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Injury-Induced Hand Dominance Transfer University of Kentucky UKnowledge University of Kentucky Doctoral Dissertations Graduate School 2010 INJURY-INDUCED HAND DOMINANCE TRANSFER Kathleen E. Yancosek University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Yancosek, Kathleen E., "INJURY-INDUCED HAND DOMINANCE TRANSFER" (2010). University of Kentucky Doctoral Dissertations. 18. https://uknowledge.uky.edu/gradschool_diss/18 This Dissertation is brought to you for free and open access by the Graduate School at UKnowledge. It has been accepted for inclusion in University of Kentucky Doctoral Dissertations by an authorized administrator of UKnowledge. For more information, please contact [email protected]. ABSTRACT OF DISSERTATION Kathleen E. Yancosek The Graduate School University of Kentucky 2010 INJURY-INDUCED HAND DOMINANCE TRANSFER _________________________________ ABSTRACT OF DISSERTATION _________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Rehabilitation Sciences in the College of Health Sciences at the University of Kentucky By Kathleen E. Yancosek Lexington, Kentucky Director: Carl Mattacola, PhD, ATC Lexington, Kentucky 2010 Copyright © Kathleen E. Yancosek 2010 ABSTRACT OF DISSERTATION INJURY-INDUCED HAND DOMINANCE TRANSFER Hand dominance is the preferential use of one hand over the other for motor tasks. 90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less- dexterous, non-dominant hand. When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer (I-IHDT). Military service members injured in combat operation may face I-IHDT following mutilating injuries (crush, avulsion, burn and blast wounds) that result in dominant limb amputation or limb salvage. Military occupational therapy practitioners utilize an intervention called Handwriting For Heroes to facilitate hand dominance transfer. This intervention trains the injured military member how to write again using the previously non-dominant hand. Efficacy and clinical effectiveness studies were needed to validate the use of this intervention. This dissertation contains three studies related to I-IHDT. One study measured handwriting performance in adults who previously (greater than 2 years ago) lost function of their dominant hands. Results verified that handwriting performance, when measured on two separate occasions (six-weeks apart) was similar (stable). A second study examined the efficacy of Handwriting For Heroes in non-impaired participants. Results demonstrated a positive effect on the variables that measured the written product: legibility, writing speed (letters-per-minute); as well as a positive effect on the variables that measured the writing process: kinematic and kinetic parameters. The final study examined the clinical effectiveness of Handwriting For Heroes in an injured military population. Results did not show as positive results as the efficacy study, despite similar compliance with the intervention. Specifically, non-impaired participants started with faster writing speeds in their non-dominant hands (higher letters-per-minute) and made more gains (wider ranges). The non-impaired participants also started with faster dexterity (betters scores on the Grooved Pegboard) but they made fewer gains than the injured service members (smaller ranges). Nevertheless, injured participants clearly made gains in all dependent variables thereby demonstrating clinical effectiveness of the intervention. KEYWORDS: Hand Dominance, Handwriting, Limb-Salvage, Dexterity, Amputation Kathleen E. Yancosek_ Student’s Signature April 20, 2010 Date INJURY-INDUCED HAND DOMINANCE TRANSFER By Kathleen E. Yancosek Dana Howell, Ph.D., OTD, OTR/L Director of Dissertation Anne Harrison, Ph.D., PT Co-Director of Dissertation Patrick Kitzman, Ph.D., PT Director of Graduate Studies April 20, 2010 Date RULES FOR THE USE OF DISSERTATIONS Unpublished dissertations submitted for the Doctor's degree and deposited in the University of Kentucky Library are as a rule open for inspection, but are to be used only with due regard to the rights of the authors. Bibliographical references may be noted, but quotations or summaries of parts may be published only with the permission of the author, and with the usual scholarly acknowledgments. Extensive copying or publication of the dissertation in whole or in part also requires the consent of the Dean of the Graduate School of the University of Kentucky. A library that borrows this dissertation for use by its patrons is expected to secure the signature of each user. Name Date DISSERTATION Kathleen E. Yancosek The Graduate School University of Kentucky 2010 INJURY-INDUCED HAND DOMINANCE TRANSFER _________________________________ DISSERTATION _________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Rehabilitation Sciences in the College of Health Sciences at the University of Kentucky By Kathleen E. Yancosek Lexington, Kentucky Director: Dr. Carl Mattacola Lexington, Kentucky 2010 Copyright © Kathleen E. Yancosek 2010 DEDICATION This dissertation is dedicated to military service members who were wounded while executing their duties in fulfillment of the mission entrusted to them. ACKNOWLEDGEMENTS I extend my gratitude to the following members of my committee: Dr. Dana Howell, my advisor and committee chair: thank you for your diligence in setting an exceptionally high standard and your patience with me as I struggled to reach that standard! I have grown so much under your wing! Dr. Anne Harrison, my committee co-chair: thank you for your wisdom and encouragement. I enjoy your student-centered teaching style! Dr. Colleen Schneck who was my advisor in 2001 at Eastern Kentucky University where I completed my Master’s degree, thank you for your authentic (and on-going) concern for my educational and professional development. You have a contagious passion for occupational therapy education, and I hope to work for you one day! Dr. Teresa Brininger, my Army mentor: thank you for your soldier-centered perspective on research. Thanks for encouraging me to make a difference in military occupational therapy! I am following in your boot tracks, Ma’am! Dr. Patrick Kitzman, my Neuroplasticity professor: thank you for teaching me about the marvelous complexity of the human nervous system. Thank you for teaching me that a scholar is always in pursuit of the next question! Dr. William Calderhead, my single-subject research design expert: thank you for the countless hours you spent teaching me the intricacies of research and manuscript writing. I appreciate your availability and guidance! I also extend my gratitude to these people: I would like to thank my husband, Barry, and our amazing sons, Joshua and William, who supported me with unconditional love! Thank you to my friends and neighbors, Lindsay, Becky, and Kathryn, who helped me in practical ways to juggle personal and professional responsibilities. I am grateful to Kristi Say, OTR/L and Michelle Hunter, OTD, OTR/L for collecting data at Walter Reed Army Medical Center. I appreciate the support of the entire staff at Walter Reed. They were willing to help me in many ways. Lastly, I acknowledge that the equipment and supplies used in the experiments of this dissertation were funded through a seed grant through the University of Kentucky’s Center for Clinical and Translation Science. I am extremely thankful for that support. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ............................................................................................................ iii LIST OF TABLES .......................................................................................................................... vi LIST OF FIGURES ...................................................................................................................... viii Chapter 1 Injury-Induced Hand Dominance Transfer ..................................................................... 1 Statement of the Problem ........................................................................................................ 2 Permanent Loss of Dominant Hand Function ............................................................................. 3 Definition of Terms ..................................................................................................................... 4 Dexterity .................................................................................................................................. 4 Hand Dominance ..................................................................................................................... 6 Handwriting ............................................................................................................................. 6 Cerebral Lateralization ............................................................................................................ 8 Evaluation .................................................................................................................................. 10 Evaluation of Dexterity ........................................................................................................
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