Surgery of the spastic hand in cerebral palsy: report of the Committee on Spastic Hand Evaluation (International Federation of Societies for Surgery of the Hand).
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Cerebral Palsy↗
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Increasing hand efficiency at cold temperatures by training hand vasodilation with a classical conditioning-biofeedback overlap design.
The prolonged exposure of hands to cold environments leads to substantial cold pain and severe deterioration of manual dexterity, finger dexterity, hand strength, and tactile sensitivity. This study taught volunteers to warm their hands at -14 degrees Celsius and measured the hand efficiency effects. The subjects were six male and female nonsmoking volunteers. All research was conducted in a cold chamber during the warm summer months to eliminate seasonal factors. A combined multiple-baseline/ABA single-subject design with multiple replications was used. Each subject's hand performance was obtained for both hands in warm and in cold conditions. One hand was trained and both hands were retested in the cold. The second hand was trained and both hands were retested in the cold. Finally, the subject inhibited warming while in the cold (treatment removal) and both hands were tested again. The treatment itself used biofeedback instrumentation to extend and enlarge previously classically conditioned vasodilative episodes. The procedure was found to be effective for bringing about temperature changes in the cold. Large treatment effects were found on all hand efficiency measures. The results suggest wide implications for the workplace, for theory, and for future research.
Acclimatization↗
Intrinsic hand muscles and digit independence on the preferred and non-preferred hands of humans.
Although the superior dexterity of one hand is an almost ubiquitous human experience, it is unclear which characteristics of the motor system controlling the preferred hand produce this superior dexterity. Between-species studies show that greater dexterity is associated with a motor system that permits more independent movements of the digits. If between-hand dexterity differences are mediated by the same mechanism as between-species dexterity differences, then there should be asymmetries within the corticospinal tracts of humans that would result in between-hand independence differences. The evidence for asymmetries in the corticospinal tracts is sparse, and if an asymmetry does exist, it appears to be limited to the control of intrinsic hand muscles. We wondered, therefore, whether there might be a difference in the degree of independent control on the two hands during performance of a task that primarily uses intrinsic hand muscles. We examined digit individuation when subjects produced abduction or adduction forces with a single digit in isolation. Consistent with previous studies in which forces or movements in single digits were generated primarily by extrinsic hand muscles, we found no difference between the individuation of the digits on the preferred and non-preferred hands. We suggest that whereas independence differences underlie large dexterity differences between species, they do not underlie the more subtle dexterity differences between the preferred and non-preferred hands. Instead, the neural substrate for handedness might be asymmetrical connectivity within M1, with more profuse connections within the dominant than non-dominant M1 imparting a greater potential for excitatory and inhibitory interactions between movement representations which might then result in the more efficient coordination of hand and arm movements of the preferred hand.
Adult↗
Processing biases towards the preferred hand: valid and invalid cueing of left- versus right-hand movements.
A Posner-like paradigm was employed to investigate the effects of valid and invalid cueing of each hand on reaction time, movement time and peak velocity in an aiming task. Given claims of left hemisphere superiority in movement selection and inhibition (and the privileged within-hemisphere access of the right hand to such systems), it was hypothesised that invalidly cueing the left hand (i.e. right-hand movement precued, left-handed movement required by a go signal) would result in increased reaction time relative to invalid right-hand cueing. The hypothesis was not confirmed as reaction times of both hands were slowed equivalently by invalid cueing. Nevertheless, it was found that the movement duration of the left hand was increased substantially by invalid cueing, while the right hand was unaffected on this measure, suggesting a possible intentional rather than attentional difference between the two hands. These results are discussed in terms of a possible asymmetry of intentional processes related to hand movement and the right-hand advantage in movement duration.
Adult↗
Cerebral organization of verbal and motor functions in left-handed and right-handed adults: effects of concurrent verbal tasks on unimanual tapping performance.
Two experiments were conducted to study the interference effects of different concurrent verbal tasks on unimanual single-finger tapping and unimanual sequential finger tapping. Experiment 1 involved 24 right-handed university students. In the dual-task conditions, right-handers showed a greater right-hand than left-hand performance reduction for single-finger tapping, and an equal right-hand and left-hand reduction for sequential tapping. Experiment 2 involved 60 left-handed university students, divided into four groups according to familial sinistrality and writing hand posture. In the dual-task conditions, left-handers showed a greater left-hand than right-hand performance reduction for single-finger tapping, and an equal left-hand and right-hand reduction for sequential finger tapping. A dichotic listening task revealed a left hemispheric dominance for auditory linguistic functioning in most of the left-handers. Familial sinistrality and hand posture, on the whole, did not influence tapping performances. However, these factors influenced the ear asymmetries on the dichotic listening task. It is speculated that, with single-finger tapping, interference only takes place beyond the point of language motor programming, that is to say, at the motor areas and the supplementary motor areas of the cortex.
Adolescent↗
The relationship between serum testosterone and visuomotor learning in hand skill in right-handed young women.
The relationship between serum testosterone level and motor learning in hand skill was studied in right-handed young women. Hand skill was assessed by a peg moving task. Subjects were required to shift 25 pegs from one of two parallel rows to the corresponding holes as fast as possible, first with right and then with left hand. One trial consisted of the time elapsed to move 25 pegs with one hand. Ten trials were performed by each hand. Peg moving times for the right and left hands linearly decreased at each successive trial (visuomotor learning). Subjects were divided into two subgroups as those having serum testosterone concentrations below and above the mean. The right hand skill and its motor learning was found to be better in subjects with low testosterone than those with high testosterone. The left hand skill was better in subjects with low testosterone than those with high testosterone; there was no significant difference in the left-hand learning in subjects with low and high testosterone (parallel regression lines). Motor learning linearly decreased with testosterone for the right hand, not for the left hand. These results seem to be in accord with the testosterone theory of cerebral lateralization (Geschwind & Behan, 1982).
Adolescent↗
[Effects of hand massage and hand holding on the anxiety in patients with local infiltration anesthesia].
PURPOSE: This study was to examine the effects of hand massage and hand holding as nursing interventions on the anxiety in patients with local infiltration anesthesia. METHOD: The design of this study was a nonequivalent, control group, non- synchronized design. The subjects of this study consisted of 15 patients for the hand group, 15 patients for the hand holding group and 17 patients for the control group awaiting surgery in the operation room of a general hospital in Daegu. As an experimental treatment, hand massage was carried out by the Hand Massage Protocol developed by Snyder (1995) and interpreted by Cho (1998) and hand holding developed by Cho (1998). The data were analyzed by SPSS/WIN, T-test, ANOVA, Cronbach's alpha, and the Scheffe test. RESULTS: The hand massage group and hand holding group were more effective than the control group in reducing anxiety, VAS score, systolic blood pressure and pulse rate. CONCLUSION: Hand massage and hand holding are effective nursing interventions that alleviates the psychological and physiological anxiety of patients with local infiltration anesthesia. In particular, the simple contact of hand holding is regarded as an effective and easily accessible nursing intervention in the operating room.
Adolescent↗
Osteoarthritis in the hand: a comparison of handedness and hand use.
Osteoarthritis (OA) of the hand has been suggested to be the result of "wear" and "tear." If so, OA should develop more frequently in the dominant hand. We compared dominant with nondominant hands of 134 consecutive community subjects aged 53-75 by questionnaire, radiographs of hands, and rheumatologic evaluation. Mean age was 60 years, 93% were right handed, and 95% were in occupations classified as nonphysical. Subjects estimated dominant hand use of 2-10 times the amount of the nondominant hand. OA was found in 133 of 134 subjects. No radiologic or clinical differences were found between the dominant and nondominant hands. Twenty-six subjects who self-reported heavier lifetime hand use had somewhat greater clinical and hand radiographic OA scores than the 36 subjects reporting lighter hand use (43.5 vs 34.5) (p less than 0.01). In our study population, OA was not more prevalent in the dominant hand.
Aged↗
Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Alcohols↗
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Alcohols↗
Left-hand dominance and hand trauma.
To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%. The left-handed were more likely to have an amputating injury of their dominant hand than were the right-handed (70% compared with 51%, respectively). The most common mechanism of amputating injury was by power saw. The present data suggest that left-handed individuals have a relative risk of sustaining an amputating injury that is 4.9 times greater than the right-handed individuals, while minor hand trauma occurs at rates proportional to the distribution of left handedness within the population. Additional safety measures and the redesigning of tools, assembly lines, and workstations are recommended to help decrease the incidence of serious hand injury among left-handed individuals.
Accidents, Occupational↗
Transparency of one-handed Amer-Ind hand signals to nonfamiliar viewers.
Thirty non-brain-damaged adults viewed 104 videotaped Amer-Ind hand signals. The majority of these hand signals were produced with one hand; 60 originally one-handed gestures and 31 left-hand adaptations of two-handed gestures were included in the data analyses. Nineteen subjects were between the ages of 20 and 30 years (younger group), and 11 subjects were between the ages of 50 and 69 years (older group). After viewing each hand signal twice in succession, the subjects wrote at least one word for that signal's meaning. The mean percentage of one-handed signals correctly identified was 48.2%; these signals varied widely in transparency (0% to 100%). The left-hand adaptations were significantly lower in transparency than the originally one-handed signals. The younger and older subjects did not differ in the mean percentage of one-handed signals they identified correctly (49.0% and 46.4%, respectively). However, some individual hand signals were easier for the younger subjects to identify; the opposite was also true.
Adult↗
Let not thy left hand know what thy right hand knoweth. The case of a patient with an infarct involving the callosal pathways.
Following a cerebral vascular accident, a patient showed a classical disconnection syndrome: left-hand tactile anomia, apraxia and dysgraphia and right-hand constructional apraxia. What made the case unusual was the presence of hand asymmetry in the performance of some matching-to-sample tasks carried out in foveal vision. The left hand committed significantly more errors than the right hand when it was not possible to identify on a perceptual basis the stimulus that was to be matched, because it was removed (memory condition) or was indicated verbally (verbo-visual matching), or had the same name but not the same physical appearance as the match (capital and lower-case letter matching). No hand difference emerged when the stimulus remained in full view throughout the matching task (perceptual condition). The hand effect, however, was limited to colours and letters. Objects, geometrical shapes and unfamiliar faces were matched with equal proficiency by both hands under every condition of presentation. Left-hand errors also significantly outnumbered right-hand errors in sorting colours according to hue and colouring drawings. MRI showed an infarct in the left cingulate white matter that ran parallel to the trunk of the corpus callosum, and an infarct of the splenium. However, the latter did not prevent the transmission of colour and letter information between the two hemispheres, as shown by the performance on perceptual equivalence tasks and by the correct right-hand responses to stimuli projected to the left visual field. We propose that this pattern of deficit is contingent upon the specific role that the left hemisphere plays in categorizing a given colour patch as belonging to a definite colour region (red, blue, etc.) and in grapheme recognition. Without the assistance of the left side the right hemisphere lacks the benefit provided by meaning identification. In our patient the left brain did receive information from the right brain and was able to process it, but was prevented by the paracallosal lesion from transmitting what it knew to the right motor area. No hand effect emerged for objects and geometrical shapes, because their semantic memory is bilaterally represented.
Aged↗
Contributions of the right and left brains to manual asymmetry in hand skill in right-handed normal subjects.
The relation of intermanual difference in hand skill to cerebral lateralization was studied in right-handed male and female subjects. Hand preference was assessed by the Edinburgh Handedness Inventory. Hand skill was measured by the peg moving task. In subjects with familial sinistrality (FS+), the mean right hand peg moving times (PMTs) were found to be significantly and negatively linearly correlated with the mean left minus right (L - R) hand PMTs in females (no correlation in males). Contrarily, there was a direct relationship between the mean L - R hand PMTs and the mean left hand PMTs in FS+ males (no correlation in FS+ females). Similar results were obtained with the FS- subjects. The correlations were modified by eye and foot preferences. The overall results suggested that generally the right brain in males and the left brain in females are of importance in determining the intermanual difference in hand skill; an insufficient right brain (a slower left hand) in males and a sufficient left brain (a faster right hand) in females would create a more asymmetrical organization in skill between hands.
Adult↗
Recovery of hand grip strength and hand steadiness after exhausting manual stretcher carriage.
Rescue activities frequently require not only substantial and sustained hand-grip forces but also a subtle coordination of hand and finger muscles, e.g. when manipulating injection syringes after manual stretcher carriage. We investigated the recovery kinetics of manual coordination and muscle strength after exhausting stretcher carriage (4.5 km/h, load at each handle bar: 25 kg). Hand steadiness (frequency and duration of wall contacts when holding a metal pin into a small bore) and parameters of hand-grip strength were determined in 15 male volunteers before and immediately after the stretcher carriage. Measurements were repeated after 0.5, 1, 4 and 24 h of recovery. Mean carrying time was 215+/-87 s (SD), mean transport distance amounted to 264+/-104 m. During the carriage test, forces at the stretcher handles oscillated in the order of +/-50 N within each gait cycle. Immediately after exhaustion, hand steadiness was significantly deteriorated (threefold increase in frequency and duration of wall contacts), maximum and mean hand-grip force over 15 s were reduced by almost 20%. While the recovery of hand steadiness was complete by minute 30 after stretcher carriage, a significant reduction in maximum and mean hand-grip force by 12% could still be observed after 24 h. The present findings demonstrate that hand steadiness recovers much faster than maximum hand-grip strength after exhaustive manual stretcher carriage (less than 30 min vs. more than 24 h). Probably, muscle damage induced in particular by the eccentric components during stretcher transport seems to affect only the generation of large forces. By contrast, the generation and coordination of the much lower forces required for hand-steadiness appears to be impaired only during the short transient of metabolic recovery.
Adult↗
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Alcohols↗
Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital.
We determined risk factors for hand contamination and compared the efficacy of 3 randomly allocated hand hygiene agents in a group of surgical intensive care unit nurses. We cultured samples of one of the subjects' hands before and samples of the other hand after hand hygiene was performed. Ring wearing was associated with 10-fold higher median skin organism counts; contamination with Staphylococcus aureus, gram-negative bacilli, or Candida species; and a stepwise increased risk of contamination with any transient organism as the number of rings worn increased (odds ratio [OR] for 1 ring worn, 2.6; OR for >1 ring worn, 4.6). Compared with use of plain soap and water, hand contamination with any transient organism was significantly less likely after use of an alcohol-based hand rub (OR, 0.3; 95% confidence interval [CI], 0.1-0.8) but not after use of a medicated hand wipe (OR, 0.9; 95% CI, 0.5-1.6). Ring wearing increased the frequency of hand contamination with potential nosocomial pathogens. Use of an alcohol-based hand rub resulted in significantly less frequent hand contamination.
Alcohols↗
Monkey hand postural synergies during reach-to-grasp in the absence of vision of the hand and object.
Understanding how the CNS controls reach-to-grasp will require behavioral and neurophysiological studies of reach-to-grasp in the monkey, including the evaluation of whole-hand grasp with explicit force requirements. In this study, monkeys performed a reach-to-grasp task in which the size, shape, and orientation of the objects were varied. The monkeys were required to grasp each object at five force levels based on visual feedback. Seventeen positions on the wrist and hand were monitored to quantify kinematics. Hand shaping began with initiation of reach and continued throughout the reach, matching object properties even without vision of the hand or object. Grasp aperture scaled to object size. Singular value decomposition analysis of the marker positions identified two dominant hand postures. The first eigenvector or "eigenposture" consisted of an open hand configuration midway between flexion and extension that explained >93% of the variance. The second eigenposture consisted of hyperextension of all joints that accounted for another 4-5% of the variance. The two eigenpostures were similar across force levels and between monkeys. Reach kinematics consisted of a U-shaped hand path with a bell-shaped velocity profile. Trajectory and speed were independent of grasp force and object properties. In summary, hand shaping during the reach occurred without vision of the hand or object, and hand kinematics were not dependent on grasp force. Furthermore, the reach was independent of grasp force and object properties. These observations imply that the kinematics of reach-to-grasp and grasp force are controlled independently. Similar to humans, monkeys may use a simplifying strategy to reduce the degrees of freedom of the hand during reach-to-grasp.
Animals↗