The effect of wrist position on testing light touch sensation using the Semmes-Weinstein pressure aesthesiometer: a preliminary study.

The objective of the study was to determine the normative values for light touch sensation measured by the Semmes-Weinstein pressure aesthesiometer when the wrist is held in the maximal flexed position and when the wrist is held in the maximal extended position. Currently, normative values exist only for measurements taken when the wrist is held in a neutral position. Thirty-one subjects with no previous hand injury or pathology participated in this preliminary study. Each subject served as his or her own control; i.e., each finger with the wrist in a neutral position served as the control for the same finger when the wrist was positioned in maximal flexion and then in maximal extension. The neutral position was used as the control, because normative values already exist for that position. The results revealed no consistent differences between measurements taken when the wrist was held in a neutral position and those taken with the wrist held in the maximal, or complete, flexed or extended position. This suggests that any difference in sensation found when hands are placed in a provocative position--i.e., when wrists are flexed or extended rather than placed in a neutral resting position--may be due to pathology and not to position.

Upper extremity cumulative trauma disorder and return to work assessment.

Evaluation of the patient with upper limb cumulative trauma disorder (CTD) requires use of both qualitative and quantitative measures. The clinical evaluations are reviewed, which include tests for range of motion, strength, limb size, sensation, and dexterity. Essential observations for identifying and describing the presentation of posture, symptoms, and painful events are illustrated for qualitative descriptions related to work activities and activities of daily living (ADL). Therapeutic intervention is described in two sequential stages: calming of symptoms and then control of symptoms.

Evaluating the hand: issues in reliability and validity.

Evaluation of hand function is a qualitative and quantitative process. This article provides a review of several quantitative tests and measures used to evaluate range of motion, edema, muscle performance, sensation, dexterity, and physical capacity. The validity and reliability of these instruments are emphasized. Some of the hand assessments reviewed are in the early developmental phase with further refinements yet to come. This article demonstrates the continued need to provide support for the validity and reliability of hand-assessment instrumentation. Regardless of the statistical support provided, however, the authors believe that hand therapy will remain an art as well as a science.

Hand rehabilitation and occupational therapy.

Occupational therapy for hands has been recognized as a speciality within the profession since the 1940s. The growing numbers of patients with acquired or congenital problems affecting their hands as well as the newer surgical procedures now available to restore lost function has challenged therapists. To manage the highly specialized needs of the complicated hand problems seen in the clinical setting, there is emphasis on perfecting technical skill. Equally required is the ability to remediate not only the physical dysfunction but also the patient's response to this dysfunction. For it is in this holistic approach to patient care that occupational therapy has its true strength in helping to successfully remediate the difficulties of the patient with a hand problem. Practical application of this principle is shown in a case study.

Evaluation of impairment of the upper extremity.

Evaluation of impairment of the upper extremity is the product of a team effort by the physician, occupational therapist, physical therapist, and rehabilitation counselor. A careful recording of the anatomic impairment should be made because this is critical in determining the subsequent functional activities of the extremity. The measurement criteria for clinical and functional evaluation includes condition assessment instruments. Some assess the neurovascular system, others assess movements including the monitoring of articular motion and musculotendinous function. Sensibility assessment instruments measure sympathetic response and detect single joint stimulus, discrimination, quantification, and recognition abilities. A detailed description of each assessment is recorded and physical capacity evaluation is only one component of the entire vocational evaluation. This evaluation answers questions regarding the injured worker's ability to return to his previous job. The work simulator is a useful instrument that allows rehabilitation and testing of the injured upper extremity. Job site evaluation includes assessment criteria for work performance, work behavior, and work environment.

The expanding role of occupational therapy in the treatment of industrial hand injuries.

A recent survey of members of the American Society of Hand Therapists revealed an expanding role for the therapist in the treatment of industrial hand injuries. In the traditional role of treatment provider, occupational therapists are using their assessment tools and work capacity programming to aid in predicting return to work readiness. This is aimed at preventing reinjury of the present patient population. In addition to this, therapists have begun to identify relationships between specific injuries and work that produced them. This gives rise to a specified goal of preventing the injury from ever occuring. To reach this goal therapists are becoming involved in industrial settings and are working with industrial safety teams.

Factors affecting return to work after hand injury.

The study of 61 hand-injured subjects suggested that it is more than surgical and technical excellence that facilitates the return-to-work status among the hand-injured wage earners. Financial need, level of activities of daily living, and participation in occupational therapy were found to be directly related to return-to-work status. Additional findings indicated no difference between the rate of return to work for those whose injuries affected their dominant hand over those who had nondominant hand injuries. The amount of medical care needed and whether it was delivered as an outpatient or an inpatient were not associated with the return to work. The hand-injured subjects' relevant medical history, participation in occupational therapy, capacity in activities of daily living, desire and ability to return to work, and financial support were quantified through chart audit and interview. Occupational development was measured by using the Moorhead Occupational Work History.