Detection of submaximal effort with computer-assisted grip strength measurements.

The purpose of this study was to establish a simple observation to help in distinguishing patients who are giving their maximal effort during computer-assisted grip strength measurements from those who are not. Preliminary observations had suggested that maximal effort with this grip-strength device was characterized by greater force in the radial digits than the ulnar digits and a small variability in force between individual grasps. These observations were then prospectively analyzed in the following groups: (a) 178 assembly workers tested during a routine screening at a computer manufacturing company and during pre-placement physicals; (b) 196 workers with a hand injury or cumulative trauma disorder who were seeking consultation for medical treatment; (c) 55 workers with a hand injury or cumulative trauma disorder being measured to determine their return to work status or impairment rating; and (d) 58 asymptomatic volunteers. The volunteers were instructed to perform the maximal grip in the same fashion as the other groups and then to repeat the test exerting a submaximal effort they estimated to be 50% of their own maximal effort. The results of this study demonstrated that there is a highly significant association, P < 0.001, between the presence of a "total pattern" (radial over ulnar force being less than 1.0, unilateral grip variation greater than 15%, and difference between the left and right grip variation greater than 5%) and the presence of submaximal effort during grip-strength measurements.

Use of vibration testing in the early evaluation of workers with carpal tunnel syndrome.

Workers with symptoms of carpal tunnel syndrome (CTS) were evaluated by vibrometry to measure decreased digital vibratory perception and by questionnaire with comparison to a control group. Those workers with CTS confirmed by electromyography or surgery had significantly lower levels on vibrometry testing (P less than .001), and those with symptoms only also showed significantly lower vibrometry values (P less than .01 to .001). Early detection by vibrometry coupled with ergonomic intervention is suggested to be a cost-effective method to control cumulative trauma syndrome of the upper extremity.

Peripheral nerve dysfunction in practicing dental hygienists.

Hand-intensive repetitive procedures such as those performed by dental hygienists can lead to cumulative trauma disorders of the upper extremity. One such disorder is median nerve dysfunction leading to carpal tunnel syndrome (CTS). Vibrometry has been used in industrial settings as a method of early detection of sensory nerve impairment. This technique uses vibratory stimuli to assess the level of sensory perception in the fingertips. Using programmed frequency stimuli, 58 practicing dental hygienists were evaluated bilaterally for median nerve dysfunction. Results indicated that 15 (25.9%) of the dental hygienists reported the presence of CTS symptoms, while 7 (12.0%) tested positive for mild median nerve dysfunction. The findings suggest that vibrometry testing could aid in the early detection of CTS, thereby reducing its effects on clinical practice and facilitating early treatment.

Airport emergency medical services.

To obtain improved emergency medical services at the Minneapolis/St. Paul International Airport, a combination of utilization of existing fire, police, and medical services and improved technology was adopted. Exemplified by the use of EMT and an automatic cardiac defibrillator/pacer (Heart Aide), this system resulted in increased survival for victims of cardiac arrest at the Twin Cities airport. Furthermore, this system allowed for improved triage efficiency and breadth of services that complemented the already existing aircraft crash disaster program.