Rajiv Gandhi University of Health Sciences s31

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1 Name of the Candidate FASIUZAMAN SHAHBAZ AHMED and Address SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTRE, PANDESHWARA, MANGALORE-575001 2 Name of the Institute SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTRE, MANGALORE. 3 Course of Study and Master of Physiotherapy (MPT) Subject 2 years Degree Course. “Neurology and Psychosomatic Diseases” 4 Date of Admission 01/01/2010 To Course 5 Title of the Topic “A Study to Establish Normative Data for Manual Dexterity in Older Adults Using Purdue Pegboard ”

1 6. Brief resume of the intended work: 6.1 Need for the study: The hand is a receptor of information from the environment, in everyday life all kinds of grips are of vital importance for ordinary activities.1 The hand serves as an important creative tool, an extension of intellectual, a means of non verbal communication and a major sensory tactile organ. The quality of performance in daily living skills, work related functions, and recreational activities are determined to a large degree by hand function and manual dexterity.2 The motor performance of the individual is influenced by a number of factors, of which the most important are age and laterality.3 The hand undergoes many physiological and anatomical changes associated with aging.2 Hand function remains fairly stable until the age of 65 years after which it diminishes slowly. After the age of 75 years, age difference in performance becomes more apparent as seen in prehensile pattern of frequency, hand strength, performance time and range of motion.4 One change that may be associated with increasing age is decreasing hand function.5 Skillful manipulation of an object by hands often involves reach, grasp, carry, release in hand manipulation and bimanual coordination.6 Manual dexterity is defined as the ability to integrate precision and speed with finely coordinated movements of the arm, hand and fingers.7 Several methods that measure manual dexterity have been developed including the Valpar assessment system, the Box and Block test and the Purdue Pegboard test.7, 8. The Purdue Pegboard is intended to measure two types of activities: (1) gross movements of the hand, fingers and arms and (2) finger dexterity, which can be considered the ability to integrate speed and precision with finely controlled discrete movements of the fingers.9-11. The advantages of Purdue Pegboard test are (a) it measures dexterity as well as fine motor co-ordination (b) it examines eye hand co-ordination (c)

2 and it can be used to test hand function in neurological, musculoskeletal and developmental disorders.10 During hand rehabilitation, dexterity testing is frequently used to assess manual function. Previous studies have been done on normative data for Purdue Pegboard test with 600 participants with age group of 5 to 65 yrs but there are no normative data available for older adults i.e. with age group of 65 to 85 yrs. Normative value will help to screen for older adults with decreased dexterity and also will provide a baseline. It will also help to differentiate whether the decline in manual dexterity is age related or as a result of any pathology. Keeping all these in mind this study is intended to find out the normative data for Purdue Pegboard test among older adults.

6.2 Review of Literature

1. Aron S Buchman, Robert S Wilson, Julia L Bienias et al12 conducted a study on upper extremity performance by using grip and pinch dynamometry; movement speed by finger tapping and Purdue Pegboard; and muscle bulk and concluded that men were stronger than women in all ages but women scored higher on Purdue Pegboard than men.

2. Kurt W. Kornatz, Evangelos A Christou and Roger M Enoka et al13 did a study to find whether practice improves manual dexterity in 10 healthy and 10 sedentary old adults (age: 72.9 ± 5.8 yrs) and concluded that practice of simple finger task was accompanied by the reduction in discharge rate variability of motor units, a decrease in fluctuations in motor output of a hand muscle, and an improvement in the manual dexterity in old adults.

3. Krunal Desai, Kirti Kene, Mita Doshi et al10 conducted a study on Purdue Pegboard using 600 subjects between the age group of 5 – 65 yrs on Indian population and concluded that as the age increases manual dexterity decreases.

3 4. Graziano Onder, Brenda W.J.H Penninx, Luigi Ferrucci et al14 evaluated the ability of upper and lower extremity performance measure among 884 women to predict progressive and catastrophic disability on activities of daily living and mobility and concluded that all upper and lower extremity measure significantly predicted the onset of progressive ADL disability.

5. Ayse Ozcan, Zeliha Tulum, Lamia Pinar et al7 conducted a study to compare pressure pain threshold, grip strength, dexterity and touch pressure of dominant and non-dominant hands of right- and left- handed subjects and their findings revealed a difference in those variables only between the non-dominant and dominant hands of right-handed subjects but not in the left-handed subjects.

6.Eli Carmeli, Hagar Patish and Raymond Coleman et al2 conducted a study to find out age related changes in prehension pattern and hand dexterity in elderly population and concluded that hand function and dexterity starts declining gradually after the age of 65 years so ideal hand assessment should be taken to determine specific treatment protocol.

7.Arunkumar Pennathur, Contreras Luis Rene, Arcuate Karina et al11 conducted an experimental study on 57 older patients (60-90years) to quantify manual dexterity of older patients using Purdue Pegboard and concluded that assembly performance in older patients is significantly affected by age but there is no such difference in assembly performance between older men and women.

8.Wilson BC, Locoviello JM, Wilson JJ et al15 conducted a study to establish the normative data on the Purdue

4 Pegboard with 206 right handed male and female children of age ranging between 2 years, 6 months and 5 years, 11 months and concluded that scores increase monotonically with age.

9.When establishing a normative data on the Purdue pegboard among 176 subjects aged between 14 and 19 years from the seven-county Milwaukee area, V Mathiowetz, Rogers SL, Dowe-Keval M found that females performed better than males on three out of four subtests and concluded that the scores increased with age.16

6.3 Objective of the study: 1. To establish a normative data for Purdue Pegboard test in elderly population. 2. To compare the dexterity values between elderly male and female participants.

6.4 Hypothesis: As this study is intended to measure normative data hypothesis is not applicable to this study.

Materials and Method: 7.1 Source of data: The Older adults who are willing to participate and meeting the selection criteria will be included from the society, and geriatric care centers in Mangalore.

Sampling: Purposive sampling.

7.2 Method of collection of data: 5 A total of 200 subjects of both the genders from the age of 65 to 85 years will be divided into 2 age cohort of 10 years (i.e., 65-75 and 75-85) and each cohort will contain equal number of participants for both genders. An informed written consent will be obtained from each of the participants before they participate in this study. Pre-participation data will be taken for each subject prior to the study which includes Name, Age, Sex, Dominance, and 7. History of illness, Medications, History of any injury or surgery in the upper extremity.

Procedure: Purdue Pegboard Test: The Purdue pegboard is made up of wooden board. Its length is 23 inches and its breadth is 15 inches. It contains 4 cups which contains pins, washers and collars, there are 2 centre rows each having 25 small holes drilled in them. The person to be tested should be seated comfortably at a normal height table (at approximately 30"). This test battery consists of 4 components: 1)Right Hand(30 sec) 2)Left Hand(30 sec) 3)Both Hands(30 sec) 4)Assembly(60 sec)

1) Right Hand: The participant has to pick up one pin at a time with his right hand from right hand cup. Starting with top-hole, he has to place each pin in right hand row. This is to be done for 30 seconds. At the end of 30 sec the participant has to stop. The number of pins inserted was counted and that gives the right hand score.

2) Left Hand: Instructions are given to the participant similar to that given for Right hand subtest.

6 3) Both Hands: Instructions are given to the participant similar to that given for Right hand subtest to perform this subtest with both hands. 4)Assembly: Sequence consists of assembling pins, collars, & washers. The participant has to pick up one pin from right hand cup with his right hand. And while he is placing it in top hole in right hand row, he has to pick up a washer with his left hand. As soon as pin has been placed, participant drops the washer over the pin, while the washer is being placed over the pin by left hand the participant has to pick up a collar with his right hand, while collar is being dropped over the pin participant has to pick up another washer with left hand & drop it over the collar. This completes the first assembly. Instructions and directions are given in the local language. Participants will be given an opportunity of 3 trials for practice before the test. Scoring 1) For right & left hand, each properly inserted pin is equal to1 point. 2) For both hands, each pair of pin properly inserted is equal to1 point. 3) Each assembly is 4 points.17

Materials to be used:  Purdue Pegboard  MMSE Scale  Pins  Collars  Washers  Score Sheet  Stop Watch

Inclusion Criteria 1) Community dwelling healthy elderly aged between 65 and 85 years older. 7 2) Both the genders will be included. 3) Participants should be able to follow the instruction for the test; hence MMSE should be ≥ 23.

Exclusion Criteria 1. Subjective sensory or motor complaints in upper extremities such as numbness, tingling and weakness. 2. Any known neurological disorders. 3. Any upper extremity injury.

Statistical analysis

Study design: Descriptive Cross-sectional study. TEST: Mean and Standard deviation. Independent ‘t’ test.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.

Yes. This study intends to measure the manual dexterity of hand in older adults by using Purdue Pegboard.

7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes. Consent has been obtained from the Institute’s ethical committee.

List of references. 1. Kamieniarz M, Stryla W, Kowalska P et al. Assessment of the children manual dexterity and hand grip strength: Test –Retest Reliability study. Computational methods in science and technology. 2002;8:69-78. 2. Eli Carmeli, Hagar Patish, Raymond Coleman. The aging hand. Journal

8 of gerontology. 2003;58:146-152. 3. Kraus PH, Przuntek H, Kegelmann A. Motor performance: normative data, age dependence and handedness. J Neural Transm. 2000;107:73- 85. 4. Shiffman LM. Effects of aging on adult hand function. Am J Occupy Ther. 1992;46:785-792. 5. Hackel ME, Wolfe GA, Bang SM et al. Changes in hand function in the aging adult as determined by the Jebsen Test of Hand Function. Phys Ther. 1992;72:373-377. 6. Hemant P Nandgaonkar. Rivet and Eyelet Deftness Test (RED Test): A measure for hand dexterity. The Indian Journal of Occupational Therapy. 2002;34:14-22. 7. Ayse Ozcan, Zeliha Tulum, Lamia Pinar et al. Comparison of pressure pain threshold, grip strength, dexterity and touch pressure of dominant and non-dominant hands within and between right and left handed 8. subjects. J Korean Med Sci. 2004;19:874-878. 8. Desrosiers J, Bravo G, Hebert R et al. Validation of the box and block test as a measure of dexterity of elderly people; reliability, validity and norms studies. Arch Phys Med Rehabil.1994;75:751-755. 9. Monique A.M Berger, Arno J Krul, Hein A.M Daanen. Task specificity of finger dexterity tests. Applied Ergonomics. 2008;40:145-147. 10.Desai K, Kene K, Doshi M et al. Normative Data of Purdue Pegboard on Indian Population. The Indian Journal of Occupational Therapy. 2006;37(3): 69-72. 11.PennathurA,Contrerase LR, Arcautes K. Manual Dexterity of older Mexican American adults.Int Journal of Industrial Ergonomics. 2003;32:419-431. 12. Aron S Buchman, Robert S Wilson, Julia L Bienias et al.

9 Gender difference in upper extremity motor performance of older person. Geriatrics and Gerontology Int. 2005;5:59-65. 13.Kurt W Kornatz, Evangelos A Christou , Roger M Enoka. Practice reduces motor unit discharge variability in a hand muscle and improves manual dexterity in old adults. Appl Physiol. 2005; 98:2072-2080. 14.Graziano Onder, Brende W.J.H Penninx et al. Measures of physical performance and risk for progressive and catastrophic disability: results from the women’s health and aging study. Journal of Gerontology. 2005; 60:74-79. 15.Wilson BC, Locoveillo JM, Wilson JJ et al. Purdue Pegboard performance for normal preschool children. Journal of clinical and experimental Neurophysiology. 1982;04:19-26. 16.Mathiowetz V, Rogers SL, Dowe-Keval M.The Purdue Pegboard: norms for 14 – 19 year olds. Am J Occup Ther. 1986;40:32-37. 17.Tiffin J. Purdue Pegboard examiner manual, Chicago IL; Science Research Associate:1968;5-8.