Posts Tagged grip strength

[Abstract] Measurement Properties of the Hand Grip Strength Assessment. A Systematic Review with Meta-analysis



The aim of this study was to critically appraise, compare and summarize the quality of the measurement properties of grip strength (GS) in healthy participants and patients with musculoskeletal, neurological or systemic conditions.

Data Sources

We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline. To identify studies on measurement properties of GS, we searched the Medline, Embase, CINAHL, PEDro and Cochrane Library databases from inception till June 2019. Meta-analyses were carried out using a random effect model and 95% confidence intervals (CI) were calculated.

Study Selection

Studies were included if they reported at least 1 measurement property of hand GS in healthy patient population or with musculoskeletal, neurological and systemic conditions

Data Extraction

The extracted data included the study population, setting, sample size, measurement evaluated and the test interval.

Data Synthesis

Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intra-class correlation coefficients (ICC) 0.92, 95% CI: -0.88 to 0.94 for healthy participants, ICC 0.95, 95% CI: -0.93 to 0.97 for upper extremity conditions and an ICC of 0.96, 95% CI: -0.94 to 0.97 for patients with neurological conditions. Minimum Clinically Important Difference (MCID) scores for hand GS were: 5.0 kg (dominant side) and 6.2 kg (non-dominant side) for post-stroke patients, 6.5 kg for the affected side after distal radius fracture, 10.5lbs and 10 kilopascals for immune-mediated neuropathies, 17kg for patients with lateral epicondylitis and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group, and MCID GS estimates of 2.69 – 2.44 kg in the healthy group


Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.

via Measurement Properties of the Hand Grip Strength Assessment. A Systematic Review with Meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Impaired force control contributes to car steering dysfunction in chronic stroke

Purpose: Precise control of a car steering wheel requires adequate motor capability. Deficits in grip strength and force control after stroke could influence the ability steer a car. Our study aimed to determine the impact of stroke on car steering and identify the relative contribution of grip strength and grip force control to steering performance.

Methods: Twelve chronic stroke survivors and 12 controls performed three gripping tasks with each hand: maximum voluntary contraction, dynamic force tracking, and steering a car on a winding road in a simulated driving environment. We quantified grip strength, grip force variability, and deviation of the car from the center of the lane.

Results: The paretic hand exhibited reduced grip strength, increased grip force variability, and increased lane deviation compared with the non-dominant hand in controls. Grip force variability, but not grip strength, significantly predicted (R2 = 0.49, p < 0.05) lane deviation with the paretic hand.

Conclusion: Stroke impairs the steering ability of the paretic hand. Although grip strength and force control of the paretic hand are diminished after stroke, only grip force control predicts steering accuracy. Deficits in grip force control after stroke contribute to functional limitations in performing skilled tasks with the paretic hand.

  1. Implications for rehabilitation
  2. Driving is an important goal for independent mobility after stroke that requires motor capability to manipulate hand and foot controls.

  3. Two prominent stroke-related motor impairments that may impact precise car steering are reduced grip strength and grip force control.

  4. In individuals with mild-moderate impairments, deficits in grip force modulation rather than grip strength contribute to compromised steering performance with the paretic hand.

  5. We recommend that driving rehabilitation should consider re-educating grip force modulation for successful driving outcomes post stroke.

via Impaired force control contributes to car steering dysfunction in chronic stroke: Disability and Rehabilitation: Vol 0, No 0

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[ARTICLE] Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial – Full Text



New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The wearable soft-robotic ironHand glove is such a system that supports grip strength during the performance of daily activities and hand training exercises at home.


This pilot randomized controlled clinical study explored the effect of prolonged use of the assistive ironHand glove during daily activities at home, in comparison to its use as a trainings tool at home, on functional performance of the hand.


In total, 91 older adults with self-perceived decline of hand function participated in this study. They were randomly assigned to a 4-weeks intervention of either assistive or therapeutic ironHand use, or control group (received no additional exercise or treatment). All participants performed a maximal pinch grip test, Box and Blocks test (BBT), Jebsen-Taylor Hand Function Test (JTHFT) at baseline and after 4-weeks of intervention. Only participants of the assistive and therapeutic group completed the System Usability Scale (SUS) after the intervention period.


Participants of the assistive and therapeutic group reported high scores on the SUS (mean = 73, SEM = 2). The therapeutic group showed improvements in unsupported handgrip strength (mean Δ = 3) and pinch strength (mean Δ = 0.5) after 4 weeks of ironHand use (p≤0.039). Scores on the BBT and JTHFT improved not only after 4 weeks of ironHand use (assistive and therapeutic), but also in the control group. Only handgrip strength improved more in the therapeutic group compared to the assistive and control group. No significant correlations were found between changes in performance and assistive or therapeutic ironHand use (p≥0.062).


This study showed that support of the wearable soft-robotic ironHand system either as assistive device or as training tool may be a promising way to counter functional hand function decline associated with ageing.



Hand function predominantly determines the quality of performance in activities of daily living (ADL) and work-related functioning. Older adults with age-related loss of muscle mass (i.e. sarcopenia) [1] and/or age-related diseases (e.g. stroke, arthritis) [23] suffer from loss of hand function. As a consequence, they experience functional limitations, which affects independence in performing ADL [35].

An effective intervention for improving hand function of (stroke) patients should consist of several key aspects of motor learning, such as high-intensity and task-specificity in repetitive and functional exercises that are actively initiated by the patient him/herself [67]. In a traditional rehabilitation setting, those kinds of interventions are performed with one-on-one attention from the healthcare professional for each patient. This might become problematic in the near future when the population of older adults with age-related diseases (e.g. stroke, rheumatoid arthritis) with hand function decline will rise, resulting in an increased need for healthcare professionals and a rise of healthcare costs [8]. Therefore, new alternatives to provide intensive therapy for all patients are needed in the future.

New technological developments, such as robot-assisted hand training, have the potential to provide such intensive, repetitive and task-specific therapy. Several reviews [911] already showed positive results on motor function after robot-assisted training of the upper extremity. However, limiting factors of robot-assisted therapy are the need for supervision of a healthcare professional, the high costs of the devices and the limited availability of wearable devices for training at home [12]. Furthermore, it is often not efficient in transferring the trained movements into daily situations [6]. Therefore, the next generation robotic training approaches should pay substantial attention towards home-based rehabilitation and the functional nature of the exercise involved.

A new way of providing functional, intensive and task-specific hand training would involve using new technological innovations that enable support of the affected hand directly during the performance of ADL, based on the concept of a wearable robotic glove [1318]. In this way, the affected hand can be used repeatedly and for prolonged periods of time during functional daily activities. These robotic gloves can use different human-robot interfaces to provide assistance for the affected hand, such as an EMG-controlled glove, a tendon driven glove, a glove controlled by force sensors etc. [1314161819]. All these robotic gloves use soft and flexible materials to make such devices more lightweight and easy to use, accommodating wearable applications. This concept of a wearable soft-robotic glove allows persons with reduced hand function to use their hand(s) during a large variety of functional activities and may even turn performing daily activities into extensive training, independent from the availability of healthcare professionals. This is thought to improve hand function and patient’s independence in performing ADL.

Therefore, an easy to use and wearable soft-robotic glove (ironHand system), supporting grip strength and hand training exercises at home, was developed within the ironHand project [20]. Previous studies have examined feasibility [20] and the orthotic effect of the ironHand system [21]. In a first randomized controlled clinical study, the effect of prolonged use of such an assisting glove during ADL at home on functional performance of the hand was explored, in comparison to its use as a training tool at home.[…]


Continue —> Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial

Fig 2.
Overview of the ironHand system with assistive functionality (left panel) and therapeutic functionality (right panel). * Reprinted from Bioservo Technologies under a CC BY license, with permission from Bioservo Technologies, original copyright 2017.


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[NEWS] NEOFECT Wins Design Week VirtualTech Award for Second Year In a Row

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NEOFECT was once again honored at the San Francisco Design Week (SFDW) Awards, winning the VirtualTech award for its new Smart Board for Home NextGen, a gamified rehabilitation device for stroke survivors to use at home.

This marks the second consecutive year that the company has received the VirtualTech award, according to a company announcement.

“The Smart Board for Home NextGen is the epitome of the 2019 SFDW Awards theme, and we’re humbled to have won this year after receiving Honorable Mention in the VirtualTech category last year for our Smart Glove for Home,” says Scott Kim, co-founder and CEO of NEOFECT USA, in the release.

“We took every aspect of the patient experience into account when redesigning the Smart Board for Home NextGen,” Kim adds.

“For example, stroke patients’ grip is often weak, so we re-engineered the handle to be more secure. We developed more interactive virtual reality games, like tennis, so patients can have more variety, and also created a dual-player option.”

SFDW is an international design competition that honors projects encouraging thought leadership in design, focusing on “Where Innovation Meets Social Responsibility.”

The awards celebrate and recognize exemplary work in all fields of design, including architecture, interior design, industrial design, communication design, and user experience design.

Twenty-four winning projects and 11 honorable mentions were selected by a jury comprised of professionals—including executives from Lyft, Google, Microsoft, and Fitbit—who reviewed submissions from a pool of applicants from the USA and Europe. Each winning project was judged based on impact, singularity, inclusiveness, social responsibility, ease of use, visual appeal, and feasibility.

Award winners from leading design firms, in-house teams, and creative individuals were honored recently during a ceremony that took place at Pier 27 in San Francisco, the release explains.

“We are extremely excited the San Francisco Design Week Awards returned this year,” states SFDW Executive Director Dawn Zidonis.

“As with last year, the quality of the many entries exceeded our expectations. Congratulations to this year’s outstanding and diverse winners, including NEOFECT.”

[Source(s): NEOFECT, Business Wire]


via NEOFECT Wins Design Week VirtualTech Award for Second Year In a Row – Rehab Managment

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[WEB SITE] MoreGrasp: Getting a better grip on things

September 18, 2018 by Barbara Gigler, Graz University of Technology

The goal of the MoreGrasp project was to develop a sensoric grasp neuroprosthesis to support the daily life activities of people living with severe to completely impaired hand function due to spinal cord injuries. The motor function of a neuroprosthesis was to be intuitively controlled by means of a brain-computer interface with emphasis on natural motor patterns. After three years, the breakthrough was reported by the members of the project consortium led by Gernot Müller-Putz, head of the Institute of Neural Engineering at TU Graz, which include the University of Heidelberg, the University of Glasgow, the two companies Medel Medizinische Elektronik and Bitbrain as well as the Know Center.

Gernot Müller-Putz says, “In , all the circuits in the brain and muscles in the body parts concerned are still intact, but the neurological connection between the brain and limbs is interrupted. We bypass this by communicating via a computer, which in turn, passes on the command to the muscles.” The muscles are controlled and encouraged to move by electrodes that are attached to the outside of the arm and can, for example, trigger the closing and opening of the fingers. The key was the sufficient distinguishability of the brainwaves to control the neuroprosthesis. For instance, if the participant thought about raising and lowering their foot and the signal measured by the EEG opened the right hand, the subject then—for instance—would think of a movement of the left hand and the right hand would close again.

The MoreGrasp consortium developed this technique further. This mental ‘detour’ of any distinguishable movement pattern is no longer necessary, as Müller-Putz explains: “We now use so-called ‘attempted movement.'” In doing so, the test subject attempts to carry out a movement like grasping a glass of water. Due to the tetraplegia, the brain signal is not passed on, but can be measured by means of an EEG and processed by the computer system. Müller-Putz is extremely pleased with the success of the research. He says, “We are now working with signals that only differ from each other very slightly. Nevertheless, we have managed to control the neuroprosthesis successfully. For users, this results in a completely new possibility of making movement sequences easier—especially during training. A variety of grips were investigated in the project: the palmar grasp (cylinder grasp, as for grasping a glass), the lateral grasp (key grasp, as for picking up a spoon), and opening the hand and turning it inwards and outwards.

Large-scale study

End users can register on the special online platform to enter a large-scale feasibility study intended to check compatibility of the technique in everyday life. Participants eligible for the study will be tested according to a complex procedure. Afterward, each subject will be provided with a tailor-made BCI training course which must be completed independently in sessions lasting several hours each week. In this way, brain signals will be gathered and the system itself will learn during each experiment.

 Explore further: Potential brain-machine interface for hand paralysis

via MoreGrasp: Getting a better grip on things

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[Abstract] The wearable hand robot: supporting impaired hand function in activities of daily living and rehabilitation


Our hands are very important in our daily life. They are used for non-verbal communication and sensory feedback, but are also important to perform both fine (e.g. picking up paperclips) and gross (e.g. lifting heavy boxes) motor tasks. Decline of hand function in older adults as a result of age-related loss of muscle mass (i.e. sarcopenia) and/or age-related diseases such as stroke, rheumatoid arthritis or osteoarthritis, is a common problem worldwide. The decline in hand function, in particular grip strength, often results in increased difficulties in performing activities of daily living (ADL), such as carrying heavy objects, doing housework, (un)dressing, preparing food and eating.
New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The ironHand and HandinMind systems are examples of such novel wearable soft-robotic systems that have been developed in the ironHand and HandinMind projects. Both systems are developed to provide grip support during a wide range of daily activities. The ironHand system consists of a 3-finger wearable soft-robotic glove, tailored to older adults with a variety of physical age-related hand function limitations. The HandinMind system consists of a 5-finger wearable soft-robotic glove, dedicated towards application in stroke. In both cases, the wearable soft-robotic system could be connected to a computer with custom software to train specific aspects of hand function in a motivating game-like environment with multiple levels of difficulty. By adding the game environment, an assistive device is transformed into a dedicated training device.
The aim of the current thesis is to define user requirements, to investigate feasibility and to evaluate the direct and clinical effects of a wearable soft-robotic system that is developed to support impaired hand function of older adults and stroke patients in a wide range of daily activities and in exercise training at home.

via The wearable hand robot: supporting impaired hand function in activities of daily living and rehabilitation — University of Twente Research Information

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[Thesis] The Effects of Limb Dominance on Cross-Education in a Four Week Resistance Training Program – Full Text PDF


Cross-education is known as the phenomenon of strength transfer from the trained side of the body to the untrained side of the body by unilateral resistance training. Research has shown that limb dominance has an effect on the amount of strength that is gained on the untrained side. Studies have found that there is a greater cross over effect in strength from the dominant side of the body to the non-dominant side of the body than vice versa. The present study examined this effect by taking 12 college females and splitting them into three groups: dominant training, nondominant training, and control group. The hypothesis was that the dominant training group would have a greater increase in peak grip strength in the untrained, non-dominant arm than the arm of the untrained, dominant group of the non-dominant training group. The dominant training group only trained their dominant arm with a hand dynamometer, while the non-dominant training group only trained their non-dominant arm with the same hand dynamometer. Both groups went through a 4-week, 13 sessions of grip strength training on the handy dynamometer.
They performed 3 sets of 6 maximal squeezes with a 2-minute rest in between sets. Pre-and post tests were taken of maximum grip strength squeeze. There was no significance difference in peak grip strength between the untrained arms of both groups. Also, there was no significance  difference in peak grip strength between the trained arms of both groups however there was a
trend in data in the untrained arm of the dominant training group showing a slight increase in  strength from baseline measurements. These findings do not directly support the hypothesis however, if the number of subjects’ value was greater, the trend in data in the dominant training group might have found significant effect from limb dominance.

Full Text PDF

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[WEB SITE] NYU Students Invent Smartphone-Based Stroke Rehab Devices – Rehab Managment

Using smartphone-enabled technology attached to garments, invented by students from the NYU Tandon School of Engineering, stroke recovery could be more like a game than an arduous task.

The wearable mechatronic devices—including a jacket to measure arm placement, a glove to measure wrist and finger placement and finger joint angles, and a finger trainer built of hand-friendly, compliant material—are all connected by a smartphone.




When a patient performs an assigned therapeutic exercise, microcontrollers within the devices measure such information as grip strength and display it via the smartphone to both the patient and the medical provider.

The activity can then turn into a virtual reality game in which the patient observes the performance of the unaffected side of the body and tries to mimic the activity on the affected side of the body, explains a media release from NYU Tandon School of Engineering.

The team that invented the devices includes NYU Tandon Professor of Mechanical and Aerospace Engineering Vikram Kapila, who guided the students; Preeti Raghavan, MD, of NYU Langone’s Rusk Rehabilitation Ambulatory Care Center; Ashwin Raj Kumar, a doctoral student in mechanical and aerospace engineering; and Sai Prasanth Krishnamoorthy, a master’s degree student in mechatronics and robotics engineering.

The patent-pending devices were recently awarded third place in BMEidea, a competition for biomechanical and bioengineering students, per the release.

“Smartphone-integrated stroke rehabilitation is a marked improvement over the conventional treatment programs of the past,” says Kapila, who oversees NYU Tandon’s Mechanotronics Lab, in the release.

“The medical community acknowledges that while the central nervous system is highly adaptive and has the ability to regain functions with concerted effort, a patient must assiduously practice those regained skills. This makes stroke rehab a long and sometimes trying ordeal. Providing patients with immediate feedback and placing that feedback in the context of a virtual reality game that they can use within their own homes is definitely encouraging and motivational,” he adds.

[Source(s): NYU Tandon School of Engineering, PR Newswire]

Source: NYU Students Invent Smartphone-Based Stroke Rehab Devices – Rehab Managment

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[ARTICLE] Grip strength is a representative measure of muscle weakness in the upper extremity after stroke – Full Text


Background: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity.
Objective: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke.
Methods: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson’s correlation coefficient was used to determine the association between the muscle strength measurements.
Results: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77–0.82) and the less affected upper extremity (r = 0.65–0.82).
Conclusion: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.

Continue —>  Grip strength is a representative measure of muscle weakness in the upper extremity after stroke – Topics in Stroke Rehabilitation –

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[REVIEW] Virtual reality for stroke rehabilitation.


BACKGROUND: Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness.

OBJECTIVES: To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke.

SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers.

SELECTION CRITERIA: Randomised and quasi-randomised trials of virtual reality (‘an advanced form of human-computer interface that allows the user to ‘interact’ with and become ‘immersed’ in a computer-generated environment in a naturalistic fashion’) in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information.

MAIN RESULTS: We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke.

PRIMARY OUTCOMES: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies.

SECONDARY OUTCOMES: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited.

AUTHORS’ CONCLUSIONS: We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).

via Virtual reality for stroke rehabilitation. – PubMed – NCBI.

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