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PubMed2001

[Value of several examination systems in patients with carpal tunnel syndrome. Comparison of Dellon computer-assisted sensation test with Mellesi hand status and Levine examination scheme].

The goal of the presented carpal tunnel syndrome (CTS) follow-up study was to compare the clinical value of the Millesi hand function score with the "Pressure Specifying Sensory Device" (PSSD) introduced by A. L. Dellon using self-administered patient questionnaires. 25 patients (10 male, 15 female) with an electrodiagnostically confirmed CTS were enrolled in this study, performing one preoperative and five postoperative examinations over 24 weeks. 12 of the 25 patients underwent an "open" two-portal carpal tunnel release with two minimal incisions (group OT); the other 13 patients were treated with a two-portal endoscopic carpal tunnel release (group ET). Additionally, in eleven out of the twelve patients of group OT, an epineuriotomy of the median nerve was performed during the same session. Concerning preoperative data of the Millesi score and the PSSD, no statistically significant differences were found between group OT and ET. However, preoperative comparison with the contralateral hand demonstrated a reduction in hand function of 15% and an increase in the pressure perception threshold of 41% compared to normative data could be measured with the PSSD. The subjective functional value of the hand was objectively evacuated using the Levine score. In the second postoperative week, a significant decrease in hand function could be obtained with the Millesi score in group OT. In group ET, the decrease in hand function representing the operative trauma was significantly lower than in group OT. Data of the static one- and two-point pressure perception threshold revealed a statistically significant improvement of the sensibility in both groups. The results of the Millesi score recorded at the last examination in the 24th postoperative week showed an improvement in hand function in both groups compared to preoperative data. Concerning static one- and two-point measurements with the PSSD, distinct improvements compared to the preoperative data could also be detected in both groups although significant differences between group OT and ET were evident: Data of group OT regarding the whole postoperative course demonstrate a continuous improvement in sensibility of the index finger. In contrast, the analysis of the PSSD measurements in group ET revealed an increase in all the parameters starting in the sixth postoperative week and ending with significantly worse static one- and two-point threshold measurements than in group OT. On the other hand, data of self-administered patient questionnaires using the Levine Score revealed significant improvements in hand function and reduction in pain intensity in both groups compared to preoperative results. Differences between both groups at the end of the examination course were not evident. In conclusion, the Millesi hand score with its emphasis on the motor function proved to be a reliable method to record the severity of CTS preoperatively, the severity of the surgical trauma and changes in the course of rehabilitation of the affected hand. A good correlation was found between data obtained with the Millesi Score and the self-administered patient questionnaires according to Levine. But when compared with the PSSD, both methods could not directly document the preoperative status and postoperative changes of the median nerve. Preoperative static two-point pressure threshold measurements with the PSSD confirmed their status as a screening parameter as published by A. L. Dellon. In the postoperative course of group ET, a distinct worsening in the sensibility of the index and little finger could only be detected with the PSSD before the patients noticed the onset of related symptoms.

Adult↗
PubMed2003

State-of-the-art hand hygiene in community medicine.

Hand hygiene becomes more important in community medicine not only since antibiotic resistant bacteria such as MRSA spread within the community. Hands may be colonized with transient microorganism in up to 75%. Among those transient pathogens S. aureus, C. difficile or the hepatitis C virus may be found. During patient care the number of microorganisms on the hands steadily increases. In addition hands may be contaminated with different kinds of germs even if only "clean" activities are carried out. Gloves may be worn but do not provide complete protection from contamination due to leaks. Therefore hands should always be treated after gloves are taken off. State-of-the-art treatment of hands is the hygienic hand disinfection with alcohol-based hand rubs. They are more effective, quicker to carry out, better tolerated by the skin, with a positive effect on compliance, and cost effective in comparison to antiseptic soaps based on chlorhexidine or triclosan and in comparison to normal non-medicated soaps. Healthy skin easily tolerates alcohol-based products from the beginning on. Only health care workers with an underlying irritative contact dermatitis which is often caused by bar or liquid antiseptic soaps may have difficulties to use alcohol-based products initially. In such a case treatment of the underlying skin condition is the way to go and not staying with a preparation which has caused the dermatitis. All this knowledge is now reflected in current guidelines on hand hygiene. Beside liquids alcohol-based gels can be used if they have an antimicrobial activity equal to alcohol-based liquid preparations. Hand hygiene remains the single most important tool to avoid cross transmission of microorganisms between patients. This state-of-the-art hand hygiene should also be emphasized more in community medicine. This review may help to go the first step into this direction.

Alcohols↗
PubMed2003

Pantomime to visual presentation of objects: left hand dyspraxia in patients with complete callosotomy.

Investigations of left hand praxis in imitation and object use in patients with callosal disconnection have yielded divergent results, inducing a debate between two theoretical positions. Whereas Liepmann suggested that the left hemisphere is motor dominant, others maintain that both hemispheres have equal motor competences and propose that left hand apraxia in patients with callosal disconnection is secondary to left hemispheric specialization for language or other task modalities. The present study aims to gain further insight into the motor competence of the right hemisphere by investigating pantomime of object use in split-brain patients. Three patients with complete callosotomy and, as control groups, five patients with partial callosotomy and nine healthy subjects were examined for their ability to pantomime object use to visual object presentation and demonstrate object manipulation. In each condition, 11 objects were presented to the subjects who pantomimed or demonstrated the object use with either hand. In addition, six object pairs were presented to test bimanual coordination. Two independent raters evaluated the videotaped movement demonstrations. While object use demonstrations were perfect in all three groups, the split-brain patients displayed apraxic errors only with their left hands in the pantomime condition. The movement analysis of concept and execution errors included the examination of ipsilateral versus contralateral motor control. As the right hand/left hemisphere performances demonstrated retrieval of the correct movement concepts, concept errors by the left hand were taken as evidence for right hemisphere control. Several types of execution errors reflected a lack of distal motor control indicating the use of ipsilateral pathways. While one split-brain patient controlled his left hand predominantly by ipsilateral pathways in the pantomime condition, the error profile in the other two split-brain patients suggested that the right hemisphere controlled their left hands. In the object use condition, in all three split-brain patients fine-graded distal movements in the left hand indicated right hemispheric control. Our data show left hand apraxia in split-brain patients is not limited to verbal commands, but also occurs in pantomime to visual presentation of objects. As the demonstration with object in hand was unimpaired in either hand, both hemispheres must contain movement concepts for object use. However, the disconnected right hemisphere is impaired in retrieving the movement concept in response to visual object presentation, presumably because of a deficit in associating perceptual object representation with the movement concepts.

Adult↗
PubMed2005

Fifteen-year follow-up of hand eczema: persistence and consequences.

BACKGROUND: Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown. OBJECTIVES: The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease. METHODS: In a 15-year follow-up of hand eczema, patients diagnosed in a previous population-based study were sent a questionnaire with 20 questions concerning the persistence and course of the disease, and its occupational and medicosocial consequences. RESULTS: Addresses were available for 1115 persons, of whom 868 answered the questionnaire. Sixty-six per cent of the respondents reported periods of hand eczema and 44% reported symptoms during the previous year, with no sex difference. Twelve per cent reported continuous eczema. However, 74% of those reporting symptoms considered that their hand eczema had improved; of these more were women than men (78% vs. 66%, P < 0.01). Twenty people, 3% of those who were gainfully employed in 1983, reported a change to another occupation because of their hand eczema, 15 of these reporting improvement after the job change. A considerable need for medical consultation was reported, as was the influence on psychosocial functions among those who had eczema the previous year, e.g. sleep disturbances (36%) and hampered leisure activities (72%). Job changes related to hand eczema and psychosocial impairment were also reported by individuals who had not sought medical help for their hand eczema. CONCLUSIONS: This study demonstrates a variable and poor long-term prognosis for hand eczema in the general population. One-third sought medical care during follow-up, while the vast majority with ongoing hand eczema experienced negative psychosocial consequences. For about 5%, the hand eczema gave far-reaching consequences including long sick-leave periods, sick pension and changes of occupation.

Activities of Daily Living↗
PubMed2006

Problems in the coupling of eye and hand in the sequential movements of children with Developmental Coordination Disorder.

BACKGROUND: Shifting gaze and attention ahead of the hand is a natural component in the performance of skilled manual actions. Very few studies have examined the precise co-ordination between the eye and hand in children with Developmental Coordination Disorder (DCD). METHODS: This study directly assessed the maturity of eye-hand co-ordination in children with DCD. A double-step pointing task was used to investigate the coupling of the eye and hand in 7-year-old children with and without DCD. Sequential targets were presented on a computer screen, and eye and hand movements were recorded simultaneously. RESULTS: There were no differences between typically developing (TD) and DCD groups when completing fast single-target tasks. There were very few differences in the completion of the first movement in the double-step tasks, but differences did occur during the second sequential movement. One factor appeared to be the propensity for the DCD children to delay their hand movement until some period after the eye had landed on the target. This resulted in a marked increase in eye-hand lead during the second movement, disrupting the close coupling and leading to a slower and less accurate hand movement among children with DCD. CONCLUSIONS: In contrast to skilled adults, both groups of children preferred to foveate the target prior to initiating a hand movement if time allowed. The TD children, however, were more able to reduce this foveation period and shift towards a feedforward mode of control for hand movements. The children with DCD persevered with a look-then-move strategy, which led to an increase in error. For the group of DCD children in this study, there was no evidence of a problem in speed or accuracy of simple movements, but there was a difficulty in concatenating the sequential shifts of gaze and hand required for the completion of everyday tasks or typical assessment items.

Child↗
PubMed2006

Rhythmic coordination of hand and foot in children with Developmental Coordination Disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) have difficulties producing stable rhythmic bimanual coordination patterns in comparison with age-related peers. Rhythmic coordination of non-homologous limbs (e.g. hand and foot) is even more difficult to perform because of mechanical differences between the limbs. The aim of the present study is to investigate the stability of hand-foot coordination patterns of children with DCD. METHODS: Ten children with DCD (mean age 7.0 years, SD 1.1 years) and 16 control children (mean age 7.4 years, SD 1.3 years) participated in the study. They were asked to perform in-phase or anti-phase tapping movements in three different interlimb coordination combinations: (1) hand-hand (homologous), (2) hand-foot same body side (ipsilateral), and (3) hand-foot different body side (contralateral). Coordination stability was measured by the variability of the relative phase between the limbs under a 'steady state' (preferred) frequency condition, and by the critical frequency (i.e. the point at which loss of pattern stability was observed) in a condition in which the movement frequency was 'scaled' up (only anti-phase tapping). RESULTS: Coordination patterns of children in the DCD group were less stable in all three limb combinations compared with controls. Further, hand-foot coordination patterns were less stable than hand-hand coordination patterns. With regard to hand-foot coordination, ipsilateral patterns were equally stable compared with contralateral patterns in the in-phase task, but less stable in the anti-phase task. No differential effects were found between the DCD and control groups across the different limb combinations, except for steady-state anti-phase coordination in the ipsilateral limb condition. This effect was due to a relatively good performance of the control children in this condition in comparison with the other limb combination conditions. CONCLUSIONS: Children with DCD have difficulties producing stable rhythmic hand-foot coordination patterns compared with control children.

Child↗
PubMed2006

No evidence for a substantial involvement of primary motor hand area in handedness judgements: a transcranial magnetic stimulation study.

Twelve right-handed volunteers were asked to judge the laterality of a hand stimulus by pressing a button with one of their toes. Judgements were based on two-dimensional drawings of the back or palm of a right or left hand at various orientations. Suprathreshold single-pulse transcranial magnetic stimulation (TMS) was given to the left primary motor hand area (M1-HAND) at 0, 200, 400, 600, 800 or 1000 ms after stimulus onset to probe the functional involvement of the dominant left M1 at various stages of handedness recognition. We found that mean reaction times and error rates increased with angle of rotation depending on the actual biomechanical constraints of the hand but suprathreshold TMS had no influence on task performance regardless of the timing of TMS. However, the excitability of the corticomotor output from the left M1-HAND was modulated during the reaction. Judging left hand drawings was associated with an attenuation of motor-evoked potentials 300-100 ms before the response, whereas judging right hand drawings facilitated the motor-evoked potentials only immediately before the response. These effects were the same for pictures of backs and palms and were independent of the angle of rotation. The failure of TMS to affect task performance suggests that there is no time window during which the M1-HAND makes a critical contribution to mental rotation of the hand. The modulation of motor-evoked potentials according to the laterality of the stimulus indicates a secondary effect of the task on corticomotor excitability that is not directly related to mental rotation itself.

Adult↗
PubMed1981

Functional properties of monkey motor cortex neurones receiving afferent input from the hand and fingers.

1. Records have been made from area 4 of the cerebral cortex in five conscious monkeys. The properties of 216 neurones responsive to natural stimulation of the hand and fingers have been investigated.2. 46% of these neurones responded only to cutaneous stimulation (especially light brushing across the glabrous skin) and a further 38% responded only to movement of the digits. 4% responded to brief prods of the hand. 12% of the sample responded to more than one stimulus modality.3. Many hand-input neurones, including pyramidal tract neurones, responded at short-latency (8-15 msec) to light mechanical stimulation of the hand and to weak electrical stimulation of the median nerve.4. Responsive neurones were found at all depths of the cortical grey matter. Responses of shortest latency were encountered in neurones probably located in layers IV and V.5. The behaviour of eighty hand-input neurones was analysed during a simple, stereotyped task which involved pulling a lever and collecting a food reward from a small well. For comparison, the activity of 117 neurones with inputs from the wrist, elbow or shoulder was also analysed.6. Nearly all hand-input neurones modulated their activity either before (48/80) or during (29/80) the retrieval of the reward which required precision grip between index finger and thumb. Many were silent during proximal arm movements and some displayed activity patterns independent of these movements.7. By contrast, the activity of many neurones with proximal arm (elbow, shoulder) inputs was unrelated to food retrieval and manipulation, but well related to arm movements.8. Forty-three of the eighty neurones had cutaneous input from the hand. Twenty-seven were active before hand contact. Thirty-five modulated their discharge when contact was made (twenty-one excitation, fourteen inhibition).9. Most hand-input neurones were more active during fractionated movements of the hand or fingers than during power or ball grips requiring simultaneous flexion of all digits. Neurones with glabrous inputs often showed intense activity during small, precise finger movements and during active tactile exploration without the aid of vision.10. Analysis of the discharge frequency of twenty-five hand-input neurones revealed that some (mainly non-pyramidal tract neurones) had a similar mean frequency and range of modulation during both active movement and passive stimulation. Others (mainly pyramidal tract neurones) had a greater frequency range and higher mean frequency during active than during passive movements.

Action Potentials↗
PubMed2002

Anticipatory control of hand and eye movements in humans during oculo-manual tracking.

Anticipatory activity of hand and eye has been examined during oculo-manual tracking of a constant velocity visual target with a hand cursor. Both target and cursor were presented briefly (< 480 ms), but repeatedly, at regular inter-stimulus intervals (ISI). In Expt 1, the build-up of hand and eye responses was examined for target velocities varying from 10-40 deg x s(-1) with an ISI of 2.4 s. The velocity 100 ms after target onset (i.e. prior to visual feedback) for both hand and eye (V100) progressively increased over the first four presentations but then attained a steady state (SS). SS V100 values for eye and hand increased in proportion to target velocity and were thus predictive of forthcoming movement. Hand velocity exceeded eye velocity but both exhibited similar anticipatory trajectories. In Expt 2, target velocity was constant (40 deg x s(-1)) but ISI varied from 0.48-3.74 s. Subjects made anticipatory eye movements for all ISIs but hand movements were often reactive at the longest ISI. If the target failed to appear as expected, subjects initiated predictive hand and eye responses with timing appropriate for the prevailing ISI. In Expt 3, predictive responses were compared with responses to randomised presentation. Peak hand velocity was greater in the randomised mode than in the predictive condition, whereas the converse was true for peak eye velocity. This difference is discussed in terms of the mechanisms of positional error correction in hand and eye. Results provide evidence of similar anticipatory mechanisms in hand and eye, using storage of velocity and timing to achieve rapid prediction of target motion.

Adult↗
PubMed1986

Efficacy of alcohol-based hand rinses under frequent-use conditions.

Fifty volunteers randomly assigned to one of five hand washing agents (10 subjects per agent)--a nonantiseptic liquid soap (control), an antiseptic hand rinse containing 60% isopropyl alcohol (IPA) with emollients (Alc A), an antiseptic hand rinse containing 70% IPA and 0.5% chlorhexidine gluconate with emollients (Alc B), an antiseptic containing 4% chlorhexidine gluconate and 4% IPA (CHG), and 70% IPA--washed their hands 15 times per day for 5 days under supervision by using a standardized technique and measured amounts of test agent. Microbiologic samples of hand flora were obtained at base line and after hand washes 1 and 15 on test days 1 and 5. After the initial hand wash there were significant reductions over base line in aerobic and anaerobic log CFU among those using Alc A, CHG, and IPA. By the end of the first day of hand washing (15 washes), there were 2-log or greater reductions in aerobic counts among subjects using all antiseptics, but no significant reductions in controls. By the end of day 5, all agents produced significant reductions in aerobic (P = 0.0002) and anaerobic (P = 0.002) counts over control soap. Subject assessment of effects of hand washing on the skin and overall satisfaction varied significantly by product (P = 0.04 and 0.05, respectively). We conclude that alcohol-based hand rinses are highly efficacious, and such products are recommended as a health care personnel hand wash, particularly when sink and running water are inaccessible.

1-Propanol↗
PubMed2004

Hand cortical bone mass and its associations with radiographic joint damage and fractures in 50-70 year old female patients with rheumatoid arthritis: cross sectional Oslo-Truro-Amsterdam (OSTRA) collaborative study.

OBJECTIVE: To investigate the relationship between hand bone mineral density (BMD) and radiographic joint damage, and between hand BMD and fractures in 50-70 year old women with longstanding RA. METHODS: Demographic, clinical data, and imaging data on hand radiographs and Genants vertebral deformity score on spine radiographs were collected from 135 women with RA of > or =5 years, recruited from three European rheumatology clinics. Metacarpal hand BMD was measured by digital hand x ray radiogrammetry (DXR), and hip and lumbar spine BMD by dual x ray absorptiometry (DXA). Multiple regression analyses were used to examine associations between hand BMD and radiographic joint damage, and hand BMD and fractures. RESULTS: Hand BMD was strongly and independently associated with radiographic hand joint damage in a linear regression model adjusted for age, centre, BMI, disease duration, RF, 18 deformed joint count, ESR, and femoral neck BMD. In a multivariate logistic regression model adjusted for relevant variables, hand BMD and femoral neck BMD, but not spine BMD, were independently associated with vertebral deformities and with non-vertebral fractures. CONCLUSION: BMD measured by DXR on conventional hand radiographs in patients with RA may potentially be used as an indicator of joint damage and of vertebral and non-vertebral fracture risk.

Absorptiometry, Photon↗
PubMed1992

Topographic reorganization of the hand representation in cortical area 3b owl monkeys trained in a frequency-discrimination task.

1. Adult owl monkeys were trained to detect differences in the frequency of a tactile flutter-vibration stimulus above a 20-Hz standard. All stimuli were delivered to a constant skin site restricted to a small part of a segment of one finger. The frequency-difference discrimination performance of all but one of these monkeys improved progressively with training. 2. The distributed responses of cortical neurons ("maps") of the hand surfaces were defined in detail in somatosensory cortical area 3b. Representations of trained hands were compared with those of the opposite, untrained hand, and to the area 3b representations of hands in a second set of monkeys that were stimulated tactually in the same manner while these monkeys were attending to auditory stimuli (passive stimulation controls). 3. The cortical representations of the trained hands were substantially more complex in topographic detail than the representations of unstimulated hands or of passively stimulated control hands. 4. In all well-trained monkeys the representations of the restricted skin location trained in the behavioral task were significantly (1.5 to greater than 3 times) greater in area than were the representations of equivalent skin locations on control digits. However, the overall extents of the representations of behaviorally stimulated fingers were not larger than those of control fingers in the same hemisphere, or in opposite hemisphere controls. 5. The receptive fields representing the trained skin were significantly larger than receptive fields representing control digits in all but one trained monkey. The largest receptive fields were centered in the zone of representation of the behaviorally engaged skin, but they were not limited to it. Large receptive fields were recorded in a 1- to 2-mm-wide zone in the area 3b maps of trained hands. 6. Receptive-field sizes were also statistically significantly larger on at least one adjacent, untrained digit when compared with the receptive fields recorded on the homologous digit of the opposite hand. 7. There was an increase in the percent overlaps of receptive fields in the cortical zone of representation of the trained skin. A significant number of receptive fields were centered on the behaviorally trained skin site. 8. The effects of increased topographic complexity, increased representation of the trained skin location, increased receptive-field size, and increased receptive-field overlap were not observed in the representations of the untrained hands in these same monkeys. Only modest increases in topographic complexity were recorded in the representations of passively stimulated hands, and no effects on receptive-field size or overlap were noted.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1997

Systematic changes in directional tuning of motor cortex cell activity with hand location in the workspace during generation of static isometric forces in constant spatial directions.

We examined the activity of 46 proximal-arm-related cells in the primary motor cortex (MI) during a task in which a monkey uses the arm to exert isometric forces at the hand in constant spatial directions while the hand is in one of nine different spatial locations on a plane. The discharge rate of all 46 cells was significantly affected by both hand location and by the direction of static force during the final static-force phase of the task. In addition, all cells showed a significant interaction between force direction and hand location. That is, there was a significant modulation in the relationship between cell activity and the direction of exerted force as a function of hand location. For many cells, this modulation was expressed in part as a systematic arclike shift in the cell's directional tuning at the different hand locations, even though the direction of static force output at the hand remained constant. These effects of hand location in the workspace indicate that the discharge of single MI cells does not covary exclusively with the level and direction of force output at the hand. Sixteen proximal-arm-related muscles showed similar effects in the task, reflecting their dependence on various mechanical factors that varied with hand location. The parallel changes found for both MI cell activity and muscle activity for static force production at different hand locations are further evidence that MI contributes to the transformation between extrinsic and intrinsic representations of limb movement.

Analysis of Variance↗
PubMed2005

Reduction of the hand representation in the ipsilateral primary motor cortex following unilateral section of the corticospinal tract at cervical level in monkeys.

BACKGROUND: After sub-total hemi-section of cervical cord at level C7/C8 in monkeys, the ipsilesional hand exhibited a paralysis for a couple of weeks, followed by incomplete recovery of manual dexterity, reaching a plateau after 40-50 days. Recently, we demonstrated that the level of the plateau was related to the size of the lesion and that progressive plastic changes of the motor map in the contralesional motor cortex, particularly the hand representation, took place following a comparable time course. The goal of the present study was to assess, in three macaque monkeys, whether the hand representation in the ipsilesional primary motor cortex (M1) was also affected by the cervical hemi-section. RESULTS: Unexpectedly, based on the minor contribution of the ipsilesional hemisphere to the transected corticospinal (CS) tract, a considerable reduction of the hand representation was also observed in the ipsilesional M1. Mapping control experiments ruled out the possibility that changes of motor maps are due to variability of the intracortical microstimulation mapping technique. The extent of the size reduction of the hand area was nearly as large as in the contralesional hemisphere in two of the three monkeys. In the third monkey, it represented a reduction by a factor of half the change observed in the contralesional hemisphere. Although the hand representation was modified in the ipsilesional hemisphere, such changes were not correlated with a contribution of this hemisphere to the incomplete recovery of the manual dexterity for the hand affected by the lesion, as demonstrated by reversible inactivation experiments (in contrast to the contralesional hemisphere). Moreover, despite the size reduction of M1 hand area in the ipsilesional hemisphere, no deficit of manual dexterity for the hand opposite to the cervical hemi-section was detected. CONCLUSION: After cervical hemi-section, the ipsilesional motor cortex exhibited substantial reduction of the hand representation, whose extent did not match the small number of axotomized CS neurons. We hypothesized that the paradoxical reduction of hand representation in the ipsilesional hemisphere is secondary to the changes taking place in the contralesional hemisphere, possibly corresponding to postural adjustments and/or re-establishing a balance between the two hemispheres.

Animals↗
PubMed1999

Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.

STUDY OBJECTIVE: To evaluate the effectiveness of warning labels permanently attached to mechanical ventilators in improving the practice of hand washing and use of gloves by respiratory care practitioners (RCPs) in the ICU. DESIGN: The study consisted of two 4-week periods. Daily observations of hand washing and use of gloves by RCPs were made over four 1-h observation periods. Prior to the first 4-week period, the importance of hand washing and use of gloves was presented to all staff. At the end of the first period, "Wash Hands Use Gloves" labels were permanently placed on all ventilators in the ICU. The RCPs were not aware they were being observed for hand washing and use of gloves in either period. MEASUREMENTS AND RESULTS: The total number of encounters between the RCPs and patients as well as the rates of hand washing and use of gloves were obtained during the study. The rates of hand washing and use of gloves were significantly higher during the second period when labels were attached to the ventilators, as compared to the rates during the first period: hand washing, 92% vs 46% (p < 0.05); use of gloves, 92% vs 43% (p < 0.05), respectively. During the first period, the rates of pre-encounter hand washing (78%, 48%, 27%, and 29% in weeks 1 through 4, respectively) and the use of gloves (56%, 37%, 32%, and 45% in weeks 1 through 4, respectively) were primarily declining. This was not observed during the second period of the study (94%, 88%, 95%, and 92% in weeks 1 through 4, respectively) for the rates of pre-encounter hand washing and the use of gloves. CONCLUSIONS: Simple measures such as the placement of warning labels on mechanical ventilators can significantly improve hand washing and use of gloves by RCPs in the ICU.

Allied Health Personnel↗
PubMed2006

Somatic sensation of hand-object interactive movement is associated with activity in the left inferior parietal cortex.

Manipulation of objects and tool-use are known to be controlled by a network of frontal motor and parietal areas. Here, we investigate which of these areas are associated with the somatic sensation of hand-object interactive movement using functional magnetic resonance imaging. To dissociate the sensation of movement from the motor control commands, we used a new kinesthetic illusion. Twelve blindfolded right-handed participants placed the palm of their right or left hand on an object (a ball). Simultaneously, we vibrated the tendon of the wrist extensor muscle. This elicited the illusion that the wrist is flexing and the touched object is also moving along with the hand (hand-object illusion). As controls, we vibrated the skin surface over the nearby bone, which does not elicit any illusions, or we vibrated the tendon when the hand did not touch the object, which only generates the illusory flexion of the hand. We found that the hand-object illusion specifically activated the left inferior parietal lobule (IPL) (supramarginal gyrus and parietal operculum, including cytoarchitectonic areas ip1 and op1) and area 44. The left IPL was activated both during the hand-object illusions with the right and left hands, and the activity was greater than in the right corresponding parietal region, suggesting a dominant role of the left hemisphere. We conclude that the left IPL is involved in the somatic perception of hand-object interactive movement and suggest that the underlying mechanism is the somatic integration of internal information about the body and external information about the object.

Adult↗
PubMed2006

Dynamic movement of center of gravity with hand grip.

We studied the movement of center of gravity (CG) in young and aged subjects during maximum grip of right or left hand. Body-sway was recorded with stabilometry in rest-stand position and in maximum grip. The data from right-or left-handed young subjects were analyzed. Maximum grip power was not different between dominant hand and un-dominant hands. Total length (LNG) and total movement area of CG (REC AREA) during the measurements were significantly larger in maximum grip than in rest-stand. In right-handed subjects, LNG increased to 245% and 250% of rest-stand value, and REC AREA increased to 589% and 633% in right and left hand grip, respectively. In left-handed subjects, LNG increased to 186% and 188% of rest-stand value, and REC AREA increased to 400% and 533% in right and left hand grip, respectively. No significant difference of LNG and REC AREA was observed between right and left hand grip in either hand dominant subject Maximum grip did not affect CG in rest-stand. In aged subjects, maximum grip power was significantly less than in young subjects (48%). LNG and REC AREA in rest-stand were significantly larger in aged subjects than in young subjects (220% and 400%, respectively). They were not different during maximum grip with either hand. While aged subjects have difficulty of controlling CG in rest-stand, they have less problems to stabilize CG during maximum grip. These data indicated that dynamic movement of CG might be important to understand person's activity of daily living.

Activities of Daily Living↗
PubMed1991

Transfer of training of the biofeedback-assisted control of hand temperature.

This study examined the effect of prior biofeedback-assisted training of hand warming or hand cooling on the subsequent ability to train the opposite response. A two-group crossover design employed 43 subjects with one group receiving three days of hand warming followed by three days of hand cooling, while the second group received the opposite sequence. Analysis indicated subjects were able to produce the appropriate changes in hand temperature and were more successful at hand cooling than hand warming. During the transfer of training phase, subjects with prior training in hand cooling were able to produce warming above baseline levels compared with subjects initially trained to hand warm. In contrast, prior training of hand warming had no effect on the subsequent ability to cool hands.

Adult↗