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Spray dispensing of antiseptics is effective for hand disinfection.

The effectiveness of three hand antiseptics administered using a spray dispenser (Nebucid 840) was studied together with that of conventional hand disinfection. The tests were carried out by a group of 20 dental students. To obtain baseline samples, the subjects washed their hands with unmedicated Sterisol liquid soap under running water for 30s and dried them on sterile-packed paper towels. Microbiologic samples were taken from fingerprints pressed gently onto blood agar plates, which were then incubated aerobically and analyzed. The hand disinfection efficacy of 3 ml Isosept solution rubbed onto the hands for 30 s, followed by air drying for 60 s, was studied as a conventional control method. Dermocol, HD 410, and Hibisol antiseptics were sprayed onto the subjects' hands for 3 s using the automatic dispenser, after which the hands were gently rubbed for 30 s and air-dried for 60 s, before fingerprint contact sampling. All the tests were performed three times, with a minimum of 3 days between the series. The results showed Hibisol applied with the spray dispenser to be significantly more effective in reducing bacterial growth than the other methods. No growth was observed on 51 plates out of 60, while bacterial growth was observed in 29 cases out of 60 in the Isosept series. In most cases the spray-dispensed antiseptics proved to be more efficient than the conventional hand antiseptic. All the antiseptics were significantly more effective than the liquid soap.

Adult↗

Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections.

Direct hand-to-hand contact is an important mechanism of transmission of rhinovirus infection. The rhinoviruses are inactivated at a low pH. A survey of organic acids in vitro revealed that these compounds have antirhinoviral activity that persists for at least 3 h after application to the skin. In additional studies of salicylic acid (SA) and pyroglutamic acid (PGA), the hands of volunteers were contaminated with rhinovirus at defined times after application of the acid, and then volunteers attempted to inoculate the nasal mucosa with one hand and quantitative viral cultures were done on the other hand. In one study, 3.5% SA or 1% SA with 3.5% PGA was compared with controls 15 min after application to assess the efficacy of the inactivation of virus and prevention of infection. Virus was recovered from the hands of 28 out of 31 (90%) of the volunteers in the control group compared to 4 out of 27 (15%) and 0 out of 27 in the groups administered 3.5 and 1% SA, respectively (P < 0.05). Rhinovirus infection occurred in 10 out of 31 (32%) of the controls and 2 out of 27 (7%) of volunteers in both treatment groups (P < 0.05 compared with control). In a second study, the efficacy of 4% PGA was evaluated 15 min, 1 h, and 3 h after application. Significantly fewer volunteers had positive hand cultures at all time points compared with the control group, but the proportion that developed rhinovirus infection was not significantly reduced. These results suggest the feasibility of the prevention of rhinovirus transmission by hand treatments that are virucidal on contact and have activity that persists after application.

Acids↗

Hand synergies during reach-to-grasp.

An emerging viewpoint is that the CNS uses synergies to simplify the control of the hand. Previous work has shown that static hand postures for mimed grasps can be described by a few principal components in which the higher order components explained only a small fraction of the variance yet provided meaningful information. Extending that earlier work, this study addressed whether the entire act of grasp can be described by a small number of postural synergies and whether these synergies are similar for different grasps. Five right-handed adults performed five types of reach-to-grasps including power grasp, power grasp with a lift, precision grasp, and mimed power grasp and mimed precision grasp of 16 different objects. The object shapes were cones, cylinders, and spindles, systematically varied in size to produce a large range of finger joint angle combinations. Three-dimensional reconstructions of 21 positions on the hand and wrist throughout the reach-to-grasp were obtained using a four-camera video system. Singular value decomposition on the temporal sequence of the marker positions was used to identify the common patterns ("eigenpostures") across the 16 objects for each task and their weightings as a function of time. The first eigenposture explained an average of 97.3 +/- 0.89% (mean +/- SD) of the variance of the hand shape, and the second another 1.9 +/- 0.85%. The first eigenposture was characterized by an open hand configuration that opens and closes during reach. The second eigenposture contributed to the control of the thumb and long fingers, particularly in the opening of the hand during the reach and the closing in preparation for object grasp. The eigenpostures and their temporal evolutions were similar across subjects and grasps. The higher order eigenpostures, although explaining only small amounts of the variance, contributed to the movements of the fingers and thumb. These findings suggest that much of reach-to-grasp is effected using a base posture with refinements in finger and thumb positions added in time to yield unique hand shapes.

Adult↗

Intramuscular hand neuroprosthesis for chronic stroke survivors.

The purpose of this study was to assess the feasibility of a percutaneous hand neuroprosthesis system for stroke survivors. Case reports of 4 chronic stroke survivors who were implanted with percutaneous intramuscular electrodes in various muscles of the forearm for hand grasp and release are presented. A percutaneous hand neuroprosthesis was able to open a spastic hemiparetic hand as long as the upper limb was in a resting position, the wrist and proximal forearm were supported, participants did not try to assist the stimulation, and an individual other than the participant modulated the stimulation. However, when participants tried to assist the stimulation or complete a functional task, hand opening was significantly reduced due to increased finger flexor hypertonia, even with increased stimulation intensity. Similarly, electrically stimulated hand opening was significantly reduced following voluntary hand closure. Techniques that provide real-time modulation of hypertonia with closed loop control, control strategies that are independent of the contralateral limb, and methods to enhance proximal control must be developed to demonstrate the feasibility of a hand neuroprosthesis system for persons with hemiparesis.

Adult↗

Dynamometry of intrinsic hand muscles in patients with Charcot-Marie-Tooth disease.

BACKGROUND: Several problems are associated with manual muscle testing and dynamometry in the hands of patients with Charcot-Marie-Tooth (CMT) disease. OBJECTIVE: To evaluate the efficacy of the Rotterdam Intrinsic Hand Myometer (RIHM) to directly measure intrinsic hand muscle strength in CMT disease. METHODS: We measured hand muscle strength and hand function in 41 patients with CMT disease. RESULTS: RIHM measurement of intrinsic strength had excellent reliability. We found overlapping RIHM strength values in Medical Research Council grades 3 to 5. High grip and pinch strength could be found in patients with severe intrinsic muscle weakness. RIHM measurements were more strongly correlated with fine motor skills of the hand than grip and pinch strength. CONCLUSIONS: The Rotterdam Intrinsic Hand Myometer is a reliable instrument to measure intrinsic hand muscles strength in patients with Charcot-Marie-Tooth disease, providing more detailed information than manual muscle testing and a more direct assessment of intrinsic muscle loss than grip and pinch dynamometers.

Adolescent↗

Ease and accuracy of evaluation of fetal hands during obstetrical ultrasonography: a prospective study.

Hand malformations characterize many congenital syndromes, including mendelian disorders, skeletal dysplasias, and karyotype abnormalities. Although identification of a hand anomaly alters obstetrical management, evaluation of the fetal hands is not included in current ultrasonographic guidelines. We prospectively studied the utility of allotting up to 5 min to examine fetal hands during obstetrical ultrasonography. Both hands were visualized in 87% of patients (188 of 215). Eight hand abnormalities were present at delivery. Six had been identified antenatally, four during the study with ultrasonography. There were no false positives. Four fetuses with hand malformations were aneuploid. Fetal hands should be examined during a comprehensive obstetrical sonographic evaluation, especially when risk factors for aneuploidy are present.

Aneuploidy↗

[Central agenesis of the hand].

Central aplasia represent under 10% of congenital malformations of the hand. It is characterised by the partial or complete absence of the median ray. We adopted the classification of Swanson and considered this anomaly a stop of median longitudinal development. We separate 2 groups: Hand in folk: the aplasia interested only the median digits, all metacarpal are present. Hand in lobster's pincer: all median rays are absent including the metacarpal. We report a set of 16 children carriers of 23 central aplasia of the hand, it was about 14 hands in lobster'pincer and 9 hands in folk. In any case, the gene was merely aesthetic, the hand's function was complete. A child has been operated, and benefitted a closing of the median crack defect, he had a free thumb. For the other cases, abstention has been decided, indeed to close this cracks deprive these hands of a first corner the alone present.

Child↗

Hand transplantation: current status.

The hand is a very special organ, with unique functions and versatility in the human body. Our hands are pivotal in manipulating our environment, receiving feedback from our surroundings and communicating our unspoken words by gestures. Thus, the loss of a hand is a tragic, disfiguring event with profound personal, vocational, financial and social implications. Transplantation of life-saving solid organs is now widely accepted in both the medical and lay communities. The technical skills and prerequisites for hand transplantation have been honed over recent decades, culminating in the recent commencement of hand transplantation in several centers around the world. However, unlike life-saving solid organ transplantation, hand transplantation has been greeted with less enthusiasm in the professional community because it is not yet clear what the long-term risks-to-benefits ratio is. The scientific background, and the potential risks, benefits, and ethical aspects of this procedure are discussed. Successful transplantation to amputees of fully integrated and functional hands is a worthy goal. Hopefully, at some point in the future, hand transplantation will become another safe and viable option for amputees to consider.

Amputation, Traumatic↗

Hand circulation after radial artery harvest for coronary artery bypass grafting.

Despite wide spread use of the radial artery (RA) graft for coronary artery bypass grafting, the change of hand circulation after RA harvest has not been fully clarified. Severe hand ischemia such as resting pain or gangrene is a rare complication and has been reported in 4 patients. These cases resulted from occlusive artery disease in forearm, which should be carefully explored before RA harvest. Incidence of mild hand ischemia such as hand claudication or fatigue is unknown, but our study suggested that around 10% of the patients developed mild hand ischemia after RA harvest. The blood flow to the forearm territory was decreased by 20% after RA harvest despite the compensatory dilatation of ulnar artery. The presence of low perfusion in the affected hand has been pointed out in some studies. We reported the decreased tissue oxygenation of the affected hand during hand grip exercise. The Allen test is the most popular preoperative screening method, but is associated with considerable numbers of false-positive and false-negative results. Full length scanning of ulnar artery by ultrasonography seems to have a lower false-positive rate. But further clinical experience is necessary to establish a more reliable screening method.

Coronary Artery Bypass↗

[Anthropometric parameters of the hand and their importance for the free skin autograft].

The transverse and longitudinal dimensions of the hand were measured in 500 subjects (250 women and 250 men), 15 to 78 years of age, divided in six age groups. Largest were the hand dimensions in women 25 to 34 years of age and in men 25 to 54 years of age. The mean values of the transverse dimension of the hand in women was 73,45 mm and in men--87,66 mm. The mean value of the longitudinal dimension of the female hand was 178,62 mm and of the male hand--187,39 mm. Estimations were made of the finger surface in 20 women and 20 men, aged from 25 to 44 years. Largest was the surface of the III. finger: 47,71 cm2 in women and 57,51 cm2 in men. Smallest was the surface of the V finger: 31,08 cm2 in women and 37,63 cm2 in men. The hand surface, the fingers excluded, was 160,34 cm2 in women and 178 cm2 in men. The complete surface of the female hand was 369,34 cm2 and of the male hand 426,35 cm2.

Adolescent↗

Dominantly inherited unilateral terminal transverse defects of the hand (adactylia) in twin sisters and one daughter.

Most previous cases of unilateral terminal transverse defects of the hand have not been familial. Several previously reported cases of apparent autosomal dominant inheritance of such defects have subsequently been reclassified as type B brachydactyly. We report a pair of adult twin women with unilateral terminal transverse defects affecting the left hand in one woman and the right hand in the other woman. The latter woman has one daughter with a unilateral terminal transverse defect affecting the left hand. The hand anomaly is characterized by absence of the terminal portions of digits 2 to 5 with a mildly hypoplastic thumb (adactylia). Tiny nail remnants are evident on the remaining digital stumps, and no soft tissue syndactyly is apparent. At 2 years of age, the daughter has hypoplastic first, fourth, and fifth metacarpals with no ossification of the second or third metacarpals or any of the phalanges. The affected mother has hypoplastic metacarpals for digits 2 to 4 and a vestigial fifth proximal phalanx on the affected hand, with no other phalanges evident by roentgenogram other than those of the thumb. The mother's twin sister has similar findings, except the ossified phalangeal remnant is on her second and third fingers rather than her fifth finger. Doppler flow arterial patterns appeared normal in each hand of affected family members. The other hand and both feet are clinically and radiologically normal in each case, and the family history is negative for any other individuals with limb anomalies. A review of the literature suggests that this family may very well be unique.

Adult↗

Self-reported hand and wrist arthritis and occupation: data from the U.S. National Health Interview Survey-Occupational Health Supplement.

BACKGROUND: There is a paucity of population-based studies examining occupational hand-wrist arthritis. We examined relationships between hand-wrist arthritis, occupation, and biomechanical exposures in the U.S. National Health Interview Survey-Occupational Health Supplement. METHODS: A randomized, multi-stage, and cross-sectional national prevalence survey was carried out. RESULTS: Self-reported, medically attended hand-wrist arthritis was common among employed persons (period prevalence 1.58%; lifetime prevalence 3.58%). Highest prevalences occurred among technicians, machine operators, assemblers, and farmers, and in the mining, agriculture, and construction industries. Work requiring repetitive hand bending and twisting was associated with hand-wrist arthritis (Odds Ratio 1.43; 95%CI: 1.11-1.84; P = 0.005). Among workers with hand arthritis, 7.4% had made major changes in their work, 7.6% missed work, and 4.5% stopped working or changed jobs because of the problem. CONCLUSIONS: Our study links hand-wrist arthritis to occupation and potentially modifiable workplace ergonomic factors. The spectrum of hand-wrist "cumulative trauma" disorders may considerably exceed that of soft-tissue injuries like carpal tunnel syndrome and tendonitis, and may include arthritis, a widely prevalent, disabling condition.

Arthritis↗

Influence of object spatial location and task complexity on children's use of their preferred hand depending on their handedness consistency.

The goal of the present study was to compare the use of the preferred versus the nonpreferred hand in children performing two tasks of different levels of complexity, in various positions in space. Right-handed and left-handed consistent children were compared to their inconsistent counterparts. The results showed that the general tendency to use one's preferred hand to grasp an object is more or less pronounced depending on the object's spatial location and the task's complexity. The children used their preferred hand more often even when the object was presented contralaterally, and did so to a greater extent during the more complex task. Inconsistent-handers were more likely to shift to using their nonpreferred hand when the object was presented to this hand's side. Finally, we found that the influence of handedness consistency on hand use for the spatial positions varied with the complexity of the task. These results favor a view of handedness as a dynamic process in which motor preferences interact with task demand, probably through task-related attention.

Child↗

Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity.

Our purposes were: 1) to establish the predictive validity of stereoscopic visual acuity and microsurgical performance, and 2) to establish the construct and concurrent validity of hand-motion analysis as an objective and sensitive measure of microsurgical performance. Using a surgical microscope, 50 surgical residents completed a standardized microsurgical suturing task at baseline and following microsurgical training. Microsurgical performance was evaluated by blinded, expert microsurgeons using global rating scales. Measures of stereoscopic visual acuity and hand-motion analysis were correlated with expert global rating scores. Global rating scores correlated significantly with number of hand movements (r = -0.47, P = 0.001) and hand-travel distance (r = -0.37, P = 0.008). Economy of hand-motion improved significantly following microsurgical training (number of hand movements, P = 0.046; hand-travel distance, P = 0.04). Measures of stereoscopic visual acuity did not correlate significantly with global rating scores. Hand-motion analysis appears to be an objective and sensitive instrument for assessing microsurgical performance, with evidence of both concurrent and construct validity. The predictive validity of stereoscopic visual acuity and microsurgical performance remains unclear.

Adult↗

Hand preference in children with developmental coordination disorders: cause and effect?

Inter- and intra-modal matching by eight-year-old children diagnosed as having hand-eye coordination problems (HECP) and categorized as left-handed, together with a left-handed control group of children without such problems, were tested using a manual sensory matching task. The task required the children to locate target pins, visually (seen target), proprioceptively (felt target) or in combination (felt and seen target), while matching to the located target was always carried out without vision. Performance was superior when the target was located visually or visually/proprioceptively for both groups of children. These results question the conclusion that intra-modal will always be more accurate than inter-modal matching. When the combined scores for both hands were analyzed, the HECP children showed inferior performance to the control children in both inter- and intra-modal matching. Separate right and left hand analyses, demonstrated that the differences between the HECP group and control children could be accounted for by lowered performances when the right hand (nonpreferred) was used to match the located target position. Putative neurological disorders related to the development of the hemisphere controlling the nonpreferred hand (left hemisphere) are invoked to account for the poor performance with the nonpreferred hand of the HECP children.

Brain↗

Coordination of hand movements and saccades: evidence for a common and a separate pathway.

We studied the reaction times and initial directions of hand movements and saccades of human subjects who fixated and pointed as quickly as possible at eccentric targets which were presented unexpectedly. The targets were positioned on a horizontal bar which was placed in front of the subject. Different stimulus conditions were used in the experiments. Knowledge of the target position or the presence of an auditory co-stimulus slightly affected the reaction times of saccades in response to visual stimuli. Auditory co-stimuli reduced the reaction times considerably when the targets were presented after a delay of 200 ms after extinction of the central fixation point. Similar reductions were observed in the reaction times of the hand movements. However, these reductions were seen in hand responses to undelayed as well as delayed target presentations. The saccades were always made in the correct direction when the target was presented without delay. When the target was delayed about 50% of the saccades were made in the wrong direction. Even for undelayed targets the hand sometimes made mistakes. The number of mistakes increased to 35% when the target presentation was accompanied by the sound pulse. For delayed targets the proportion of wrong hand movements was about 50%. For such targets saccades and hand movements were practically always made in the same direction. If visual information is available, saccades and hand movements are generated independently of each other. However, if visual information is not present at the appropriate time and the target position has to be guessed, saccades and hand movements are generated on the basis of shared information.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗

The influence of task resistance on the characteristics of maximal one- and two-handed lifting exertions in men and women.

Dynamic lifting strength was assessed at lift velocities ranging from 0 to 1 m.s-1 using a hydrodynamometer in which the viscous resistance to motion could be preset. Nine men and nine women performed one- and two-handed dynamic exertions against low, medium, and high resistances. The subjects were required to lift as forcefully and as fast as possible from a height of 400 mm to just above head height. The instantaneous forces recorded at knee, knuckle, hip, shoulder, elbow, and head heights were compared with those obtained during maximal one- and two-handed isometric lifts performed at the same heights. The position of peak force relative to stature was lower for one-handed lifts (35.9% of stature) than for two-handed lifts (38.4% of stature) (P < 0.005), but was unaffected by lift resistance (P > 0.05) and subject sex (P > 0.05). Lifting forces during two-handed exertions were on average 1.5 times greater than for one-handed exertions (P < 0.0001). However, the difference in the strength of one- and two-handed lifts was highly dependent on hand height (P < 0.0001) and task resistance (P < 0.005), and was greater for the men than for the women (P < 0.001). When static lifting strength was measured at heights relative to stature and normalized by dividing by body weight, there was no significant difference in performance between the men and the women [mean normalized female:male: (f:m) strength ratio = 0.76, P > 0.05]. Under dynamic conditions the sex difference in lifting performance was pronounced (mean normalized f:m strength ratio = 0.68, P < 0.01), especially for power output (mean f:m power.unit body weight-1 ratio = 0.52, P < 0.005). The proportion of generality (r2 x 100) between dynamic and static lifting strength was found to range between 63% and 87%. These data suggest that the dynamic and static tests of lifting strength measured a common, intrinsic ability to produce maximal lifting forces. The finding that sex differences in strength are dependent on whether the exertion is static or dynamic has important implications for biomechanical models of human strength.

Adult↗

Pain, thermal sensation and cooling rates of hands while touching cold materials.

Hand cooling and resulting comfort and pain were studied in 12 subjects, while touching six different materials (polyurethane foam, wood, nylon, rustproof steel, aluminium, and temperature-controlled metal) which were initially at ambient temperature. This was done for three ambient temperatures (-10 degrees, 0 degree and 10 degrees C), after pre-exposure exercise or rest, with bare hands or while wearing gloves. The observed cooling curves were analysed as Newtonian cooling curves. The observed time constants appeared to be significantly related to the materials' contact coefficients, the presence of hand protection, the preceding activity, and the interaction between contact coefficient and the presence of hand protection. These parameters also allowed a good description of the time constant (r2 = 0.8) of the related cooling curves. Thermal and pain sensation could be described in terms of the local skin temperature, ambient temperature and hand protection. Equal pain and thermal levels were associated with lower temperatures of the back of the hand than of the contact side. The slightly painful condition was associated with a skin temperature of 16 degrees C for the back and 19 degrees C for the palm of the hand. The pain level appeared to be inversely related to cooling speed. Skin freezing occurred at higher skin temperatures when touching cold objects than when exposed to cold air as a result of reduced supercooling. The regression equations determined allowed calculations to be made of safety limits for hand cooling while in contact with a wide range of materials.

Adolescent↗