Abstract
Study Design
Cross-sectional research design.
Introduction
Current assessment of hand function is not focused on evaluating the real abilities required for autonomy.
Purpose of the Study
To quantify the relevance of grasp types for autonomy to guide hand recovery and its assessment.
Methods
Representative tasks of the International Classification of Functioning, Disability and Health activities in which the hands are directly involved were recorded. The videos were analyzed to identify the grasps used with each hand, and their relevance for autonomy was determined by weighting time with the frequency of appearance of each activity in disability and dependency scales. Relevance is provided globally and distinguished by hand (right-left) and bimanual function. Significant differences in relevance are also checked.
Results
The most relevant grasps are pad-to-pad pinch (31.9%), lumbrical (15.4%), cylindrical (12%), and special pinch (7.3%) together with the nonprehensile (18.6%) use of the hand. Lumbrical grasp has higher relevance for the left hand (19.9% vs 12%) while cylindrical grasp for the right hand (15.3% vs 7.7%). Relevancies are also different depending on bimanual function.
Discussion
Different relative importance was obtained when considering dependency vs disability scales. Pad-to-pad pinch and nonprehensile grasp are the most relevant grasps for both hands, whereas lumbrical grasp is more relevant for the left hand and cylindrical grasp for the right one. The most significant difference in bimanual function refers to pad-to-pad pinch (more relevant for unimanual actions of the left hand and bimanual actions of the right).
Conclusions
The relative importance of each grasp type for autonomy and the differences observed between hand and bimanual action should be used in medical and physical decision-making.
Source: Relevance of grasp types to assess functionality for personal autonomy – Journal of Hand Therapy
TBI Rehabilitation 