured the temporal coordination of fingertip coordination and the path ratio between the grip and vertical load-force trajectory (straightness). We used generalized procrustes analysis to determine if there were changes in shape of the force trajectory and intertrial variability. RESULTS: The Jebsen-Taylor test times decreased 45% from the first to the second data session. The overall time to complete the grip-lift task decreased 22%, mainly because of a faster transition from grasp to lift. The grip-force/load-force path ratios decreased from 1.7 to 1.35 (1 = straight line). Generalized procrustes analysis indicated a change in the shape and a decrease in variability in shape of the force-ratio path. CONCLUSIONS: Our results demonstrate that the efficiency in grasping had developed during a 13-year period for this small group of participants with cerebral palsy, which suggests that improvement in hand function occurs over a longer time frame than commonly would be expected.

Adult↗
PubMed2006

Robotic cardiovascular surgery.

Cardiovascular surgery has traditionally been performed through a median sternotomy, allowing the surgeon generous access to the heart and surrounding great vessels. Recently, less invasive methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart, thus resulting in a paradigm shift in cardiac surgery. Originally, long instruments without pivot points were used, however; with the application of robotic telemanipulation systems that allow for improved dexterity, the surgeon is able to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, this article reviews the recent history and clinical results of robotics in cardiovascular surgery.

Animals↗
PubMed1999

Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus.

BACKGROUND: The purpose of this study was to evaluate the functional outcome and the complications of reconstruction with an osteoarticular allograft in patients who had had intra-articular resection of the proximal aspect of the humerus. METHODS: Sixteen patients who had had intra-articular resection and reconstruction of the proximal aspect of the humerus for the treatment of a tumor between 1986 and 1996 were evaluated. The length of the resected part of the humerus ranged from eight to 27.5 centimeters. The resections were classified as either S34A or S345A resections of the shoulder girdle on the basis of the Musculoskeletal Tumor Society classification system. Reconstruction was performed with use of a nonirradiated, frozen osteoarticular allograft with intact capsular and rotator cuff attachments. Dual orthogonal dynamic compression plates were used for internal fixation of the allograft to the host bone. The oncological parameters that were evaluated included survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft, and fragmentation of the epiphysis of the allograft (subchondral collapse). Survival of the graft was assessed with Kaplan-Meier survival analysis. The modified Musculoskeletal Tumor Society evaluation system was used to assess functional outcome. RESULTS: At a median of forty-seven months (range, fourteen to 130 months) after the operation, fourteen of the patients in the study group were free of disease and two had died of disease. No patient had local recurrence or nonunion. Late complications included four fractures of the allograft and one infection of the graft. A Kaplan-Meier survival curve demonstrated a 68 percent rate of survival of the allograft at five years. Instability of the glenohumeral joint in the form of ptosis and anterior subluxation was noted in three patients, and dislocation of the glenohumeral joint was seen in eight patients. On the basis of the modified Musculoskeletal Tumor Society functional evaluation, the mean score at the most recent follow-up evaluation (at a mean of thirty-four months) was 70 percent. This score was lower than the mean score of 81 percent at a mean of fourteen months. All patients had normal manual dexterity and had mild or no pain at the most recent follow-up evaluation. However, all had restriction of recreational activities or partial disability in addition to limitations with regard to placement of the hand and the ability to lift. CONCLUSIONS: Reconstruction of the proximal aspect of the humerus with an osteoarticular allograft is an option that provides good relief of pain and preserves manual dexterity. However, in our study, function was limited by impairment of elevation of the shoulder and hand as well as by decreased strength of the shoulder. There was an extremely high rate of complications, including joint instability, fracture of the allograft, and infection of the allograft. We no longer routinely perform this reconstruction at our institution.

Adolescent↗
PubMed2002

Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

BACKGROUND: Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release. METHODS: A prospective, randomized, multicenter center study was performed on 192 hands in 147 patients. The open method was performed in ninety-five hands in seventy-two patients, and the endoscopic method was performed in ninety-seven hands in seventy-five patients. All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to, or had refused, nonoperative management. Follow-up evaluations with use of validated outcome instruments and quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at two, four, eight, twelve, twenty-six, and fifty-two weeks after the surgery. Complications were identified. The cost of the procedures and the time until return to work were recorded and compared between the groups. RESULTS: During the first three months after surgery, the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores, better Carpal Tunnel Syndrome Functional Status Scores, and better subjective satisfaction scores. During the first three months after surgery, they also had significantly (p < 0.05) greater grip strength, pinch strength, and hand dexterity. The open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work (median, thirty-eight days compared with eighteen days after the endoscopic release). No technical problems with respect to nerve, tendon, or artery injuries were noted in either group. There was no significant difference in the rate of complications or the cost of surgery between the two groups. CONCLUSION: Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome.

Adult↗
PubMed1976

Cognitive style, hemispheric specialization, and tested abilities of transsexuals and nontranssexuals.

Tests on which the 12 males and the 8 male transsexuals differed significantly and might be useful to clinicians for differentiation were the Embedded-figures Test, the Porteus Mazes, and the O'Connor Finger Dexterity Test. Sex differences emerged on the Embedded-figures Test and the first half of the dexterity test. There were no significant differences between 12 males and 14 females or males and 8 transsexuals on conjugate lateral eye movement, eye dominance, Digit Span, and Digit Symbol. Embedded-figures Test appears to tap some aspect of gender identity (males with female identities respond like females) while the first half of the O'Connor taps a biologically determined sex difference (males respond alike whether they have male or female identities).

Cognition↗
PubMed1981

Use of a text of psychomotor ability in an expanded role.

To examine the use of a test of psychomotor ability of disabled persons, a group of 118 persons with permanent impairment of one hand were given the disability rating together with the O'Connor Finger Dexterity Test. Scores showed a substantial correlation of .69 between these two instruments. Scores on the Finger Dexterity Test were strongly correlated to the activities of daily living subscale of the Hand Disability Rating Scale (.88), while rating of disability was not. Age appeared unrelated to either test or disability scores.

Adolescent↗
PubMed1991

Influence of caffeine on selected manual manipulation skills.

To assess the effects of caffeine on selected manual manipulation skills 16 college-age (21 +/- 1.7 yr.) caffeine-naive women (less than 90 mg/day), having avoided products containing caffeine for four days, reported for testing eight hours postprandial. Measurements included duration and frequency of error for hand steadiness, duration and frequency error for following a tracing pattern, and duration of completing a tweezer-pin placement dexterity test. Caffeine doses of either 2.5 or 5.0 mg/kg body weight or a placebo (200 mg. methylcellulose) were administered randomly to all subjects on three separate occasions using a double-blind format. A 2 x 3 repeated-measures analysis of variance and a Newman-Keuls post hoc test yielded a significant difference in hand steadiness error time from pre- to posttest for 5 mg/kg but not for 2.5 mg/kg or the placebo trial. For frequency of hand steadiness error, significant changes occurred for both 5.0 and 2.5 mg/kg. A dose of 5.0 mg/kg group resulted in significant differences in both tracing error time and error frequency. As both doses of caffeine significantly increased dexterity time, it was concluded that caffeine has detrimental effects on selected performance skills of young caffeine-naive women.

Adult↗
PubMed1992

Effect of caffeine on motor performance by caffeine-naive and -familiar subjects.

The purpose of this investigation was to assess the effect of caffeine on selected manipulation skills by caffeine-naive and caffeine-familiar subjects. The subjects were 20 caffeine-naive (less than 90 mg/d) and 20 caffeine-familiar (greater than 750 mg/d) college-age (21 +/- 1.7 yr.) women. Measurements included steadiness error time and frequency, duration of tracing, error time and frequency, and dexterity. Doses of 2.5, 5.0 mg.kg-1 body weight caffeine or a placebo (200 mg. methylcellulose) were administered randomly to all subjects on three separate occasions. A 2 x 3 repeated-measures analysis of variance yielded a significant group difference for steadiness error time between the 5 mg.kg-1 and 2.5 mg.kg-1 dose and between 5 mg.kg-1 and the placebo. For frequency of steadiness errors, the nonuser group posted significant gains for both 5.0 and 2.5 mg.kg-1 over the placebo control. On tracing error time and error frequency, 5.0 mg.kg-1 resulted in significant increases from both 2.5 mg.kg-1 and the placebo group. In the caffeine-naive group, both doses of caffeine led to significant increases in dexterity time from the placebo, and the 5.0 mg.kg-1 dose was significantly different from the 2.5 mg.kg-1 trial. It was concluded that caffeine had detrimental effects on selected performance skills of caffeine-naive women but not in caffeine-familiar women.

Adult↗
PubMed1993

Asymmetries of manual motor response in relation to age, sex, handedness, and occupational activities.

Questions about left- and right-hand asymmetries require the analysis of preference and manual skill with respect to handedness. Hand preference and hand skill were examined in relation to sex, age, and occupational activities. 512 adults from manual, mixed, and intellectual activities and 253 children were tested for their manual preferences and performance. Analysis of variance followed by Scheffé post hoc tests, for right-handed adults, indicated significant effects for occupational activity and sex in dexterity and strength. Manual workers, under technological pressure, seemed more consistent in their manual preferences than their peers. For left-handed persons there were no significant effects. Dexterity and strength were also related to sex and age, suggesting different cultural opportunities for both sexes in relation to motor activities.

Adult↗
PubMed2002

Correlation between tests of attention and performance on grooved and Purdue pegboards in normal subjects.

This study investigated the relation between tests of manual dexterity and attentional functions with 49 normal, right-handed medical students (26 women, 23 men, ages 19-30 years) who were assessed with a Purdue Pegboard Test, Grooved Pegboard Test, and a Test for Attentional Performance, comprising measures of tonic and phasic alertness and divided attention. Weak to moderately high partial correlations controlling for finger size were obtained between pegboard test performance of the left hand and phasic alertness (r = .31-.50). Purdue Pegboard Assembly subtest scores were weakly correlated with divided attention (r = -.39). These findings suggest that attention is an important determinant of performance for manual dexterity tests of the nondominant hand.

Adult↗
PubMed1998

Prehension in man revisited: lesson from the monkey (Macaca fascicularis).

The manus in human is capable of performing intricate movements. To determine whether human dexterity is the result of neuromuscular co-ordination arising from a rich cortical network or due to biomechanical adaptation, the multitendoned extrinsic flexor muscles and intrinsic flexor musculature of the hand were examined in nine human cadavers and compared to those in three macaque monkeys. The flexor pollicis longus was present in all the upper limbs of the human cadavers and absent in all the upper limbs of the monkeys. An accesory origin of the flexor pollicis longus was seen in the upper limb of an Indian cadaver. The opponens pollicis which is possibly the most important intrinsic muscle of the hand was observed to be present in the manus of both human and monkey. Although the macaque monkey lacks a flexor pollicis longus, its digital dexterity has been reported to be equal to man. In this context, it would appear that neural output is the more important factor in prehensile activities.

Aged↗
PubMed1985

Diurnal variation in mood and performance in a time-isolated environment.

In order to document circadian rhythmicity in various psychological functions under the chronobiologically 'pure' condition of temporal isolation, a battery of mood and performance tests were administered about 6 times per day to a heterogeneous group of 18 subjects (ages 19-81, 5 female). Each subject spent about 5 days in temporal isolation, entrained to a routine equivalent to his/her own habitual sleep/wake cycle. Average time of day functions were obtained for the mood and performance variables, and compared to rectal temperature data subjected to exactly the same statistical analysis. Significant time of day effects were found in the mood variables of alertness, sleepiness, weariness, effort required, happiness and well-being. Times of 'best' mood were different from the time of peak temperature. Moreover, the minima of sleepiness, weariness and effort occurred earlier in the day than the maximum of alertness. Significant time of day effects were also found in the speed with which search and dexterity tasks were completed. Only the dexterity tasks showed a complete parallelism with the temperature rhythm.

Adult↗
PubMed1994

The effects of different treatment activities on functional fine motor coordination in adults with brain injury.

OBJECTIVES: Occupational therapists frequently work to improve the fine motor coordination skills of adults who have dexterity deficits secondary to brain injury. Most therapists use a combination of tabletop and functional activities to foster improved coordination in these clients. This study examined the effects of puzzle construction and kitchen activities on fine motor coordination in a group of 45 men with brain injury, as measured by pretest and posttest performance on two subtests of the Jebsen-Taylor Test of Hand Function. METHOD: Subjects were randomly assigned to either a parquetry block assembly group (n = 22) or a meal preparation group (n = 23). RESULTS: Subjects in the functional meal preparation group showed significantly greater improvement in dominant-band dexterity for picking up small objects than subjects in the tabletop puzzle activity group. Other coordination test results were comparable for the two treatment groups. CONCLUSION: These findings suggest that functional activities may be better than tabletop activities for fine motor coordination training with this population.

Adolescent↗
PubMedDate not supplied

Comparison of the test-retest reliability of the Work Box using three administrative methods.

OBJECTIVE: The purpose of this study was to compare the test-retest reliability of three administrative methods of the Work Box: (a) the original instructions, (b) a revised version of the original instructions, and (c) another revised version that was based on suggestions made by authors of the first two versions of the instructions. METHOD: Sixty subjects without disabilities were randomly grouped so that 20 subjects were tested per administrative method. The assessment was administered to each subject on two occasions, with a 7-day to 14-day period between tests. Scores were recorded as time in seconds, and intraclass correlation coefficients (ICCs) were used to calculate the reliability. RESULTS: The ICCs for assembly, disassembly, and total scores were .589, .604, and .654, respectively, for the original instructions; .424, .572, and .545 for the revised instructions; and .781, .579, .717 for the second revised instructions. Reliability was found to be higher for men than for women and for subjects who claimed to have more rather than less experience in similar manual dexterity tasks. CONCLUSIONS: On the basis of the reliability of each administrative method and comments made by subjects about their understanding of the instructions, the second revised version of the instructions is recommended as the standard method. The results also indicate that the assessment is most appropriate for a population of men with manual dexterity experience. With further standardization, the Work Box could be a valuable assessment tool for therapists working in industrial rehabilitation settings.

Adolescent↗
PubMedDate not supplied

Perceptual-motor function of school-age children with slow handwriting speed.

OBJECTIVES: This study investigated differences in perceptual-motor measures and sustained attention between children with slow and normal handwriting speed and the relationship between these factors. METHOD: Thirty-four slow handwriters and 35 normal speed handwriters (7 to 11 years of age) attending elementary schools in Taiwan were given three perceptual-motor tests and a vigilance task to assess sustained attention. Performances on these measures were analyzed using multivariate analysis of variance and regression analyses. RESULTS: A significant difference was found between slow and normal handwriters in upper-limb coordination, visual memory, spatial relation, form constancy, visual sequential memory, figure ground, visual-motor integration, and sustained attention. The three significant predictors of handwriting speed for the slow handwriters were age, visual sequential memory, and visual-motor integration. For the normal speed handwriters, age and upper-limb speed and dexterity were the only two significant predictors. CONCLUSIONS: Slow and normal speed handwriters responded to handwriting demands through different perceptual-motor systems. Whereas upper-limb speed and dexterity seems to play an important role in normal speed handwriters, slow handwriters seem to rely more on visually directed processes, including sequence memory and visual-motor integration.

Child↗