强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。     

强制性使用运动疗法在脑卒中和脑外伤上肢康复中的应用

目的：定量评价强制性使用运动疗法在脑卒中和脑外伤中的康复效果。方法：9例脑卒中和脑外伤患者使用夹板固定限制健侧手，患侧手进行每日6小时康复训练，共2周；在治疗前2周，治疗前和治疗后分别采用Carrol上肢功能评定和金子翼上肢功能评定对患者进行评价。结果：治疗后和治疗前及基线相比，两种评价方法值均具有显著性差异（P＜0．05）。结论：强制性使用运动疗法对脑卒中和脑外伤上肢功能有显著的康复效果。     

The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial

OBJECTIVE: To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke. DESIGN: Two-centre, observer-blinded, stratified, block-randomized controlled trial. SETTING: General community. PATIENTS: Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003. Interventions: The experimental intervention involved practice of functional, unilateral and bilateral tasks that were designed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks. Members in both groups participated in three sessions a week for six weeks. MAIN OUTCOME MEASURE(S): The primary test of arm function was the Box and Block Test. Secondary tests included the Nine-Hole Peg Test, maximal grip strength, the Test d'Evaluation des Membres supérieurs des Personnes Agées (TEMPA) and the Stroke Rehabilitation Assessment of Movement. RESULTS: Results are for the more affected arm. Baseline performance on the Box and Block Test was an average of 26 blocks (standard deviation (SD) = 16) in the experimental group (n = 47) and 26 blocks (SD = 18) in the control group (n = 44). These values represent approximately 40% of age-predicted values. Values for the postintervention evaluation were an average of 28 (SD = 17) and 28 (SD = 19) blocks for the experimental and control group respectively. No meaningful change on other measures of arm function was observed. CONCLUSIONS: A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke.     

脑卒中后上肢运动功能表现与习得性废用的相关性研究

【】 目的：探索脑卒中亚急性期患者的上肢运动功能表现与习得性废用之间的相关性。方法：本研究从两家医院共招募了28位脑卒中亚急性期患者,所有患者在出院后1个月由同一名作业治疗师对其进行功能评定。上肢运动功能评价采用Fugl-Meyer评估(Fugl-Meyer Assessment, FMA)、上肢动作研究量表(Action Research Arm Test, ARAT)、盒子和木块测试(Box and Block Test,BBT)、偏瘫上肢功能测试香港版(Functional Test for the Hemiplegic Upper Extremity-Hong Kong Version,FTHUE-HK),习得性废用评价采用家居活动记录表(Motor Activity Log,MAL),日常生活能力评价采用功能性独立量表(Functional Independence Measure,FIM)。相关性分析采用Spearman等级相关性分析。结果：MAL的使用量评分(Amount of Use, AOU)(MAL-AOU)与MAL的活动质量评分(Quality of Movement,QOM)(MAL-QOM)及FMA显示强相关性(r=0.751至r=0.860);MAL-AOU与其它上肢运动功能表现呈现中等相关(r=0.551至r=0.744);MAL-QOM与ARAT之间显示出一般相关(r=0.38),与其它上肢功能表现则中等相关(r=0.599至r=0.724);FIM与所有量表均未显示出显著相关性。结论：上肢功能水平越好的脑卒中亚急性期患者越愿意在日常生活中使用患侧上肢;判断自我上肢能力水平时,患者则显示出更多依赖于上肢粗大功能表现,而非手部精细功能表现。     

A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong

OBJECTIVE: To investigate the beneficial effect of constraint-induced movement therapy in improving the function of hemiplegic upper extremity in the early subacute stroke patients.DESIGN: A prospective, single-blinded, randomized controlled study comparing the effectiveness of constraint-induced movement therapy or control treatment at post intervention and 12 weeks follow-up.SUBJECTS: The inclusion criteria were 2-16 weeks after stroke, hemiparesis of the affected limb, minimal function of > or =20 degrees wrist extension and > or =10 degrees extension of all digits and Mini-Mental State Examination score > or =17.INTERVENTIONS: The intervention group underwent a programme of 10 days upper extremity training (4 hours per day) with the unaffected limb being restrained ina shoulder sling and the control group received an equivalent duration of conventional rehabilitation therapy.MAIN MEASURES: Functional level for hemiparetic upper extremity, Motor Activity Log, Action Research Arm Test and modified Barthel Index.RESULTS: There were 23 and 20 subjects respectively in the constraint-induced movement therapy and control groups. Significant improvements were seen at post intervention and 12 weeks after constraint-induced movement therapy in functional level for hemiparetic upper extremity (P= 0.001), and in the ;amount of use' (P= 0.001) and ;how well' (P= 0.021) subscales of the Motor Activity Log. The total Action Research Arm Test score, grasp (P= 0.004), grip (P= 0.004), pinch (P= 0.032) and gross (P= 0.006) components showed significant improvement over the control group at post intervention. The grip component (P=0.019) and the total Action Research Arm Test score (P= 0.009) were superior to the control group at 12 weeks.CONCLUSION: Significant improvement in hand function could be achieved with constraint-induced movement therapy in subacute stroke patients, which was maintained up to 12 week follow-up.     

Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. CASE DESCRIPTION: The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. METHODS: The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. OUTCOMES: Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. DISCUSSION: This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.     

强制性使用运动疗法对慢性期脑卒中患者上肢运动功能的康复疗效

目的 探讨强制性使用运动疗法（CIMT）对慢性期脑卒中患者上肢运动功能的康复疗效。方法 15例慢性期脑卒中偏瘫患者（平均病程13．5个月）在CIMT治疗期间健侧穿戴吊带和夹板限制肢体动作，每天清醒时固定时间不少于90％，连续12d；同时接受塑形训练，密集训练患侧肢体活动，完成日常生活动作，连续两周共10个工作日。在CIMT治疗前2周的基线期、治疗前和治疗后采用上肢功能测验（UEFT）和简易上肢机能检查（STEF）评价患者的上肢运动功能。结果 患者在CIMT治疗前2周的基线期内，UEFT和STEF显现出微小改善（ES；0．11，0．13）；接受2周CIMT治疗后，UEFT和STEF显现出较为明显的改善（ES：0．8，0．5）。结论 C1MT是改善慢性期脑卒中患者上肢运动功能的一种有效治疗方法，短期CIMT介入可以促进患侧上肢功能多方面的改善。     

Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score

OBJECTIVE: To document upper limb recovery in stroke patients and investigate whether the Orpington Prognostic Score (OPS) performed within 48 hours of admission to hospital post ischaemic stroke was a predictor of upper limb function at six months and two years. DESIGN: Inception cohort design. SETTING: Teaching Hospital. SUBJECTS: One hundred and fourteen patients hospitalized with acute ischaemic stroke were stratified into three groups based on their OPS within 48 hours of admission post stroke and underwent further assessments at two weeks, six months and two years after stroke onset. MAIN MEASURES: Rivermead Arm Score (RAS), Nine Hole Peg Test (NHPT) and grip strength (GS). RESULTS: Patients with a good OPS and intermediate OPS showed significant recovery in all outcome measures for up to six months post stroke (p < 0.05), while those with a poor OPS at 48 hours showed no significant improvement (p > 0.05). The OPS score at 48 hours was the most highly correlated variable with upper limb outcome at six months (r= -0.728) and at two years (r= -0.712) compared with other variables such as age, class of stroke, sensation, grip strength and RAS. CONCLUSION: Stroke patients demonstrate differential upper limb recovery patterns which need to be taken in consideration when designing studies that investigate efficacy of rehabilitation, and the OPS is highly correlated with upper limb recovery at six months and two years.     

上肢康复训练系统在脑卒中偏瘫患者上肢功能康复中的应用

目的:观察上肢康复训练系统对脑卒中患者上肢功能康复的临床疗效。方法:脑卒中偏瘫上肢功能障碍患者42例,分为观察组22例和对照组20例。2组患者均接受常规药物治疗和康复训练。观察组在此基础上加用Rejoyce上肢康复训练。治疗前后采用Fugl-Meyer量表上肢部分(FMA-UE)、Rejoyce手功能测试(RAHFT)和功能独立性评定(FIM)评定2组疗效。结果:治疗4周后,2组FMA-UE、RAHFT及FIM评分治疗前后及组间比较均差异无统计学意义;治疗8周后,2组FMA-UE、RAHFT及FIM评分均较治疗前及治疗4周时明显提高(P0.05,0.01),且观察组更高于对照组(P0.05)。结论:Rejoyce上肢康复训练结合常规康复作业治疗能更好地改善脑卒中恢复期患者偏瘫上肢及手的功能,更有效地提高患者日常生活活动能力。     

A test of fine finger dexterity

The lack of instruments available for the measurement of fine dexterity (i.e., speed of interdigital manipulation) implies a gap not only in the occupational therapist's ability to quantify and deal precisely with patients' problems in this area, but also in the knowledge base of occupational therapy itself. The Rosenbusch Test of Finger Dexterity (developed by Doris F. Rosenbusch, MA, OTR), a new instrument that measures the speed of interdigital manipulation of objects by each hand separately, was tested on 64 subjects with normal hand function and 10 subjects known to have disabilities affecting fine dexterity. The determination of significant differences by the subjects' sex, dominant and nondominant hands, and normal and dysfunctional hands was performed with t tests. The scores of the subjects with normal hand function versus those with disabled hand function were then compared on all variables. The findings demonstrate that this instrument is ready to be used experimentally and compares favorably with current commercial tests on both reliability and validity coefficients.     

Effects of task-oriented training on upper extremity function and performance of daily activities by chronic stroke patients

[Purpose] The aim of this study was to determine the effects that task-oriented training has on upper extremity function and performance of daily activities by chronic stroke patients. [Subjects and Methods] Task-oriented training was applied to two chronic hemiplegic patients in this research. The training was provided to each patient for 30 minutes a day, five times a week for two weeks. The treatment program included six different types of training that could be performed by the patients themselves. Evaluation was performed four times, that is, once a week for three weeks before the intervention and once after the intervention. The change in upper extremity function was measured with the Manual Function Test, and the change in performance of daily activity was measured with the Functional Independence Measure. [Results] The upper extremity function of both subjects was improved after application of task-oriented training. However, in the performance of daily activities, subject one showed improvement compared to with before the intervention, whereas subject two showed the same results. [Conclusion] This research confirmed that two weeks of task-oriented training for chronic stroke patients is effective for improvement of upper extremity function and performance of daily activities by chronic stroke patients.Key words: Task-oriented training, Upper function, Stroke     

Evaluation of arm and prosthetic functioning in children with a congenital transverse reduction deficiency of the upper limb.

OBJECTIVE: To assess upper extremity functioning of children with unilateral transverse upper limb reduction deficiency, using standardized instruments, and to investigate their validity and reliability. DESIGN: Cross-sectional study. SUBJECTS: Twenty subjects aged 4-12 years; 9 prosthetic users and 11 non-users. METHODS: The Assisting Hand Assessment, Unilateral Below Elbow Test, Prosthetic Upper extremity Functional Index and ABILHAND-Kids were assessed in all children. Users were tested with and without their prosthesis. We compared results of users and non-users, and of users with and without their prosthesis. Validity was determined by testing hypotheses and correlations with other measures. Test-retest reliability was assessed from repeated measurements in 10 children. RESULTS: Children with an upper limb reduction deficiency performed well on daily activities. They could use their prosthesis in 68% of the activities, but were currently using it in only 30%. Children find their prosthesis useful for specific activities, rather than for daily activities in general. The Assisting Hand Assessment and Prosthetic Upper extremity Functional Index showed best validity; test-retest reliability was good to excellent. CONCLUSION: The use of standardized instruments adds relevant information on functioning of children with an upper limb reduction deficiency. We found additional support for validity and reliability of, in particular, the Assisting Hand Assessment and Prosthetic Upper extremity Functional Index.     

Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial

The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation. This prospective, randomised, single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group. All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format. Independent assessors, blinded to group allocation, tested all subjects. Outcome measures used were three items of the Jebsen Taylor Hand Function Test (JTHFT), two arm items of the Motor Assessment Scale (MAS), and three mobility measures, the Timed Up and Go Test (TUGT), Step Test, and Six Minute Walk Test (6MWT). Both groups improved significantly between pre- and post-tests on all of the mobility measures, however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items. Following four weeks training, the Mobility Group had better locomotor ability than the Upper Limb Group (between-group differences in the 6MWT of 116.4 m, 95% CI 31.4 to 201.3 m, Step Test 2.6 repetitions, 95% CI -1.0 to 6.2 repetitions, and TUGT -7.6 sec, 95% CI -15.5 to 0.2 sec). The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec (95% CI -7.4 to 20.4 sec) faster than the Mobility Group. Our findings support the use of additional task-related practice during inpatient stroke rehabilitation. The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains.     

Virtual reality and haptics as a training device for movement rehabilitation after stroke: a single-case study

OBJECTIVE: To investigate whether training in a virtual environment with a haptic device will improve motor function in the left hemiparetic arm of a stroke subject. DESIGN: Single case, A-B-A design. SETTING: University hospital research laboratory. PARTICIPANT: A man in his late fifties (right handed), with a right-hemisphere lesion that caused a deficit in the left upper extremity. INTERVENTION: The subject trained with a 3-dimensional computer game during a 4-week period that consisted of twelve 90-minute sessions. MAIN OUTCOME MEASURES: Three tests (Purdue pegboard test, dynamometer hand-grip strength, upper-extremity test) and a subjective interview were used to evaluate motor performance. RESULTS: Improvements were found in fine manual dexterity, grip force, and motor control of the affected upper extremity. The subject reported that there was a change in his day-to-day use of the upper extremity and that he was able to use it in activities that were previously impossible for him. CONCLUSIONS: Training with virtual reality and haptics can promote motor rehabilitation.     

Effects of a novel forced intensive strengthening technique on muscle size and upper extremity function in a patient with chronic stroke

[Purpose] This research demonstrated a forced intensive strength technique as a novel treatment for muscle power and function in the affected upper extremity muscle to determine the clinical feasibility with respect to upper extremity performance in a stroke hemiparesis. [Subject and Methods] The subject was a patient with chronic stroke who was dependent on others for performing the functional activities of his affected upper extremity. The technique incorporates a comprehensive approach of forced, intensive, and strength-inducing activities to enhance morphological changes associated with motor learning of the upper extremity. The forced intensive strength technique consisted of a 6-week course of sessions lasting 60 minutes per day, five times a week. [Results] After the 6-week intervention, the difference between relaxation and contraction of the affected extensor carpi radialis muscle increased from 0.28 to 0.63 cm², and that of the affected triceps brachii muscle increased from 0.30 to 0.90 cm². The results of clinical tests including the modified Ashworth scale (MAS; from 1+ to 1), muscle strength (from 15 to 32 kg), the manual function test (MFT; scores of 16/32 to 27/32 score), the Fugl-Meyer assessment (FMA; scores of 29/66 to 49/66 score), and the Jebsen-Taylor hand function test (JTHFT; from 38/60 to 19/60 sec) were improved. [Conclusion] Our results suggest that the forced intensive strength technique may have a beneficial effect on the muscle size of the upper extremity and motor function in patients with chronic stroke.Key words: Upper extremity, Strength, Stroke     

The responsiveness of the ten-meter walking test and other measures in patients with hemiparesis in the acute phase

The responsiveness of the Ten-Meter Walking Test (10 MWT) for assessing the walking ability of patients with hemiparesis in the acute phase was evaluated. To put this into perspective, the responsiveness of two other measures, the Berg Balance Scale (BBS) and the Motricity Index (MI) were evaluated as well. Nineteen patients with hemiparesis due to stroke or cerebral tumour in the acute phase were recruited to this study. To measure its responsiveness, the 10 MWT was performed three times a week, and the BBS and the MI performed twice a week. The responsiveness of all tests was computed using the Effect Sizes (ES) and Standardized Response Means (SRM). The ES for the 10 MWT was 1.17 and the SRM was 1.68. The ES and SRM of the BBS were 0.59 and 0.99. The ES and SRM of the MI were 0.27 and 0.96. The results of this study indicate that the 10 MWT is a responsive assessment tool, and appears to be more responsive than other commonly used tests.     

Constraint-induced movement therapy for motor recovery in chronic stroke patients.

OBJECTIVE: Assessment of the effectiveness of constraint-induced (CI) movement therapy and quantitative evaluation of the effects of CI therapy. DESIGN: Intervention study; case series; pretreatment to posttreatment measures and follow-up 3 months after intervention. SETTING: An outpatient department. PATIENTS: Five chronic stroke patients with moderate motor deficit; convenience sample. INTERVENTIONS: CI therapy consisting of restraint of the unaffected upper extremity in a sling for 14 days combined with 6 hours of training per weekday of the affected upper extremity. MAIN OUTCOME MEASURES: Actual Amount of Use Test (AAUT), Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), and Arm Motor Ability Test (AMAT) RESULTS: There was a substantial improvement in the performance times of the laboratory tests (AMAT, WMFT, p < or = .039) and in the quality of movement (AMAT, WMFT, p < or = .049; MAL, p = .049), particularly in the use of the extremity in "real world" environments (AAUT, p = .020), supported by results of quantitative evaluation. The effect sizes were large and comparable to those found in previous studies of CI therapy. CONCLUSIONS: CI therapy is an efficacious treatment for chronic stroke patients, especially in terms of real world outcome.     

Hand dominance and side of stroke affect rehabilitation in chronic stroke

OBJECTIVE: To examine the difference between upper extremity deficits in subjects with left versus right hemispheric lesions at baseline and after bilateral arm training. DESIGN: A one-way ANOVA was used to detect group differences and a least square means analysis used to determine significance in pre-to-post scores for each group. SETTING: Testing was in the Physical Therapy and Rehabilitation Science Department Research Laboratory, University of Maryland, Baltimore. Training was at the Senior Exercise Rehabilitation Center in the Veterans Administration Hospital, Baltimore. SUBJECTS: Twenty-two (11 left hemispheric lesion, 11 right hemispheric lesion) right-handed subjects with chronic stroke. INTERVENTIONS: A six-week nonprogressive repetitive bilateral arm training with rhythmic auditory cueing (BATRAC). MAIN MEASURES: Fugl-Meyer Upper Extremity Test, Wolf Motor Arm Test, University of Maryland Arm Questionnaire for Stroke (UMAQS), isometric strength and active and passive range of motion for both sides. RESULTS: No statistical differences were seen at baseline between groups in this sample. Both groups demonstrated improvement after BATRAC in Fugl-Meyer Upper Extremity Test (change scores of those with left lesions = 5.5; right lesions = 3.6) and UMAQS (change scores of those with left lesions = 5 and right lesions = 2.9). Additionally, patients with left hemispheric lesions but not right lesions made improvements in the Wolf Motor Arm Test (time and weight), in strength measures of paretic elbow flexion, shoulder extension, shoulder abduction and nonparetic wrist flexion, wrist extension and shoulder abduction. CONCLUSIONS: There were no baseline motor function differences between those with left and right hemispheric lesions in this sample. There was a clear training response advantage for patients with left hemispheric lesions after completing six weeks of bilateral arm training. As a result, treatment approaches for upper extremity hemiparesis may need to be more specifically selected based on side of stroke.     

Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke

OBJECTIVE: To examine the effects of a home-based arm exercise programme of sensory and motor amplitude electrical stimulation. DESIGN: Non-concurrent, multiple-baseline, single-subject design. SUBJECTS: Ten adults with chronic arm hemiparesis following stroke. Subjects ranged in age from 38 to 74 years and were 2-16 years post stroke. Three subjects had right-sided involvement; seven had left. INTERVENTION: Subjects completed an eight-week, individualized, home programme of neuromuscular and sensory amplitude electrical stimulation. All subjects engaged in stimulation-assisted task-specific exercises for 15 minutes 2 -3 times daily. Participants with sensory deficits received an additional 15 minutes of sensory amplitude stimulation twice daily. The Action Research Arm Test was used to examine arm function; the Stroke Rehabilitation Assessment of Movement was used to examine movement quality; and the Modified Ashworth Assessment of Spasticity was used to examine muscle tone. RESULTS: A statistically significant improvement was demonstrated by six of the 10 subjects on the Action Research Arm Test, and five subjects on the Stroke Rehabilitation Assessment of Movement. Four subjects had > or = 10% improvement on the Modified Ashworth Assessment of Spasticity. Two subjects demonstrated significant improvement on all three outcome measures; six subjects improved on two or more measures; and seven subjects improved on one or more measure. Subjects who improved on two or more measures tended to have had more recent onset of stroke, were older and had higher baseline motor and functional capacity. CONCLUSION: Subjects with chronic stroke can experience impairment and functional improvements following a home-based programme of motor and sensory amplitude electrical stimulation.     

Manual dexterity and related functional limitations in hereditary motor and sensory neuropathy. An explorative study

Purpose. To explore impairments in manual dexterity and perceived limitations in upper extremity-related activities in subjects with Hereditary Motor and Sensory Neuropathy (HMSN).

Method. Cross-sectional study of 20 HMSN subjects. Manual dexterity was assessed using the Jebsen test of hand function. Perceived limitations were assessed using the Rehabilitation Activities Profile (RAP) and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH).

Results. Impaired manual dexterity was found in four out of seven Jebsen sub-tests. Turning over cards, lifting large light and large heavy objects were most impaired, as reflected by median z scores of 5.7, 12.0 and 16.9, respectively. Perceived limitations, as reflected by median and percentile (P25; P75) sum-scores, were 7.5 (3; 11.7) for the RAP domains of personal care (scale 0 - 69) and 6.0 (1.25; 15.5) for the domains of occupation (scale 0 - 42). The median (P25; P75) DASH score (scale 0 - 100) was 13.3 (2.7; 48.1). Jebsen test scores were significantly associated with RAP and DASH scores.

Conclusions. Manual dexterity of HMSN subjects, especially requiring the manipulation of flat and of large objects, was impaired and associated with the amount of perceived limitations in upper extremity function. Major limitations were perceived in activities related to upper extremity function by 25% of HMSN subjects. Measurement of manual dexterity and perceived limitations should be incorporated into the evaluation and treatment of HMSN subjects.