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PubMed2002

The impact of gender, body dimension and body composition on hand-grip strength in healthy children.

Maximum hand-grip (HG) strength, body composition and main anthropometric variables were evaluated in 278 children with normal weight and growth, aged 5-15 yr divided into 3 age groups: group 1, age+/-SD: 7.6+/-0.9 yr 7.6+/-0.9 SD (Tanner stage 1); group 2, age: 10.8+/-0.7 yr (Tanner stage: 2-3); group 3, age: 13.2+/-0.9 yr (Tanner stage: 4-5). Weight, height, body surface area (BSA), BMI, percent body fat (BF) and fat free mass (FFM) increased progressively and significantly from the younger to the older age group. A significant difference between genders was detected only for BF and FFM, females having a higher fat mass and a lower FFM compared to males. Most children were right-handed (91%). In either genders, a curvilinear relation was detected between HG strength and age, with best fit for the dominant (d) hand given by the equations: dHG=5.891 *10(0.051) age, r2=0.986, p<0.001 in males and dHG=6.163 *10(0.045) age r2=0.973, p<0.001 in females. The increase in HG strength after 11 yr appears to be steeper in males as compared with that found in females. In both d and non-dominant (nd) hand, a significant difference in HG strength was detected between males and females, the average difference being about 10% at all ages. For both genders, nd hand was significantly weaker than d hand in the older age groups (2 and 3), but not in the younger group 1. Age and gender-dependent differences in HG strength (but not differences between d and nd hand) disappear if HG strength is normalized for FFM. Thus, in general, dHG strength normalized for FFM resulted on average to be 0.67+/-0.11 kg/kg. A multiple linear regression analysis indicated that HG was positively correlated with BMI, BSA, stature, stature2 and FFM (p<0.001 for all correlations) without differences between genders, while a negative correlation was found between HG strength and %BF. The most significant correlation was found between HG strength and FFM, without any significant difference between genders, so that the overall equation describing the line for the d hand was: dHG strength= 2.32+0.63 FFM, r2=0.72, p<0.001. In conclusion, the present study indicates that the age-dependent increase of HG strength as well as the between-gender differences are strongly related to changes of FFM values occurring during childhood. Moreover, the study provides a standard normative value of maximal HG strength for the healthy children population in Northern Italy.

Adolescent↗
PubMed2004

[Outpatient hand surgery--possibilities and limitations].

On January 1st 2004, a new contract between the government, health insurance services, and hospitals was inaugurated in Germany. The aim of the contract is to decrease costs for surgical therapies by abolishing or at least minimizing hospitalization of patients. Hand surgery is widely affected by the new contract, since a very large part of surgical therapies for the hand was declared to be compulsory outdoor and another major part to be preferable outdoor. The surgeon may decide whether a patient needs inpatient or outpatient treatment but has to justify his decision. Hospitals and surgical clinics are both allowed to offer outpatient hand surgery and get the same payment under the same regulations. For most hospitals, structural changes will be necessary to offer outpatient surgery without financial loss. In our experience a personal and regular contact between patient and surgeon is most necessary for the best surgical result. Many of the compulsory outpatient operations in hand surgery can be done sufficiently and at high standard. This may not be the case for the second group to be handled not compulsory outdoor. The new contract allows hospitals to offer postoperative care for only 14 days, whereas many specific hand surgical procedures will need the surgeon's control and care for a much longer time. On the other hand, clinics and general practitioners have strict limitations for the prescription of hand therapies. We believe that the quality of hand surgery is highly dependent on sufficient postoperative treatment. If the postoperative care is neglected or restricted, secondary costs such as sick leave will increase.

Ambulatory Surgical Procedures↗
PubMed2005

The brain's fingers and hands.

The brain keeps track of the changing positions of body parts in space using a spatial body schema. When subjects localise a tactile stimulus on the skin, they might either use a somatotopic body map, or use a body schema to identify the location of the stimulation in external space. Healthy subjects were touched on the fingertips, with the hands in one of two postures: either the right hand was vertically above the left, or the fingers of both hands were interwoven. Subjects made speeded verbal responses to identify either the finger or the hand that was touched. Interweaving the fingers significantly impaired hand identification across several experiments, but had no effect on finger identification. Our results suggest that identification of fingers occurs in a somatotopic representation or finger schema. Identification of hands uses a general body schema, and is influenced by external spatial location. This dissociation implies that touches on the finger can only be identified with a particular hand after a process of assigning fingers to hands. This assignment is based on external spatial location. Our results suggest a role of the body schema in the identification of structural body parts from touch.

Adult↗
PubMed2005

Visual bias of unseen hand position with a mirror: spatial and temporal factors.

Two experiments examined the integration of visual and proprioceptive information concerning the location of an unseen hand, using a mirror positioned along the midsagittal plane. In experiment 1, participants tapped the fingers of both hands in synchrony, while viewing the mirror-reflection of their left hand. After 6 s, participants made reaching movements to a target with their unseen right hand behind the mirror. Reaches were accurate when visually and proprioceptively specified hand positions were congruent prior to the reach, but significantly biased by vision when the visual location conflicted with the real location. This effect was independent of the target location and depended strongly upon the relative position of the mirror-reflected hand. In experiment 2, participants made reaching movements following 4, 8, or 12 s active visuomotor or passive visual exposure to the mirror, or following passive exposure without the mirror. Reaching was biased more by the visual location following active visuomotor compared to passive visual exposure, and this bias increased with the duration of visual exposure. These results suggest that the felt position of the hand depends upon an integrated, weighted sum of visual and proprioceptive information. Visual information is weighted more strongly under active visuomotor than passive visual exposure, and with increasing exposure duration to the mirror reflected hand.

Adolescent↗
PubMed2006

How active gaze informs the hand in sequential pointing movements.

Visual information is vital for fast and accurate hand movements. It has been demonstrated that allowing free eye movements results in greater accuracy than when the eyes maintain centrally fixed. Three explanations as to why free gaze improves accuracy are: shifting gaze to a target allows visual feedback in guiding the hand to the target (feedback loop), shifting gaze generates ocular-proprioception which can be used to update a movement (feedback-feedforward), or efference copy could be used to direct hand movements (feedforward). In this experiment we used a double-step task and manipulated the utility of ocular-proprioceptive feedback from eye to head position by removing the second target during the saccade. We confirm the advantage of free gaze for sequential movements with a double-step pointing task and document eye-hand lead times of approximately 200 ms for both initial movements and secondary movements. The observation that participants move gaze well ahead of the current hand target dismisses foveal feedback as a major contribution. We argue for a feedforward model based on eye movement efference as the major factor in enabling accurate hand movements. The results with the double-step target task also suggest the need for some buffering of efference and ocular-proprioceptive signals to cope with the situation where the eye has moved to a location ahead of the current target for the hand movement. We estimate that this buffer period may range between 120 and 200 ms without significant impact on hand movement accuracy.

Adult↗
PubMed2000

Eye-hand coordination to visual versus remembered targets.

It has been suggested that the basal ganglia preferentially contribute to movements made to remembered targets, whereas the cerebellum preferentially contributes to movements based on visual cues. Thus, it is possible that eye-hand coordination may differ in these two types of movement. To examine this issue we compared the response characteristics of combined eye and hand movements made towards visual versus remembered targets. In addition, the influence of the eye movement on the hand movement was investigated by comparing the effects of visual fixation in each task. Our results demonstrated that hand movement amplitude was greater when the hand movements were produced in isolation versus in combination with an eye movement. This was true regardless of whether the movement was made to a visual or a remembered target. This suggests that the integration of eye position information into the manual motor response occurs at a common neural site for both tasks. By contrast, the timing between saccade and hand onsets and offsets differed in the two conditions. This is consistent with the idea that the timing inherent in eye-hand coordination is the result of separate processing within either the basal ganglia or cerebellar systems. Taken together, the results from this study demonstrate that certain processes underlying eye-hand coordination during movements to visual versus remembered targets share a common neural substrate whereas others function independently.

Adult↗
PubMed2000

Activation of the cerebellum in co-ordinated eye and hand tracking movements: an fMRI study.

Dysfunction of the cerebellum leads to significant deterioration of movements performed under visual guidance and of co-ordinated eye and hand movement. Visually guided tracking tasks combine both of these control features, as the eyes and hand together track a visual target. To better understand the involvement of the cerebellum in tracking tasks, we used functional magnetic-resonance imaging to study the activation of cerebellar structures in visually guided tracking movements of the eye and hand. Subjects were tested performing ocular tracking, manual tracking without eye movement or combined eye and hand tracking of a smoothly moving visual target. Three areas were activated in the cerebellum: a bilateral region in the ansiform lobule of the lateral hemisphere, a region in the ipsilateral paramedian lobule and a region in the oculomotor vermis. The ansiform and paramedian areas were most strongly activated by hand movement, although the vermal site was also active. The reverse was found for ocular tracking, with predominantly vermal activation. Activation of these cerebellar cortical areas related to movement of eyes or hand alone was significantly enhanced when the subjects performed co-ordinated eye and hand tracking of a visual target. These results provide the first direct evidence from a functional-imaging study for cerebellar activation in eye and hand co-ordination.

Analysis of Variance↗
PubMed1998

Coordination of multi-joint arm movements in cerebellar ataxia: analysis of hand and angular kinematics.

Kinematic abnormalities of fast multijoint movements in cerebellar ataxia include abnormally increased curvature of hand trajectories and an increased hand path and are thought to originate from an impairment in generating appropriate levels of muscle torques to support normal coordination between shoulder and elbow joints. Such a mechanism predicts that kinematic abnormalities are pronounced when fast movements are performed and large muscular torques are required. Experimental evidence that systematically explores the effects of increasing movement velocities on movement kinematics in cerebellar multijoint movements is limited and to some extent contradictory. We, therefore, investigated angular and hand kinematics of natural multijoint pointing movements in patients with cerebellar degenerative disorders and healthy controls. Subjects performed self-paced vertical pointing movements with their right arms at three different target velocities. Limb movements were recorded in three-dimensional space using a two-camera infrared tracking system. Differences between patients and healthy subjects were most prominent when the subjects performed fast movements. Peak hand acceleration and deceleration were similar to normals during slow and moderate velocity movements but were smaller for fast movements. While altering movement velocities had little or no effect on the length of the hand path and angular motion of elbow and shoulder joints in normal subjects, the patients exhibited overshooting motions (hypermetria) of the hand and at both joints as movement velocity increased. Hypermetria at one joint always accompanied hypermetria at the neighboring joint. Peak elbow angular deceleration was markedly delayed in patients compared with normals. Other temporal movement variables such as the relative timing of shoulder and elbow joint motion onsets were normal in patients. Kinematic abnormalities of multijoint arm movements in cerebellar ataxia include hypermetria at both the elbow and the shoulder joint and, as a consequence, irregular and enlarged paths of the hand, and they are marked with fast but not with slow movements. Our findings suggest that kinematic movement abnormalities that characterize cerebellar limb ataxia are related to an impairment in scaling movement variables such as joint acceleration and deceleration normally with movement speed. Most likely, increased hand paths and decomposition of movement during slow movements, as described earlier, result from compensatory mechanisms the patients may employ if maximum movement accuracy is required.

Adult↗
PubMed1998

Hand and joint paths during reaching movements with and without vision.

This study examines whether the kinematics of pointing movements are altered by the sensory systems used to select spatial targets and to guide movement. Hand and joint paths of visually guided reaching movements of human subjects were compared with two non-visual conditions where only proprioception was available: (1) movements of the same subjects with blindfolds, and (2) movements by congenitally blind subjects. While hand-path curvatures were overall quite small, sighted subjects wearing a blindfold showed a statistical increase in hand-path curvature compared with their visually guided movements. Blindfolded subjects also showed greater hand-path curvature than blind subjects. These increases in hand-path curvature for blindfolded subjects did not always lead to a decrease in joint-path curvature. While there were differences between blind subjects and sighted subjects using vision for some movement directions, there was no systematic difference between these two groups. The magnitude of joint-path curvature showed much greater variation than hand-path curvature across the movement directions. We found variation in joint-path curvature to be correlated to two factors, one spatial and one geometrical. For all subject groups, joint-path curvature tended to be smaller for sagittal-plane movements than for transverse or diagonal movements. As well, we found that the magnitude of joint-path curvature was also related to the relative motion at each joint. Joint-path curvature tended to increase when movements predominantly involved changes in shoulder angle and was minimal when movements predominantly involved elbow motion. The consistently small curvatures of hand trajectory across blind and sighted subjects emphasize the powerful tendency of the motor system to generate goal-directed reaching movements with relatively straight hand trajectories, even when deprived of visual feedback from very early in life.

Adult↗
PubMed2003

A new multitool for hand-assisted advanced laparoscopic surgery (HALS).

BACKGROUND: Hand-assisted laparoscopic surgery (HALS), which has become possible due to the introduction of effective hand-access devices, facilitates the execution of major operations. Over the past 2 years, we have been evaluating various designs for small instruments that can be used by the internal assisting hand. Here we report on the development, testing, and evaluation of a small reusable multitool that hangs from the little finger of the internal assisting hand of the surgeon when not in use. METHODS: The Dundee Multitool (DMT) was designed to enable the internal deployment (by thumb extrusion) of a small dissecting forceps (pickup), needle driver, and scissors. The multitool hangs from the little finger of the internal assisting hand when not in use. The instrument was subjected to beta testing in the laboratory using HALS trainers. When testing was completed, it was used in major HALS operations after approval by the hospital and consent of the individual patients. RESULTS: The DMT was found to work well. The various active instruments could be extruded from the casing with ease and functioned well in picking up tissues, intracorporeal suturing/tying, and the cutting of sutures and ligatures. Both in laboratory experiments and during clinical evaluation, suturing was easy when the active driving of the needle though the tissues was carried out by the external hand. The multitool needle driver, held by the internal hand as an assisting instrument in conjunction with active needle driving through the tissue edges by the dominant (external) hand, improved suturing efficiency (i.e., reduced execution time) by 30% when compared to total laparoscopic suturing. CONCLUSIONS: We have described a novel little-finger-hung multitool for HALS surgery that deploys with ease at any one time. It incorporates a needle driver, a dissecting forceps, and a suture scissors. The good functionality of the multitool has been confirmed by both laboratory experiments and clinical evaluation.

Animals↗
PubMed2006

Creating a manual for proper hand hygiene and its clinical effects.

PURPOSE: To prevent cross-infections, we created a manual for the treatment of infectious wounds that clarifies when to wash one's hands and when to wear gloves. METHODS: Six patients with widespread infectious wounds caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated. The bacterial count on the hands of the staff was calculated. We then compared the number of patients with MRSA isolated, and typed the MRSA isolates using pulsed-field gel electrophoresis (PFGE). RESULTS: The pathogenic bacterial count among hospital staff before treatment/before hand hygiene was 8.2 x 10 colony-forming units (cfu)/hand, which were not detected before treatment/after hand hygiene. The pathogenic bacterial count on the hands before hand hygiene/after treatment climbed to 9.1 x 10(5) cfu/hand, and after treatment/after hand hygiene decreased to 0.38 cfu/hand. The number of patients with MRSA isolates before this protocol was 15/402 (3.7%), but that level significantly decreased to 5/411 (1.2%) after implementation of the manual. There were 13 strains of type F by PFGE before the manual was adopted, but five strains of MRSA isolated after the present manual was enforced were all observed to have different migration patterns. CONCLUSION: A hand hygiene manual is effective for decreasing the rate of cross-infection.

Anti-Infective Agents, Local↗
PubMed2006

Prevalence and involvement patterns of radiographic hand osteoarthritis in Japanese women: the Hizen-Oshima Study.

The prevalence and pattern of joint involvement in radiographic hand osteoarthritis (OA) have been reported in Western populations, but similar data are lacking for Japanese. We examined this issue in 551 Japanese women aged > or = 40 years. Radiographs were obtained of both hands and graded according to the Kellgren-Lawrence (K-L) criteria. OA was defined as K-L grade 2 or higher. The prevalence of radiographic OA in the IP, MCP, and CMC joints was distributed similarly in both hands. The most frequent locations of radiographic OA were the distal IP joints of the index finger, the IP joint of the thumb, and the distal IP joints of the middle finger, in this order. The prevalence of radiographic OA in each joint group increased significantly with age, and that in Japanese women was lower in the thumb CMC joint and higher in the thumb IP joint compared to those in Caucasian women reported previously. The strongest predictor for the presence of radiographic OA in a particular joint was the disease status in the same joint of the opposite hand (OR = 18.5; 95% CI; 15.2-22.7), followed by the joints in the same row of the same hand (OR = 15.5; 95% CI, 11.9-20.1), and then by the joints in the same ray of the same hand (OR = 1.3; 95% CI, 1.0-1.6). Although the prevalence of hand OA is likely to show site-specific differences between Japanese and Caucasian women, our results indicate that both groups show similar involvement pattern symmetrically and in the same row of the same hand.

Aged↗
PubMed1993

Hand position affects elbow joint load during push-up exercise.

Electromagnetic motion sensors and a piezoelectric force plate were used to record simultaneously upper-extremity motion and forces in nine healthy male subjects during push-ups in six different hand positions. The intersegmental loading pattern on the elbow joint during a push-up exercise was investigated. The importance of hand position on these loads was examined. Peak forces exerted on the elbow joint along the forearm axis averaged 45% of the body weight for the 'normal' hand position and were significantly decreased if hands were positioned either 'apart' or 'superior' from 'normal'. The peak torque in the 'normal' position tended to produce elbow flexion and was 2305.9 N cm, or 56% of the maximal isometric extensor torque, which was significantly different from hands 'apart' and hand 'together' at 29 and 71% of the maximal isometric torque, respectively. The maximum torque about the forearm axis tended to produce forearm pronation with a mean value of 315.4 N cm (35% of the maximal isometric supinator torque). The maximum valgus torque at the elbow opposed by the medial ligamentous structure was 1241 N cm and was significantly increased if the hand was positioned superiorly. The valgus torque increased by 42% for the one-handed push-up under simulated fall condition. The results of this analysis give an insight into the biomechanics of a normal elbow and to its load-carrying capacity. The data may be extrapolated to the design of rehabilitation programs and possibly to the mechanisms of forearm injury during a fall.

Adult↗
PubMed1987

The effectiveness of ethanol gauze for hand disinfection in surgical wards.

The effectiveness of ethanol gauze in removing transient bacteria on the hands was investigated in a surgical ward during clinical nursing rounds. Two nurses with similar duties were selected as subjects for each round; one disinfected her hands with ethanol gauze when moving between patients while the other immersed her hands in 0.05% aqueous chlorhexidine gluconate when aware of contaminating her hands. Hand samples were taken after preliminary disinfection before the round, and again after the round on 37 occasions. Pseudomonas aeruginosa and Staphylococcus aureus were not detected in nurses using ethanol gauze, except in one nurse where S. aureus was isolated from both the pre- and postround hand culture. Both organisms were detected on four occasions from the postround hand cultures in the chlorhexidine group. Acinetobacter anitratus was not removed by pre-round disinfection, and was found on five and 11 occasions from the postround hand cultures in the ethanol gauze and chlorhexidine groups, respectively.

Bacteria↗
PubMed1987

Hand burns in children under 5 years of age.

In order to evaluate the epidemiology and functional results of hand burns in young children, 92 consecutive patients (126 hand burns) under age 5 years admitted to a Burn Center were reviewed. Scald burns (49 per cent) were most common, followed by flame (34 per cent), contact (14 per cent) and electrical burns (3 per cent). The child was left unattended by an adult in 53 per cent of cases and documented abuse was present in 6 per cent. The mean total body surface area (TBSA) burned was 17 per cent, and 77 patients (85 per cent) had additional burns in other areas (arms 34 per cent, legs 31 per cent, chest 29 per cent and face 27 per cent). Palmar burns occurred in 24 hands (19 per cent), dorsal in 41 (33 per cent), while both surfaces were burned in 61 (48 per cent). Joints involved included the MP in 96 (76 per cent), PIP in 87 (69 per cent) and DIP in 80 (63 per cent). The depth was superficial partial thickness in 53 (47 per cent), deep partial in 55 (44 per cent), and full thickness in 18 hands (14 per cent); a total of 29 hands were grafted (15 deep partial and 14 full thickness). Escharotomies were required in 12 hands (9 per cent) (9 flame and 3 scald) and partial amputation of digits was required in 3 (2 per cent). Follow-up was available in 46 hands from 7 to 120 months (mean 39 months). Partial thickness burns (34) healed with normal (32) or near-normal (2) hand function and developmental delay occurred in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Burn Units↗
PubMed1994

Hand strength: normative values.

We studied normal hand strength and the difference between dominant and nondominant hands. Two hundred fourteen volunteers were tested with a calibrated Jamar dynamometer at all five levels. A pinch gauge was used to assess key and pulp pinch. Height, weight, sex, hand dominance, and hobby demands were predictive of maximum grip. Mean maximum grip for women was 81 lb. and for men was 137 lb. Key pinch averaged 22%, while pulp pinch averaged 16% of maximum grip. Only 129 (60%) patients had maximum strengths at level 2. The majority of right-handed subjects were 10% stronger in grip strength on the dominant side. In left-handed subjects, mean grip was the same for both hands; the nondominant hand was stronger in 50% of left-handed subjects.

Adolescent↗
PubMed2005

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses.

BACKGROUND: Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers. METHODS: We studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method. RESULTS: The highest log 10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2. CONCLUSIONS: Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

Adult↗
PubMed2004

[Clinical and three-dimensional kinematic features of the upper limb after replantation of the hand].

INTRODUCTION: Functional assessments of hand replantation after traumatic amputation are considered as good although frequent deficits of long fingers mobility and hand sensitiveness occur. AIMS: To evaluate the capability of handling and the compensatory mechanisms involved in handling. METHODS: Prospective study in eight right-handed males who had distal amputation of the left upper limb with hand replantation for more than two years. Eight males with paired age and handedness served as control. Skin sensitiveness (thread test), mobility (TAM), functional capability (Box and Blocks test, 400 points test) and occupational outcome were assessed. Three-dimensional analysis (opto-electronic device) of the motion of the trunk and the upper limbs (arm, forearm, hand) was made during a pointing and gripping-shifting maneuver and the time of the related phases was measured (dynamometric cube device). Correlation between clinical assessments and three-dimensional analysis were tested. RESULTS: Patients with replantation had a remarkable recovery of the absolute and relative times of the various phases of the handling maneuver. Only the gripping phase was significantly prolonged in patients, this result was correlated with the deficit in motor function and sensitiveness of the replanted hand. The visual control was higher because of the lack of superficial and deep sensitiveness. Compensatory mechanisms involved a lateral shift of the replanted limb segments, probably attributed to the lateral shift of the trunk. CONCLUSION: Patient with a replanted hand develops a homogenesis displacement of the trunk and the pectoral girdle to compensate the shortening and the reduction in active mobility of the hand. This compensatory mechanism, observed in a small scale in healthy too, is efficient with respect to the handling phases.

Activities of Daily Living↗