http://repub.eur.nl/res/aut/13843/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/39311/ 2013-04-01T00:00:00Z Introduction: Wrist fractures are common in older adults and are expected to increase because of ageing populations worldwide. The introduction of plate and screw fixation has changed the management of this trauma in many patients. For policymaking it is essential to gain insight into trends in epidemiology and healthcare utilisation. The purpose of this study was to determine trends in incidence, hospitalisation and operative treatment of wrist fractures. Methods: A population-based study of patients aged 50 years and older using the Dutch National Injury Surveillance System and the National Hospital Discharge Registry. Data on emergency department visits, hospitalisations and operative treatment for wrist fractures within the period 1997-2009 were analysed. Results: In women, the age-standardised incidence rate of wrist fractures decreased from 497.2 per 100,000 persons (95% confidence interval, 472.3-522.1) in 1997 to 445.1 (422.8-467.4) in 2009 (P for trend <0.001). In men, no significant trends were observed in the same time period. Hospitalisation rates increased from 30.1 (28.3-31.9) in 1997 to 78.9 (75.1-82.8) in 2009 in women (P < 0.001), and from 6.4 (6.0-6.8) to 18.4 (17.3-19.5) in men (P < 0.001). There was a strong increase in operative treatment of distal radius fractures, especially due to plate fixation techniques in all age groups. Conclusion: Incidence rates of wrist fractures decreased in women and remained stable in men, but hospitalisation rates strongly increased due to a steep rise in operative treatments. The use of plate and screw fixation techniques for distal radius fractures increased in all age groups. http://repub.eur.nl/res/pub/39264/ 2013-01-24T00:00:00Z Objective: To assess the value of advanced imaging techniques in the detection of hand osteoarthritis (OA) and hand OA progression. Methods: PubMed/Medline and Embase were searched until April 2012 for studies on imaging of hand OA that presented quantitative data on validity, reliability or responsiveness. Articles presenting only data on conventional radiography (CR) were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist for validity, the Quality Appraisal of Reliability Studies (QAREL) for reliability and the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) for responsiveness. Results: Of 627 citations, 25 studies on ultrasonography (US), MRI or scintigraphy were included. No studies on CT, positron emission tomography or single photon emission CT met our eligibility criteria. Validity was generally assessed against healthy controls, CR or clinical examination. Overall, US and MRI detected more disease than CR and found significant differences between patients and healthy controls. Scintigraphy detected fewer pathological joints than CR. Intra- and inter-reader reliability varied for US (κ=0.01-1.0) and MRI (κ=0.15-0.84 and intraclass correlation coefficient=0.21-0.99) and was good for scintigraphy (κ=0.61-0.84). There were no responsiveness studies for MRI. US responsiveness studies showed a reduction of soft-tissue changes after treatment which correlated with decrease in pain (r=0.7-0.8). For scintigraphy, scores decreased over time while CR showed progression of hand OA. Conclusions: MRI and US seem to be the most promising candidates for early detection of hand OA and for future use in clinical trials. However, further research is needed to improve scoring methods, to compare US with MRI, to confirm reliability of MRI and to further determine the responsiveness of US and MRI. Copyright Article author (or their employer) 2013. http://repub.eur.nl/res/pub/38508/ 2012-12-01T00:00:00Z http://repub.eur.nl/res/pub/37661/ 2012-09-17T00:00:00Z http://repub.eur.nl/res/pub/38302/ 2012-02-01T00:00:00Z Objective: To evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). Design: Survey. Setting: Outpatient clinic of a university hospital. Participants: Children (N=116; age range, 1014y) with CHDs. Interventions: Not applicable. Main Outcome Measures: HRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. Results: All children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. Conclusions: Children with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs. http://repub.eur.nl/res/pub/33814/ 2011-11-01T00:00:00Z Purpose: Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. Methods: We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. Results: During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. Conclusions: This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. Clinical relevance: With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes. http://repub.eur.nl/res/pub/33382/ 2011-07-01T00:00:00Z Background: Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome. Methods: The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis. Subsequently, the resultant loosened structure is grafted with autologous lipoaspirate. After 1 week of postoperative extension splinting, patients are allowed normal hand use and are advised to use night splints for 3 to 6 months. The authors treated and report on their experience with 91 patients (99 hands) operated on in Miami and Rotterdam; from 50 patients, the authors report on goniometry (average follow-up, 44 weeks). Results: The contracture from the proximal interphalangeal joint improved significantly from 61 degrees to 27 degrees, and contracture from the metacarpophalangeal joint improved from 37 degrees to -5 degrees. Ninety-four percent of patients returned to normal use of the hand within 2 to 4 weeks and 95 percent were very satisfied with the result. No new scars were added, and a supple palmar fat pad was mostly restored. Complications were digital nerve injury in one patient, postoperative wound infection in one patient, and complex regional pain syndrome in four patients. Conclusions: This new minimally invasive technique shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin. By its ability to treat multiple rays, it addresses the abnormality in the entire hand. The procedure is safe and effective, especially for primary cases. Currently, comparative prospective randomized studies are in process to fully determine its role in the treatment of Dupuytren contracture. http://repub.eur.nl/res/pub/33865/ 2011-06-01T00:00:00Z Purpose: Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures. Methods: We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. The palmar sides of both hands were cooled continuously using a cold plate at 5°C. We measured the skin temperature of the fingers using videothermography and plotted graphs of the temperature changes of the nailbed. The presence of a CIVD reaction was defined as a minimum increase in temperature of 2.5°C starting at the distal phalanx. Furthermore, we measured self-reported symptoms of cold intolerance using the Cold Intolerance Severity Scale questionnaire. Results: A CIVD reaction was absent in the affected digits of 4 patients (follow-up, 637 mo), whereas the CIVD reaction in the uninjured hand was present. The CIVD was present in 6 patients after 50 months' follow-up (range, 2476 mo). Two patients had no CIVD reaction in the injured or uninjured fingers. All patients with a CIVD response had at least diminished protective sensation. Presence of the CIVD reaction did not exclude self-reported symptoms of cold intolerance. Conclusions: After peripheral nerve injury, it is possible to recover the CIVD reaction. This might be an indication of nerve recovery. However, a positive CIVD reaction does not exclude subjective symptoms of posttraumatic cold intolerance. Type of study/level of evidence: Diagnostic III. http://repub.eur.nl/res/pub/23897/ 2011-04-01T00:00:00Z Aim: To investigate the neuronal basis for the effects of mirror therapy in patients with stroke. Methods: 22 patients with stroke participated in this study. The authors used functional MRI to investigate neuronal activation patterns in two experiments. In the unimanual experiment, patients moved their unaffected hand, either while observing it directly (no-mirror condition) or while observing its mirror reflection (mirror condition). In the bimanual experiment, patients moved both hands, either while observing the affected hand directly (no-mirror condition) or while observing the mirror reflection of the unaffected hand in place of the affected hand (mirror condition). A two-factorial analysis with movement (activity vs rest) and mirror (mirror vs no mirror) as main factors was performed to assess neuronal activity resultant of the mirror illusion. Results: Data on 18 participants were suitable for analysis. Results showed a significant interaction effect of movementxmirror during the bimanual experiment. Activated regions were the precuneus and the posterior cingulate cortex (p<0.05 false discovery rate). Conclusion: In this first study on the neuronal correlates of the mirror illusion in patients with stroke, the authors showed that during bimanual movement, the mirror illusion increases activity in the precuneus and the posterior cingulate cortex, areas associated with awareness of the self and spatial attention. By increasing awareness of the affected limb, the mirror illusion might reduce learnt non-use. The fact that the authors did not observe mirror-related activity in areas of the motor or mirror neuron system questions popular theories that attribute the clinical effects of mirror therapy to these systems. http://repub.eur.nl/res/pub/24010/ 2011-03-01T00:00:00Z Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and non-dominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development. http://repub.eur.nl/res/pub/26520/ 2011-03-01T00:00:00Z Objective. To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. Methods. A total of 40 chronic stroke patients (mean time post.onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). Results. Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P <.05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P <.05). Conclusion. This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains. http://repub.eur.nl/res/pub/31622/ 2011-02-01T00:00:00Z http://repub.eur.nl/res/pub/28577/ 2010-10-01T00:00:00Z Background and Objective. To present quantitative data on sit-to-stand (STS)-related functioning and recovery during the first year after stroke. STS-related functioning was used to evaluate independent STS movement, rising speed, and actual STS performance during normal daily life. Methods. This was a prospective cohort study of 50 patients poststroke. Assessments were made at 0, 3, 6, 9, 12, 24, and 48 weeks poststroke. Actual STS performance was assessed at 0, 12, and 48 weeks. The main outcome measures were the following: ability to rise independently, rising speed (power chair stand up), number of STS movements, percentage of time walking and standing during daily life (using an activity monitor), and clinical outcomes, measured among others by the Barthel index (BI). Results. During year 1, the percentage of patients able to rise increased from 54% to 83%. Most improvements occurred during weeks 0 to 12, whereas no significant changes were observed during weeks 12 to 24. Rising speed similarly increased from 0.15 to 0.26 s-1during weeks 0 to 12 and to 0.30 s-1at week 48. Gait speed and BI also significantly increased. The number of STS movements increased significantly during weeks 0 to 12 (from 10.6 to 17.7) but not during weeks 12 to 48. Conclusions. STS-related functioning improved significantly in the first year after stroke, with the most improvement occurring during the first 12 weeks. After 12 weeks, rising speed, gait speed, and BI continue to improve. http://repub.eur.nl/res/pub/20814/ 2010-09-01T00:00:00Z Background: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods: We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results: We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion: In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence http://repub.eur.nl/res/pub/27948/ 2010-07-01T00:00:00Z Purpose: Triphalangeal thumb is a congenital malformation characterized by an additional phalanx of the thumb. Although surgical treatment of this condition is common practice, in the past this was not generally advised. Therefore, a population with an untreated triphalangeal thumb is still present. The purpose of this study is to compare function and appearance of adults with an untreated triphalangeal thumb to a normal population. Methods: Twelve adults with 23 hands with an untreated triphalangeal thumb, unilateral or bilateral, were examined using objective measurements (thumb movement, joint instability, pain, and strength) and subjective measurements (visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; and Short Form 36 health survey). Results: Objective measurements showed no limitations in range of motion or in grip and pinch strength. No joint instability was found in the interphalangeal joints. Five thumbs had instability in the metacarpophalangeal joint. Strength of the thumb in anteposition was diminished to 64% compared to a normal population. Opposition was diminished to 62%, and metacarpophalangeal joint flexion strength was diminished to 61%. The patients scored lower compared to a normal population for the domain of social functioning in the Medical Outcome Study 36-item short form health survey; the Disabilities of the Arm, Shoulder, and Hand questionnaire showed no differences. Visual analog scale scores for appearance of the thumb were scored low (2.2 of 10) by the adults, in contrast to visual analog scale scores for function (7.7). Conclusions: The examined group of adults with an untreated triphalangeal thumb had adequate thumb movement. Thumb strength was diminished for all specific thumb functions (anteposition, opposition, and thumb flexion), as low as 55%, compared to normal controls. Self-rated scores indicate that patients perceived their functionality as good. The appearance, however, was rated much lower, implying a dislike of the thumb by the patients. This indicates that the main impact of an untreated triphalangeal thumb in daily functioning might not be the diminished function but rather the dissimilar appearance. Type of study/level of evidence: Therapeutic IV. http://repub.eur.nl/res/pub/20704/ 2010-06-01T00:00:00Z Abstract BACKGROUND: Forearm fractures are common amongst children and often result in limited rotational function. In daily practice, pronation and supination of the arm are often visually estimated or measured using a conventional goniometer. The aim of this study was to compare the reliability of these two methods in paediatric patients who had previously sustained a forearm fracture. METHODS: Intra- and interrater reliability of visual estimation and conventional goniometry were determined in 47 children who had previously sustained a forearm fracture. RESULTS: Intra- and interrater reliability of visual estimation and conventional goniometry was fair to excellent, with intraclass correlation coefficients (ICCs) ranging between 0.75 and 0.94. In addition, the overall goniometer data consistently showed lower smallest detectable differences (SDDs) compared to the visual estimation data, also indicating better reliability for the goniometer method. CONCLUSIONS: A conventional goniometer is an easy, fast and reliable method to determine the pronation and supination in a child who had sustained a forearm fracture. If an uncooperative child hinders the measurement, visual estimation is a good second choice. Measurements are more reliable when repeated by the same professional. http://repub.eur.nl/res/pub/19734/ 2010-05-01T00:00:00Z Cold intolerance is a well-known phenomenon that develops in the first months after hand injury and generally does not decrease over time. In this study, we evaluated the prevalence and severity of cold intolerance after hand fracture in 129 patients using the Cold Intolerance Symptom Severity (CISS) questionnaire. Patients with nerve and/or vascular injuries were excluded. The response rate was 59%. The mean CISS score was 23. Pathological cold intolerance, defined as a CISS score over 30, was experienced by 38% of the patients. Cold intolerance is common after hand fractures and can be severely disabling in some patients. http://repub.eur.nl/res/pub/27595/ 2010-05-01T00:00:00Z Ultrasound can be used to study tendon movement. However, measurement of tendon movement is mostly based on manual tracking of anatomical landmarks such as the musculo-tendinous junction, limiting the applicability to a small number of muscle-tendon units. The aim of this study was to quantify tendon displacement without anatomical landmarks using a speckle tracking algorithm optimized for tendons in long B-mode image sequences. A dedicated two-dimensional multi-kernel block-matching scheme with subpixel motion estimation was devised to handle large displacements over long sequences. The accuracy of the tracking on porcine tendons was evaluated during different displacements and velocities. Subsequently, the accuracy of tracking the flexor digitorum superficialis (FDS) of a human cadaver hand was evaluated. Finally, the in-vivo accuracy of the tendon tracking was determined by measuring the movement of the FDS at the wrist level. For the porcine experiment and the human cadaver arm experiment tracking errors were, on average, 0.08 and 0.05. mm, respectively (1.3% and 1.0%). For the in-vivo experiment the tracking error was, on average, 0.3. mm (1.6%). This study demonstrated that our dedicated speckle tracking can quantify tendon displacement at different physiological velocities without anatomical landmarks with high accuracy. The technique allows tracking over large displacements and in a wider range of tendons than by using anatomical landmarks. http://repub.eur.nl/res/pub/19784/ 2010-04-01T00:00:00Z Objective: The aim of this observational study was to explore whether patients with traumatic peripheral nerve injury of the hand perceive referred sensations; sensations that are perceived to emanate from other areas of the body than the part being stimulated. Referred sensations have been reported following amputation, somatosensory deafferentation, local anaesthesia, stroke, brachial plexus avulsion injury, spinal cord injury and complex regional pain syndrome type 1. Design: Ten patients with ulnar or median nerve injuries underwent sensory testing of the face, upper body and legs, involving light touch with a cotton swab. Patients were asked to describe the location of the stimulated site, the sensations emanating from it and any other sensations experienced. Three patients with referred sensations were identified and followed over a period of time. Results: Clear and reproducible referred sensations were found in 3 out of 10 patients examined. Conclusion: Referred sensations were found in traumatic nerve injury, providing evidence of reorganization of the central nervous system after peripheral injury. http://repub.eur.nl/res/pub/27895/ 2010-04-01T00:00:00Z Purpose: Cadaver and in vivo studies report variable results for tendon excursion during active and passive hand movements. The purpose of this study was to measure long finger flexor digitorum profundus (FDP) tendon excursion during active and passive movement using high-resolution ultrasound images. Methods: The FDP tendon excursion was measured at the wrist level in 10 healthy subjects during full tip-to-palm active and passive flexion of the fingers. Passive movement was performed 2 ways: (1) straight to full fist: passive flexion starting at the metacarpophalangeal joint, followed by proximal interphalangeal and distal interphalangeal joint flexion; and (2) hook to full fist: passive flexion starting at the distal interphalangeal joint, followed by proximal interphalangeal and metacarpophalangeal joint flexion. Tendon excursion was measured using an in-house-developed, frame-to-frame analysis of high-resolution ultrasound images. Results: Median FDP excursion was 24.3 mm, 14.0 mm, and 13.6 mm for active fist, straight to full fist, and hook to full fist movements, respectively. Tendon excursions during active movements was significantly larger than excursions during passive movements (p = .005). The adjusted median tendon excursion was 12.7 mm/100°, 7.5 mm/100°, and 7.4 mm/100° for active fist, straight to full fist, and hook to full fist movements, respectively. Adjusted tendon excursions during active movement were significantly larger than those achieved during passive straight to full fist movement). Adjusted tendon excursions during straight to full fist movements were significantly larger than those achieved during passive hook to full fist movement. Conclusions: Active motion produced 74% and 79% increases in excursions compared to both passive motions in healthy controls. The study results can serve as a reference for evaluating excursions in patients with tendon pathology, including those who have had tendon repair and reconstruction. http://repub.eur.nl/res/pub/20965/ 2010-03-18T00:00:00Z Study Design: Test-retest reliability study on grip strength in children. Introduction: Measuring grip strength in children is difficult because of the weight and size of the instrument, brief attention span, and possible lack of task understanding. Therefore, adaptations to the measurement protocols to improve reliability would be very important for research and clinical evaluation. Purpose: In this study, we compared the reliability of a grip strength dynamometer (Lode dynamometer, Lode BV, Groningen, The Netherlands) using three different protocols. Methods: Test-retest reliability of the American Society of Hand Therapists protocol in 104 healthy children (4-12 years) was compared with the reliability in 63 healthy children of a visual feedback protocol and a suspension protocol reducing weight of the instrument. Results: For the total group, intraclass correlation coefficients for the dominant and nondominant hands were 0.95-0.97 for all protocols, indicating that all three protocols were reliable. Conclusion: No statistically significant difference was found among the reliability of the different protocols, but the suspension protocol produced small but significantly higher force levels. Level of Evidence: Not applicable. http://repub.eur.nl/res/pub/28646/ 2010-03-01T00:00:00Z After tibialis posterior tendon transfer surgery for foot-drop correction, the foot is traditionally immobilised for several weeks. To test the feasibility of early mobilisation after this procedure in patients with Hansen's disease, 21 consecutive patients received active mobilisation of the transfer starting on the 5th postoperative day. Transfer insertion strength was enhanced by Pulvertaft weave. The results were compared with a historical cohort of 21 patients receiving 4 weeks of immobilisation. The primary outcomes were active dorsiflexion, active plantar flexion and total active motion at the ankle, tendon-insertion pullout and time until discharge from rehabilitation with independent walking without aid. Assessments at discharge from rehabilitation and the last clinical follow-up at more than 1 year were compared between both groups. The Student's t-test was used to compare data between the groups, and 95% confidence interval of the difference between groups was determined. A p-value of 0.05 was considered statistically significant. The average follow-up was 22 months for both groups. There was no incidence of insertion pullout of the tendon transfer in either group. In addition, there was no difference in active dorsiflexion angle between the groups at discharge (mean difference: 2.2°, p = 0.22) and final assessment (mean difference: 2.3°, p = 0.42). The plantar flexion angles were similar in both groups at discharge (mean difference: 0.5°, p = 0.86) and final assessment (mean difference: 0.5°, p = 0.57). In addition, there was no difference in total active motion between the groups at discharge (mean difference: 2°, p = 0.54) and final assessment (mean difference: 1°, p = 0.49). The patients were discharged from rehabilitation with independent walking at 44.04 ± 7.9 days after surgery in the mobilisation group compared to 57.07 ± 2.3 days in the immobilisation group. This indicates a significant difference in morbidity (mean difference: 13 days, p < 0.001) between the two groups. In summary, this feasibility study indicates that early active mobilisation of tibialis posterior transfer in patients with Hansen's disease is safe and has similar outcomes to immobilisation with a reduced time to independent walking, warranting the design of a controlled clinical trial to further substantiate this. http://repub.eur.nl/res/pub/19783/ 2010-01-01T00:00:00Z http://repub.eur.nl/res/pub/21322/ 2010-01-01T00:00:00Z Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and nondominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development. http://repub.eur.nl/res/pub/28642/ 2010-01-01T00:00:00Z Abnormal function in the triphalangeal thumb is partly due to its extra length, which is due not only to the extra phalanx, but also to differences in the length of the first metacarpal. This study investigated whether the additional length of the first metacarpal is influenced by the growth plate location alone, or also by the type of triphalangeal thumb. Fifty-nine hands in 37 patients with triphalangeal thumbs were examined for thumb type (delta 31, trapezoid nine and full type 19), growth plate location and relative length of the first metacarpal. The first metacarpals in all three types of triphalangeal thumbs were significantly longer than in the normal population. The length of the first metacarpal was related to the site of the growth plate. The type of triphalangeal thumb did not affect the length. These findings suggest that a corrective procedure on the first metacarpal should be considered in all types of triphalangeal thumbs. http://repub.eur.nl/res/pub/26976/ 2009-12-01T00:00:00Z http://repub.eur.nl/res/pub/24429/ 2009-11-01T00:00:00Z Purpose: Previously, we studied normative and reliability data of palmar thumb abduction measurements (conventional goniometry, the Pollexograph thumb, the Pollexograph metacarpal, the Inter Metacarpal Distance, the American Society of Hand Therapists method, and the American Medical Association method) in healthy adults. Because many interventions aiming to improve palmar abduction are performed at an early age, the goal of this study was to assess normative and reliability data of these measurement methods in children. Methods: We performed measurements with the Pollexograph thumb, the Pollexograph metacarpal and Inter Metacarpal Distance in 100 healthy children to acquire normative data. A retest was performed in 63 children to assess intraobserver reliability. Results: Mean active and passive palmar abduction measured with the Pollexograph thumb was 62° (range, 40° to 76°). The range of motion of the Pollexograph metacarpal was smaller (mean 49°, range, 32° to 64°). The mean Inter Metacarpal Distance was 50 mm (range, 36-70 mm). Intraclass correlation coefficients of the Pollexograph thumb, Pollexograph metacarpal, and Inter Metacarpal Distance indicated excellent reliability (intraclass correlation coefficients between 0.85 and 0.92). Conclusions: Normative Pollexograph thumb and Pollexograph metacarpal data showed that means measured in children are comparable to values found in healthy adults. Reliability data indicated that the Pollexograph thumb, the Pollexograph metacarpal, and Inter Metacarpal Distance are also reliable measurement methods in children. http://repub.eur.nl/res/pub/24430/ 2009-07-01T00:00:00Z Study Design: Clinical measurement, cross sectional. Purpose: To introduce a new measurement device, the Pollexograph®, to easily measure palmar thumb abduction, and to compare its reliability with conventional goniometry. Methods: Fourteen hand therapists measured palmar abduction of the same healthy subject with the Pollexograph and a conventional goniometer. In addition, intrarater reliability of the Pollexograph was studied in 21 patients with a hypoplastic thumb. Results: Variance between measurements of the same subject measured by the hand therapist was 2-6 times smaller with the Pollexograph compared to conventional goniometry. Pollexograph intrarater reliability in hypoplastic thumb patients was excellent (intraclass correlation coefficient (ICC) = 0.98-0.99). Conclusions: A new tool to measure palmar abduction in clinical care, the Pollexograph, has been introduced. The Pollexograph reduces variability between raters when measuring the same subject compared with conventional goniometry and excellent measurement reliability in hypoplastic thumb patients. Level of evidence: Not applicable. http://repub.eur.nl/res/pub/24269/ 2009-04-01T00:00:00Z Matthys K, Smits M, Van der Geest JN, Van der Lugt A, Seurinck R, Stam HJ, Selles RW. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Objective: To identify neural networks associated with the use of a mirror to superimpose movement of 1 hand on top of a nonmoving contralateral hand (often referred to as mirror therapy or mirror-induced visual illusion). Design: A functional magnetic resonance imaging (fMRI) study of mirror-induced visual illusion of hand movements using a blocked design in a 1.5T magnetic resonance imaging scanner. Neural activation was compared in a no-mirror experiment and a mirror experiment. Both experiments consisted of blocks of finger tapping of the right hand versus rest. In the mirror experiment, movement of the left hand was simulated by mirror reflection of right hand movement. Setting: University medical center. Participants: Eighteen healthy subjects. Interventions: Not applicable. Main Outcome Measures: Differences in fMRI activation between the 2 experiments. Results: In the mirror experiment, we found supplementary activation compared with the no-mirror experiment in 2 visual areas: the right superior temporal gyrus (STG) and the right superior occipital gyrus. Conclusions: In this study, we found 2 areas uniquely associated with the mirror-induced visual illusion of hand movements: the right STG and the right superior occipital gyrus. The STG is a higher-order visual region involved in the analysis of biological stimuli and is activated by observation of biological motion. The right superior occipital gyrus is located in the secondary visual cortex within the dorsal visual stream. In the literature, the STG has been linked with the mirror neuron system. However, we did not find activation within the frontoparietal mirror neuron system to support further a link with the mirror neuron system. Future studies are needed to explore the mechanism of mirror induced visual illusions in patient populations in more detail. http://repub.eur.nl/res/pub/18406/ 2009-03-01T00:00:00Z Purpose: The aim of the current study was to assess reliability of 6 palmar thumb abduction measurement methods: conventional goniometry, the Inter Metacarpal Distance, the method described by the American Medical Association, the method described by the American Society of Hand Therapists, and 2 new methods: the Pollexograph-thumb and the Pollexograph-metacarpal. Methods: An experienced hand therapist and a less-experienced examiner (trainee in plastic surgery) measured the right hands of 25 healthy subjects. Palmar abduction was measured both passively and actively. Means and ranges for palmar abduction were calculated, and intrarater and interrater reliability was expressed in intraclass correlation coefficients, standard errors of measurement, and smallest detectable differences. Results: Mean active and passive angles measured with goniometry resembled values measured with the Pollexograph-thumb method (approximately 60°). Mean angles found with the Pollexograph-metacarpal method were approximately 48°. Mean active and passive distances for the Inter Metacarpal Distance were 64 mm. Mean active and passive distances found with the American Society of Hand Therapists method were 97 to 101 mm, and mean distances found with the American Medical Association method were 67 to 70 mm for active and passive measurements. Intraclass correlation coefficients for the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance indicated good and significantly higher intrarater agreement for active and passive measurements than intraclass correlation coefficients of conventional goniometry, the American Society of Hand Therapists method, and the American Medical Association method, which showed only moderate agreement. For interrater reliability, the same measurement methods were found to be most reliable: the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance. Conclusions: We found that the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction. http://repub.eur.nl/res/pub/16363/ 2009-01-01T00:00:00Z Abstract: Grip strength dynamometers often are used to assess hand function in children. The use of normative grip strength data at followup is difficult because of the influence of growth and neuromuscular maturation. As an alternative, infant welfare centers throughout the world use growth diagrams to observe normative growth. The aim of this study was to develop similar growth diagrams for grip strength in children. We measured the grip strength, hand dominance, gender, height, and weight of 225 children, 4 to 12 years old. We developed separate statistical models for both hands of boys and girls for drawing growth curves. Grip strength increased with age for both hands. For the whole group, the dominant hand produced higher grip strength than the nondominant hand and boys were stronger than girls. The grip strength of boys and girls differed between 2 and 19 N for the different age groups. Because grip strength measurements are accompanied by a rather large variance, the growth diagrams (presenting a continuum in grip strength) make it possible to better observe grip strength development with time corresponding to a more exact age. Depending on the accuracy needed, the use of one combined diagram could be considered. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. http://repub.eur.nl/res/pub/25050/ 2009-01-01T00:00:00Z Purpose: Posttraumatic cold intolerance (CI) is a frequent and important sequel after peripheral nerve injury. In this study, it is hypothesized that altered rewarming patterns after peripheral nerve injury are related to the degree of posttraumatic CI. This hypothesis is tested by quantitatively comparing rewarming patterns of the digits in controls and in median or ulnar nerve injury patients and by investigating relationships between rewarming patterns, sensory recovery, and CI. Methods: Twelve median or ulnar nerve injury patients with a follow-up of 4 to 76 months after nerve repair and 13 control subjects had isolated cold stress testing of the hands. Video thermography was used to analyze and compare rewarming patterns of the injured and uninjured digits after cold stress testing. Temperature curves were analyzed by calculating the Q value as an indicator of heat transfer (temperature added during the first 10 minutes after start of active rewarming) and the maximum slope. Results: Test-retest reliability was 0.64 and 0.79, respectively, for the Q value and maximum slope. High Q values and maximum slopes were interpreted as the presence of active rewarming. Patients with return of active rewarming had better sensory recovery and lower Blond McIndoe Cold Intolerance Severity Scale (CISS) scores. Better sensory recovery was correlated with lower CISS scores. Conclusions: Test-retest reliability of cold stress testing was good, and we found a difference in rewarming patterns between nerve injury patients and controls. The presence of active rewarming in the nerve injury patients was related to sensory recovery and fewer complaints of posttraumatic CI. http://repub.eur.nl/res/pub/25473/ 2009-01-01T00:00:00Z Objective: It has been reported that the non-dominant hand of patients with Charcot-Marie-Tooth disease is stronger than the dominant hand as a result of overwork weakness. The objective of this study was to determine if this hypothesis could be verified in our population. Design: Survey. Subjects: Twenty-eight patients with Charcot-Marie-Tooth disease type I or II from a rehabilitation department of a university hospital in the Netherlands. Methods: The strength of 3 intrinsic muscle groups of the dominant and non-dominant hand were determined using the Medical Research Council scale and the Rotterdam Intrinsic Hand Myometer. Furthermore, grip strength, pinch and key grip strength were measured. Results: We found no differences in muscle strength for the dominant and non-dominant hand, except for a stronger key grip strength of the dominant hand in patients with Charcot-Marie-Tooth disease type II. Conclusion: In our population, the dominant hand of patients with Charcot-Marie-Tooth disease type I and II was equally strong as the non-dominant hand, suggesting that there is no presence of overwork weakness in the dominant hand in our group of patients. This implies that patients with Charcot-Marie-Tooth disease do not have to limit the use of their hands in daily life in order to prevent muscle strength loss. © 2009 The Authors. Journal Compilation http://repub.eur.nl/res/pub/29587/ 2008-12-01T00:00:00Z Purpose: Grip strength and pinch strength measurements are often used to assess hand function. However, both measure a number of muscle groups in combination, and grip strength in particular is dominated by extrinsic hand muscles. The Rotterdam Intrinsic Hand Myometer (RIHM) was recently introduced to measure the force that individual fingers and thumb can exert in different directions. The aim of this study was to establish the reliability of these measurements with use of the RIHM in children. Methods: Sixty-three healthy children between 4 and 12 years of age participated in this study. The RIHM was used to measure thumb palmar abduction, thumb opposition, thumb flexion at the metacarpal-phalangeal (MP) joint, index finger abduction, and little finger abduction. A retest was performed with an average test-retest interval of 26 days. Results: For the thumb, palmar abduction strength had intraclass correlation coefficients (ICCs) of .98 for both hands. For both thumb opposition and flexion at the MP joint, ICCs were .97 for the dominant hands and .98 for the nondominant hands. Index finger abduction had ICCs of .94 and .95 and little finger abduction had ICCs of .90 and .92 for the dominant and nondominant hands, respectively. The smallest detectable differences for dominant and nondominant hands respectively were thumb palmar abduction, 15% and 15%; thumb opposition, 12% and 9%; thumb flexion (at the MP joint), 12% and 9%; abduction of the index finger, 17% and 17%; and little finger abduction, 26% and 26%. Conclusions: We found that the RIHM was reliable for use in children. Intraclass correlation coefficients and smallest detectable differences were comparable with those obtained with use of the RIHM in adults and with values found for pinch and grip strength in children. Because the RIHM measures more specific aspects of hand function than grip and pinch, adding the RIHM to measurement protocols may contribute to a more complete overview of a child's hand function. http://repub.eur.nl/res/pub/14280/ 2008-11-01T00:00:00Z Background: The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two. Methods: We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined. Results: The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance. Conclusions: Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function. http://repub.eur.nl/res/pub/33106/ 2008-05-01T00:00:00Z Background: The Jamar dynamometer and the Martin vigorimeter, two instruments often used to assess grip strength, have good validity and reliability when employed to evaluate adults. Grip strength measurements are often performed to assess children with hand disorders. However, the reliability of these measurements when used to assess children under the age of twelve years is unknown. In addition, it is not clear whether reliability differs between younger and older children. The purpose of this study was to establish test-retest reliability for different age groups and to determine which instrument is the most reliable. Methods: One hundred and four children from a primary school were included. Subjects were divided into three groups: four to six, seven to nine, and ten to twelve years of age. The grip strength of both hands was measured with the Lode dynamometer (equivalent to the Jamar dynamometer) and with the Martin vigorimeter. The mean of three maximum voluntary contractions was recorded for all measurements. A retest was performed after a mean interval of twenty-nine days. Results: In the total group, the intraclass correlation coefficient for the Lode dynamometer was 0.97 (95% confidence interval, 0.95 to 0.98) for the dominant hand and 0.95 (95% confidence interval, 0.92 to 0.96) for the nondominant hand and the intraclass correlation coefficient for the Martin vigorimeter was 0.84 (95% confidence interval, 0.77 to 0.89) for the dominant hand and 0.86 (95% confidence interval, 0.80 to 0.90) for the nondominant hand. The intraclass correlation coefficients in the different age groups were lower than those in the total group because of a lower between-subject variation. The normalized smallest detectable difference between the test and retest values was approximately 25% for the Lode dynamometer and approximately 31% for the Martin vigorimeter. Conclusions: Both the Lode dynamometer and the Martin vigorimeter are reliable instruments with which to measure the grip strength of children under twelve years of age; however, the Lode dynamometer has better test-retest reliability. Furthermore, comparison of the smallest detectable differences showed the Lode dynamometer to be a more accurate instrument. Copyright http://repub.eur.nl/res/pub/32286/ 2008-04-01T00:00:00Z Objective: To describe the use of mirror therapy in 2 patients with complex regional pain syndrome type II following traumatic nerve injury. Design: Two case reports. Subjects: Two patients with complex regional pain syndrome type II. Methods: Two patients received mirror therapy with the painful hand hidden behind the mirror while the non-painful hand was positioned so that, from the perspective of the patient, the reflection of this hand was "superimposed" on the painful hand. Pain was measured with a visual analogue scale. Results: The first case had developed a severe burning and constant pain in the hand due to a neuroma. In this patient, a strong reduction in pain was found during and immediately after mirror therapy. As a result, the patient was able to perform active exercises that were previously too painful. However, despite the pain relief during and directly after the exercises, the overall level of pain did not decrease. The second patient also had severe burning pain following a glass injury. In this patient, repeated mirror therapy for a 3-month period strongly decreased pain due to causalgia. Conclusion: The presented cases demonstrate that the use of mirror therapy in patients with causalgia related to a neuroma is worthy of further exploration as a potential treatment modality in patients with causalgia. http://repub.eur.nl/res/pub/29219/ 2008-03-01T00:00:00Z Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoǧlu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Objective: To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. Design: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting: Rehabilitation education and research hospital. Participants: A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. Interventions: Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). Results: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. Conclusions: In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity. http://repub.eur.nl/res/pub/29753/ 2008-03-01T00:00:00Z Purpose: Radial polydactyly is a congenital anomaly with a wide range of manifestations. Current classifications do not have the capacity to classify all different types of radial polydactyly when combined with triphalangeal components. The objective of this study was to test an adjusted classification and nomenclature that allows classification of triphalangeal components and triplication in radial polydactyly. Methods: Patients from 1993 to 2006 with radial polydactyly (N = 104), a total of 121 affected hands, were identified from the hospital database. All x-rays were carefully examined and classified according to the existing classifications for radial polydactyly and a modified classification. In the modified nomenclature, Wassel's level of duplication is preserved. Type VII and VIII are assigned for partial or complete duplication of the carpal bones according to Buck-Gramcko. Triplication and triphalangeal components can be assigned to each type of radial polydactyly by suffixes. Symphalangism, deviation, and hypoplasia can also be classified. Triplication on different levels of the thumb is classified by determining and including the different types of the original Wassel classification. Results: Eighteen thumbs could not be classified according to existing classifications for radial polydactyly with triphalangeal components or triplication. Using the proposed classification, all patients could be classified. Conclusions: We propose a modified classification that is a practical and utilitarian scheme for nomenclature of radial polydactyly and that may assist comparison of treatment outcomes and individual cases. Type of study/level of evidence: Diagnostic II. http://repub.eur.nl/res/pub/29830/ 2008-01-01T00:00:00Z In this study, the intra- and interobserver reliability of the Semmes-Weinstein monofilaments (SWMFs) was determined in the hands of 15 patients with Charcot-Marie-Tooth disease. In addition, the amount and distribution of sensory loss in the hand, and the relation between sensory loss, intrinsic muscle strength, and hand dexterity was explored in 45 patients. SWMF testing had good intra- and interobserver reliability with intraclass correlation coefficients of 0.91 and 0.86, respectively. The SWMF testing revealed normal sensory function in 43% of all six locations. The average loss of the intrinsic hand muscle strength was 57%. Poor strength was found in patients with both poor and with good sensory function. The correlation between the measurements of intrinsic muscle strength and the Sollerman test for dexterity was 0.70. http://repub.eur.nl/res/pub/37079/ 2007-10-01T00:00:00Z Objective: To determine reliability of maximal grip strength, muscle coordination and muscle endurance. To compare these parameters in young adults with unilateral cerebral palsy and healthy subjects. To evaluate the correlation of these variables with functional activities. Subjects: Twenty-six healthy subjects and 26 young adults with unilateral cerebral palsy recruited from a cohort study in young adults with cerebral palsy. Methods: Maximal grip strength, muscle coordination and muscle endurance were measured in both hands of all subjects. In the healthy subjects test-retest reliability was established. In the young adults with cerebral palsy, the Melbourne assessment and Abilhand Questionnaire were used to determine functional activities. Results: For the dominant and non-dominant hand the intraclass correlation coefficients for the maximal grip strength were 0.93 and 0.91, for the muscle coordination 0.81 and 0.86, and for the muscle endurance 0.59 for both sides. Maximal grip strength of the involved hand of patients was reduced compared with the uninvolved hand and compared with healthy subjects. There was no difference in muscle coordination and muscle endurance between the involved and uninvolved hands. These parameters, however, were significantly reduced in both hands compared with healthy subjects. Correlations between grip strength parameters and activity limitations were relatively weak and non-linear. Conclusion: Performance of activity is not directly related to grip strength parameters. The uninvolved hand of young adults with unilateral cerebral palsy also has impaired function. http://repub.eur.nl/res/pub/15696/ 2007-02-01T00:00:00Z OBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthroplasty (THA) with trochanteric osteotomy. INTERVENTION: Patients were verbally instructed by a physical therapist to perform partial weight bearing at a 10% body weight (BW) target load (n=33) or at a 50% BW target load (n=17). MAIN OUTCOME MEASURES: Mean peak load (%BW) and percentage of patients and mean percentage of steps below, equal to, and above the target load. Weight bearing was measured when patients walked with (condition 1) and without (condition 2) a physical therapist in the hospital and walked at home (condition 3). RESULTS: The mean peak load was significantly higher than the target in the 10% BW group for all 3 conditions (condition 1, 19.2% BW; condition 2, 20.0% BW; condition 3, 26.8% BW). In the 50% BW group, the mean peak load was significantly lower than the target in conditions 1 (28.1% BW) and 2 (32.5% BW). No significant difference in weight bearing was found when walking with or without a physical therapist (change in 10% BW, -0.1% BW; change in 50% BW, -3.17% BW). At home, the mean peak load was significantly larger compared with walking without a physical therapist in the hospital (change in 10% BW, -7.0% BW; change in 50% BW, -11.5% BW). CONCLUSIONS: Partial weight bearing at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. Other training methods (eg, biofeedback) have to be evaluated to use as training tools for partial weight bearing at specific target loads. http://repub.eur.nl/res/pub/10672/ 2006-12-12T00:00:00Z BACKGROUND: Several problems are associated with manual muscle testing and dynamometry in the hands of patients with Charcot-Marie-Tooth (CMT) disease. OBJECTIVE: To evaluate the efficacy of the Rotterdam Intrinsic Hand Myometer (RIHM) to directly measure intrinsic hand muscle strength in CMT disease. METHODS: We measured hand muscle strength and hand function in 41 patients with CMT disease. RESULTS: RIHM measurement of intrinsic strength had excellent reliability. We found overlapping RIHM strength values in Medical Research Council grades 3 to 5. High grip and pinch strength could be found in patients with severe intrinsic muscle weakness. RIHM measurements were more strongly correlated with fine motor skills of the hand than grip and pinch strength. CONCLUSIONS: The Rotterdam Intrinsic Hand Myometer is a reliable instrument to measure intrinsic hand muscles strength in patients with Charcot-Marie-Tooth disease, providing more detailed information than manual muscle testing and a more direct assessment of intrinsic muscle loss than grip and pinch dynamometers. http://repub.eur.nl/res/pub/15677/ 2006-12-01T00:00:00Z Objective measurement of weight bearing during a long-term period can give insight into the postoperative loading of the lower extremity of orthopedic patients to avoid complications. This study investigated the validity of vertical ground reaction force measurements during a long-term period using the Pedar Mobile insole pressure system, by comparing it with a Kistler force platform. In addition, the validity of a new sensor drift correction algorithm to correct for offset drift in the Pedar signal was evaluated. Ground reaction force data were collected during dynamic and static conditions from five healthy subjects every hour for 7 h. A mean offset drift of 14.6% was found after 7 h. After applying the drift correction algorithm the Pedar system showed a high accuracy for the second peak in the ground reaction force-time curve (1.1 to 3.4% difference, p>0.05) and step duration (-2.0 to 4.4% difference, p>0.05). Less accuracy was found for the first peak in the ground reaction force-time curve (5.2 to 12.0% difference; p<0.05 for the first 3 h, p>0.05 for the last 4 h) and, consequently, in the vertical force impulse (5.5 to 11.0% difference, p>0.05). The Pedar Mobile system appeared to be a valid instrument to measure the vertical force during a long-term period when using the drift correction program described in this study. http://repub.eur.nl/res/pub/31964/ 2002-09-18T00:00:00Z In this thesis, the influence of prosthetic inertial properties (mass, mass distribution and moment of inertia) on the gait of transtibial amputation (TTA) subjects is studied. Chapter 1 introduces the present ideas on prosthetic mass. It describes that the general design effort has always been, and still is, to reduce prosthetic mass. However, as far as we know, lightweight design has never been advocated in the present literature. The Chapter introduces the opposite view, found in a relatively large body of literature, that lightweight design might not be beneficial for prosthetic gait. The aim of this thesis, therefore, is to determine the optimal inertial properties of the prosthetic leg.