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PubMed2002

[The burned hand. A computer-assisted study of late function of 67 burned and operated hands].

A good functional outcome of the hand is important in the rehabilitation of severely burned patients. The aim of the study was to evaluate the late functional outcome of deeply burned hands using a computer aided system and to correlate the function with the distribution of the hand burns. Over a 12-year-period 378 patients whose acutely burned hands had been operated on at the burn center of the university hospital Aachen were invited to a follow-up examination. 67 burned and operated hands were evaluated 57 (3-364) months after the burn by the computerized evaluation system EVAL. Active flexion and extension, grip strength, pinch (key, 3-tip and 2-tip), moving 2-point sensitivity and the pattern of skin grafts and scars were assessed. The use of the hand in daily activities was evaluated by a questionnaire. The hands were classified in 4 groups according to the burn pattern: I: patchy burns (total < 12 cm2), II: confluent dorsal burns, III: confluent palmar burns, IV: mutilating burns. Good results were found in group I (n = 25), comparable to normal hand function. In group II (n = 25) there was a significant loss of total active flexion with preserved strength. Increased extension lag and impaired grip strength characterized group III (n = 8). Late functional results in group IV (n = 9) depended on the reconstructive procedure. Between the 4 groups there were significant differences in function. The results were well correlated to the burn pattern and its extent according the classification.

Activities of Daily Living↗
PubMed1993

Hand preference and the incidence of accidental unilateral hand injury.

Four hundred and eighty-six individuals gave detailed descriptions of an accidental unilateral hand injury and answered questions about their hand preference. Their handedness data were compared to 402 respondents (matched for sex and age) with no experience of hand injury. The risk of hand injury was similar for right- and left-handers. Individuals with consistent hand preference, regardless of side, were more likely to injure their preferred hand when compared to mixed preference types. The present data argue for a use explanation of hand injury risk (one is more likely to injure the hand that is used most frequently) rather than an explanation based on inherent risk factors present for left- but not for right-handers.

Accidents↗
PubMedDate not supplied

An exploratory look at hand strength and hand size among preschoolers.

The purpose of this study was to develop an initial understanding about grip strength, pinch strength and hand size in normally developing 3-, 4-, and 5-year-old children. This study also investigated whether there were relationships among lowing variables: hand strength, hand size, age, and gender. A Jamar dynamometer was used to measure grip strength, and a Jamar pinch gauge was used to measure lateral pinch strength. The study population consisted of 81 preschool children from culturally an economically diverse communities in New York City. Hand strength and hand size were found to increase with each age level. The 5-year-olds were strongest in grip and pinch ability and had larger hands than the 3-year-olds and 4-year-olds. There was no statistically significant difference observed between the boys and the girls or the preferred hand in terms of hand strength.

Child, Preschool↗
PubMed2004

A comparison of the grip force distribution in natural hands and in prosthetic hands.

PURPOSE: The aim of this study is to analyse the grip force distribution for different prosthetic hand designs and the human hand fulfilling a functional task. METHOD: A cylindrical object is held with a power grasp and the contact forces are measured at 20 defined positions. The distributions of contact forces in standard electric prostheses, in a experimental prosthesis with an adaptive grasp, and in human hands as a reference are analysed and compared. Additionally, the joint torques are calculated and compared. RESULTS: Contact forces of up to 24.7 N are applied by the middle and distal phalanges of the index finger, middle finger, and thumb of standard prosthetic hands, whereas forces of up to 3.8 N are measured for human hands. The maximum contact forces measured in a prosthetic hand with an adaptive grasp are 4.7 N. The joint torques of human hands and the adaptive prosthesis are comparable. CONCLUSIONS: The analysis of grip force distribution is proposed as an additional parameter to rate the performance of different prosthetic hand designs.

Adolescent↗
PubMed2005

Efficiency of hand drying for removing bacteria from washed hands: comparison of paper towel drying with warm air drying.

OBJECTIVE: To evaluate warm air and paper towel drying for removing bacteria from washed hands. METHODS: After hands were washed with non-antibacterial soap, they were dried using warm air with and without ultraviolet light, while being rubbed or held stationary, or paper towels. Each method was performed as a randomized trial using 30 hands. RESULTS: Log colony-forming units (CFU) on palms and fingers increased significantly when hands were dried with warm air while being rubbed for 15 seconds (P < .001), and many bacteria remained at 30 seconds without ultraviolet light (P < .001) Holding hands stationary while drying significantly decreased log CFU on palms, fingers, and fingertips (P < .01 or < .001). Few CFU were detected on palms and fingers dried with ultraviolet light. Although log CFU of palms and fingers did not decrease after drying with three sheets of paper towel, those of fingertips decreased significantly (P < .001). For palms and fingers, log reductions were greater with warm air drying while holding hands stationary, paper towels, and warm air drying while rubbing hands. For fingertips, the log reduction was often greater with paper towels than with warm air. CONCLUSIONS: Holding hands stationary and not rubbing them was desirable for removing bacteria. Ultraviolet light reinforced the removal of bacteria during warm air drying. Paper towels were useful for removing bacteria from fingertips but not palms and fingers.

Adult↗
PubMed1985

[Clinical and roentgenological study of the hands in synbrachydactyly, constriction band syndrome and cleft hand complex].

One hundred and six cases of synbrachydactyly, 63 cases of constriction band syndrome and 69 cases of cleft hand complex were clinically and roentgenologically studied and the following results were obtained. Synbrachydactyly is a group of hand anomalies in which the bone reduction appears transversely, and its severest form is a hand missing all the hand bones and the distal portion of the forearm, and with rudimentary digits on the stump. The association of dermal syndactyly or pectoralis muscle defect frequently seen in the milder cases of synbrachydactyly would be a secondary change to mesodermal hypoplasia or a related, but isolated malformation. Cleft hand complex which includes ordinary cleft hand, central ray polydactyly and central ray osseous syndactyly is a group of hand anomalies basically due to an ectodermal abnormality of separation of the digits. However, it is frequently associated with mesodermal hypoplasia or defect of various severity. The hand malformation in constriction band syndrome has a definite characteristic that the area of bone reduction is limited in phalanges.

Female↗
PubMed1979

Optimal response of eye and hand motor systems in pointing at a visual target. II. Static and dynamic visual cues in the control of hand movement.

The closed loop situation of hand pointing at a target has been experimentally divided into its static and dynamic components. When the subjects see their hand at first (closed loop) until the start of the hand movement cuts off the vision of the hand (open loop), the pointing is significantly more accurate than when it is performed without any vision of the hand before and throughout the movement (fully open loop). This suggests that initial cues as regards hand and target position, improve the motor program by a better identification of initial and final states. As poor as it is, the extra retinal signal (encoding of eye position) improves performance when the foveation is done under closed loop; it allows a better redefinition of target position, and thus modulates the hand motor program through a direct central pathway, which is quicker than the processing of the visual feedback of the hand movement error.

Eye Movements↗
PubMed1979

Optimal response of eye and hand motor systems in pointing at a visual target. I. Spatio-temporal characteristics of eye and hand movements and their relationships when varying the amount of visual information.

In a task requiring an optimal hand pointing (with regards to both time and accuracy) at a peripheral target, there is first a saccade of the eye within 250 ms, followed 100 ms later by the hand movement. However the latency of the hand movement is poorly correlated with that of the eye movement. When the peripheral target is cut off at the onset of the saccade, there is no correlation between the error of the gaze position and the error of the hand pointing. This suggests an early parallel processing of the two motor outputs. The duration of hand movement does not change significantly when subjects either see or not see their hand (closed or open loop). In the open loop situation, the undershoot of the hand pointing increases with target eccentricity, whatever the subjects are allowed or not to do a saccade toward the target. It suggests that the encoding of eye position by itself is a poor index for an accurately guided movement of the hand.

Adult↗
PubMed2005

Effects of waterproof covering on hand immersion tests using water at 10 degrees C, 12 degrees C and 15 degrees C for diagnosis of hand-arm vibration syndrome.

OBJECTIVES: To compare effects of waterproof covering on finger skin temperature (FST) and subjective hand pain during immersion tests using cold water at 10 degrees C, 12 degrees C and 15 degrees C. In the (Draft International Standard) of the International Organization for Standardization (ISO/DIS 14835-1), a water temperature of 12 degrees C and use of water covering are proposed. METHODS: Six healthy male subjects took part in the immersion tests and immersed both hands into water at 10 degrees C, 12 degrees C and 15 degrees C for 5 min, repeatedly, with waterproof covering (polyethylene gloves) or without (bare hands). The FST data from middle fingers and subjective pain scores for hand pain were analyzed. Furthermore, the test with water at 12 degrees C was repeated to assess the repeatability of the test. RESULTS: The glove and water temperature factors for FST were significant at every minute from 1 min during immersion up to 2 min after recovery, showing higher values for waterproof covering than for bare hands and showing lowest values for water temperature of 10 degrees C and highest for 15 degrees C. The glove and water temperature factors for subjective pain score were significant at the 1-min and 2-min points during immersion, showing lower scores for waterproof covering than for bare hands and showing highest scores for water temperature of 10 degrees C and lowest for 15 degrees C. The results of the first and second tests using water of 12 degrees C showed no systematic difference in FST and hand pain between the tests, with a few exceptions. CONCLUSIONS: Subjective pain during the cold immersion test with polyethylene gloves and water at 12 degrees C can be reduced, while the differences in FST between water temperatures of 10 degrees C and 12 degrees C were small or not apparent at some points during immersion and recovery. The test also seems to be suitable for repeatability. Further investigation on hand-arm vibration syndrome (HAVS) patients to validate the use of the immersion test with gloves to obtain sufficient data for diagnostic value is required.

Adult↗
PubMed2004

Efficacy of alcohol-based gels compared with simple hand wash and hygienic hand disinfection.

A recent research letter on the limited efficacy of alcohol-based hand gels has alerted the global infection control community and raised the question of the true significance of data obtained according to EN 1500. It has been described that a 1 min simple hand wash reduces artificial contamination of hands by a log(10) reduction factor of 2.8 and a 1 min reference hand disinfection with 2-propanol (60%, v/v) by a factor of 4.6 steps. The EN 1500 gel data show that the 30 s efficacy of most gels is closer to a simple hand wash than to the reference hand disinfection. The 30 s efficacy of most alcohol-based liquid products and one gel, however, is almost identical to the reference hand disinfection. In many European countries alcohol-based liquid products have been established as a standard practice in hygienic hand disinfection for decades. Replacement of these products with most available gels would be a step backward in terms of efficacy and has still to be seen critically from the efficacy point of view.

Anti-Infective Agents, Local↗
PubMed1999

Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands.

BACKGROUND: The effectiveness of hand-cleansing agents (plain liquid soap, 70% ethyl alcohol, 10% povidone-iodine, and 4% chlorhexidine gluconate) for removing a hospital strain of Acinetobacter baumannii from artificially contaminated hands of 5 volunteers was studied. METHODS: The experiments were performed by using a Latin square statistical design, with two 5 x 4 randomized blocks, and the results were estimated by ANOVA. In the first and second blocks, the fingertips of the volunteers were contaminated with approximately 10(3) colony-forming units (light contamination hand) and 10(6) colony-forming units (heavy contamination hand), respectively. RESULTS: In the first block, all products tested were effective, almost completely removing the microbial population of A baumannii artificially applied to the hands. In the second block, the use of hand-cleansing agents resulted in 91.36% (4% chlorhexidine), 92.33% (liquid soap), 98.49% (10% povidone-iodine), and 98.93% (70% ethyl alcohol) reduction in counts of A baumannii cells applied to the fingertips. The ethyl alcohol and povidone-iodine had significantly higher removal rates than plain soap and chlorhexidine (P <.05). CONCLUSIONS: These results suggest that 70% ethyl alcohol and 10% povidone-iodine may be the most effective hand-cleansing agents for removing A baumannii strain from heavily contaminated hands (10(6) colony-forming units/fingertip).

Acinetobacter↗
PubMed1977

Failure of hand disinfection with frequent hand washing: a need for prolonged field studies.

In a prolonged field trial a 4% chlorhexidine digluconate detergent scrub (Hibiscrub(R)), that had earlier proved to be an effective hand disinfectant, was studied in hospital wards. Finger tips were found to harbour more bacteria than the hand dorsum and the samples collected from them yielded more information on the bacteriological and dermatological effects of hand disinfectants in practice.In wards with a relatively low hand-washing frequency (less than 20 times in 8 hours) the bacteriological results resembled those obtained by in-use tests with volunteers. In the neonatal unit where the hand washing frequency was remarkably high, even occasionally over 100 times/8 h shift, an increase in the bacterial colony counts of the majority of the staff was recorded both before and after hand washing already after using the preparation for 1 week. Age, occupation and hand-washing frequency all correlated with the bacteriological results. Twenty-seven out of 37 persons complained of side effects such as wounds of finger tips and redness or heavy drying of the skin. Wounds, particularly on finger tips, resulted in the failure of disinfection. An increase in bacterial counts was sometimes noted without any dermatological or subjective changes. Drying of the skin was complained of less often when no increase in skin bacteria occurred.After the changeover of washing practice to a detergent followed by a rinse with spirit solution containing chlorhexidine and glycerol a decrease was recorded in the bacterial counts. It is concluded that more attention should be paid to long-term testing of hand washing and disinfection methods to ensure optimum final results in practice. It is obvious that the knowledge obtained from short time in-use testing cannot be applied to all conditions of use.

Adult↗
PubMed2002

Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU.

OBJECTIVE: To determine the effect of implementing an evidence-based hand washing policy on between-patient hand washing compliance and on blood and cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care unit (NICU). METHODS: An evidence-based hand washing policy, supported by an intensive education program, was introduced in a regional NICU. A total of 2009 preintervention neonates (16,168 patient days) over 17 months were compared to 676 postintervention neonates (5779 patient days) over 6 months. Hand washing compliance and rates of blood and CSF cultures yielding coagulase negative staphylococci (CONS) were compared before and after intervention. RESULTS: Compliance with appropriate between-patient hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced. The rate of cultures positive for CONS declined from 6.1+/-2.3 to 3.2+/-1.6 per 1000 patient days (p=0.005). Most of this reduction was attributable to a reduction in false-positive cultures, from 4.2+/-2.4 to 1.9+/-1.8 per 1000 patient days (p=0.042), but there was a trend toward decreased true-positive cultures (from 2.1+/-1.2 to 1.2+/-1.0 per 1000 patient days, p=0.074) as well. Potential confounders and demographics factors were similar between the control and intervention subjects. CONCLUSION: Implementation of an evidence-based hand washing policy resulted in a significant increase in hand washing compliance and a significant decrease in false-positive coagulase negative staphylococcal blood and CSF culture rates. Exploratory data analysis revealed a possible effect on true-positive coagulase negative staphylococcal blood and CSF culture rates, but these results need to be confirmed in future studies.

Adult↗
PubMed2004

Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury.

STUDY DESIGN: Development of Tetraplegia Hand Activity Questionnaire (THAQ). SETTING: Patients and spinal cord injury (SCI) professionals from five rehabilitation centres in the Netherlands and Belgium. OBJECTIVE: To construct a disease-specific questionnaire to evaluate interventions to the arm-hand of tetraplegics in terms of gained and lost activities relevant to the patient. METHODS: All arm-hand function-related activities were inventoried by examining existing scales and interviewing spinal cord injury patients and professionals in the field. Subsequently, item reduction was achieved; first, in the technical construction by incorporating all activities in an item list, then reducing the list by selecting the items most likely to be sensitive to change after surgical or functional electro stimulation interventions on the arm-hand as judged by an expert panel, using a Delphi method. RESULTS: The arm-hand-related activity inventory comprised 652 activities. The technical construction of the items and the Delphi procedure resulted in a questionnaire with 153 items. The experts considered many of the 'new' activities more relevant for the evaluation of hand function interventions than those found in scales studied in the literature. This is reflected in a relatively large proportion of new activities (69%) for the item list of the THAQ, and even more in the domains work/admin/telecom (88%) and leisure (100%). CONCLUSION: The questionnaire constructed to assess hand function-related activities contains relevant activities to evaluate arm-hand function-related interventions for tetraplegic SCI patients.

Activities of Daily Living↗
PubMed1999

Congenital hemiplegia in children at school age: assessment of hand function in the non-hemiplegic hand and correlation with MRI.

The aim of this study was to evaluate whether children with congenital hemiplegia show abnormal hand function on the non-hemiplegic side and whether this, if present, can be related to the type and extent of brain lesions on MRI. Twenty-two children with congenital hemiplegia of age ranging between 4.8 and 12.3 years, were assessed with a clinical and MRI assessment. Clinical assessment included a structured neurological examination, assessment of hand grips and the Movement Assessment Battery for Children which also includes one item assessing speed and accuracy in each hand. The results showed that 64% of the children studied showed some degree of functional impairment of the non-hemiplegic hand. Manual dexterity 1 from the Movement ABC was, in our experience, a more sensitive tool to detect minor functional abnormalities than the evaluation of hand grips. The severity of the impairment on the non-hemiplegic side was not significantly related to the severity of impairment in the hemiplegic hand (p > 0.05). In contrast, a significant association was found with the site of lesions as hand function in the non-hemiplegic hand was always normal in children with unilateral lesion and abnormal in the ones with bilateral parenchymal lesions (p < 0.05). Children with predominantly unilateral lesions but with bilateral ventricular dilatation or periventricular changes showed more variable results.

Brain↗
PubMed2002

Predictability of hand skill and cognitive abilities from craniofacial width in right- and left-handed men and women: relation of skeletal structure to cerebral function.

Recently, a family of homeobox genes involved in brain and craniofacial development was identified. In light of this genetic background, we hypothesized that some functional characteristics of human brain (hand skill, cognition) may be linked to some structural characteristics of human skull (e.g., craniofacial width) in humans. Hand preference was assessed by Oldfield's Handedness Questionnaire. Hand skill was measured by Peg Moving Task. Face width was measured from the anteroposterior cephalograms (x-ray) using right (R) and left (L) zygomatic points. Intelligence "g" was assessed by Cattell's Culture Fair Intelligence Test; the perceptual-verbal ability was assessed by "Finding A's Test"; the spatial ability was assessed by the mental rotation task, in right- and left-handed men and women. The percentages of right-, left-, and mixed-faced subjects were close to those found for paw preference in cats. Women tended to be more right-faced (R--L > 0) and less left-faced (R--L < 0) than men, who tended to be more left-faced and less right-faced than women. R--L face width inversely correlated with L--R PMT (peg moving time) in left-handers; there was a direct relation between these variables in right-handers. Cattell IQ linearly increased with R--L face width in left-handers, negatively correlated in right-handed men and women. Verbal ability inversely related to R--L face width in right- and left-handed men, but directly correlated in right-handed women. The number of correct response on mental-rotation task positively and linearly correlated with R--L face width in left-handers and right-handed women. It was concluded that the structural-functional coupling revealed in the present work may have its origins in parallel development of the craniofacial skeleton and brain under the influence of homeobox genes.

Adult↗
PubMed1999

Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.

OBJECTIVE: To document long-term results associated with an coordinated plan of care for acutely burned hands in children. SUMMARY AND BACKGROUND DATA: Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported. METHODS: Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized. RESULTS: Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon. CONCLUSIONS: When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results.

Adolescent↗
PubMed2004

Overview of studies of treatments for hand eczema-the EDEN hand eczema survey.

BACKGROUND: Hand eczema is a major cause of morbidity and lost earnings. Many interventions ranging from topical steroids to oral ciclosporin are used, but their evidence base and the best methods to assess their efficacy are uncertain. OBJECTIVES: As part of a long-term project to improve standards of design and reporting in hand eczema trials, we sought to describe the prevalent study designs and comment on the quality of reporting of such studies. METHODS AND DATA SOURCES: Electronic databases (Cochrane, Medline, Embase, Pascal, Jicst-Eplus, Amed) were searched from January 1977 to April 2003 using all possible variants of the terms hand and eczema/dermatitis. In addition, four general medical and 17 specialist dermatology journals were hand-searched by pairs of researchers for all possible therapeutic studies. STUDY SELECTION: Studies were eligible for inclusion if they dealt with hand eczema as diagnosed by a physician irrespective of the aetiology, and if they described the results of a study of a therapeutic intervention in humans. Single case reports and reviews were excluded, but case series and nonrandomized studies were considered alongside randomized studies. Data selection For each study, two researchers independently assessed the type of study, outcome measures, enrolment criteria, randomization, masking of interventions and how losses to follow-up were dealt with. MAIN OUTCOME MEASURES: Proportion of studies according to type of intervention and study type. Proportion of randomized controlled trials (RCTs) that adequately reported eligibility criteria, randomization generation and concealment, masking and intention-to-treat analysis. RESULTS: A total of 90 studies reported in 87 papers dealt with 11 different classes of interventions. Around 80% of the studies dealt with just four interventions: ultraviolet light, topical steroids, radiation and systemic immunosuppressives. Of the 90 studies, 44 were case series, 15 were nonrandomized controlled trials, and the remaining 31 were RCTs. Of the 31 RCTs, 16 were parallel (one with cross-over design) and 15 self-controlled. Only 11 of the RCTs adequately reported eligibility criteria. The randomization method was described in 10, and there was adequate concealment of allocation in eight. Masking the treatment allocation from both the study assessors and patients was done in 11 RCTs, and intention-to-treat analysis was reported in four. Only 13 RCTs were 4 months or longer in duration. No study reported a rationale for the sample size, and in only one study had the outcome variable been validated. CONCLUSIONS: Most 'trials' in hand eczema are not RCTs. Internally controlled (left/right) studies were common. Based on the poor overall quality of reporting, most RCTs of hand eczema trials are not adequate to guide clinical practice. Future trials of hand eczema should be randomized, using a parallel group or self-controlled design. Research is needed to develop validated and clinically relevant outcome measures. Most of the remaining issues relating to poor quality of existing evidence can be relatively easily dealt with by following the CONSORT guidelines.

Eczema↗