Normative data for hand grip strength in healthy children measured with a bulb dynamometer: a cross-sectional study

Objective

To present the normative hand grip strength values measured with a bulb dynamometer for children, by gender and age, and to correlate the findings with weight, height, body composition and handedness.

Design

Cross-sectional study.

Participants

Data from 295 healthy children of both genders aged 6 to 13 years were analysed.

Methods

Weight, height, body composition (Biodynamics model 450 bioimpedance analyser), handedness (Edinburgh scale) and grip strength measured with a bulb dynamometer (North Coast) were obtained.

Results

Grip strength of both hands increased with age in the two genders. Grip strength was similar in boys and girls between 6 and 13 years of age. The dominant hand was stronger than the non-dominant hand [mean (standard deviation) 7.0 (2.3) psi vs 6.5 (2.1) psi], with a mean difference of 0.52 psi (95% confidence interval of the difference 0.46 to 0.58). Grip strength was positively correlated with fat-free mass and height (r ≥ 0.75).

Conclusion

This study provides normative values for hand grip strength measured with a bulb dynamometer in children aged 6 to 13 years. This dynamometer provides a simple method to measure grip strength, and the results of this study provide further evidence of its performance in the measurement of grip strength.     

Functional and biomechanical assessment of the normal and rheumatoid hand

OBJECTIVE: To assess hand function in accordance with its accepted definition and to compare the results of three different assessment techniques. DESIGN: A clinical-type assessment was used together with measurement of pinch grip and three-dimensional biomechanical trials. BACKGROUND: Traditional clinical assessment may not relate to a patient's actual hand function. If hand function is defined as "the ability to use the hand in daily activities" then it is more appropriate to measure the forces available for performing everyday tasks using biomechanical tests. METHODS: Eight female patients with rheumatoid arthritis and eight control subjects were recruited for the study. Volunteers underwent a clinical-type assessment using a six-task activity board. Lateral pinch grip of both hands was measured using a custom-built transducer. Biomechanical trials were conducted using a 6 degree-of-freedom transducer and 6-camera motion analysis. RESULTS: Functional differences between the two subject groups were apparent using all three methods of assessment. Pinch strength correlated well with the biomechanical trial data but results from the clinical-type assessment provided only a weak correlation. CONCLUSIONS: Clinical-type assessments do not give an accurate measure of hand function. Pinch strength measurements can provide a cost-effective alternative to full biomechanical analysis. RELEVANCE: Traditional functional assessment uses measurements of grip or pinch strength and range of motion together with a subjective assessment of activities of daily living. This study demonstrates that pinch strength measurements can provide an accurate measure of hand function. The results from activity-board trials do not reflect hand ability and are of limited use for hand evaluation.     

Comparison of Power Grip and Lateral Pinch Strengths between the Dominant and Non-Dominant Hands for Normal Chinese Male Subjects of Different Occupational Demand

The purpose of this study was to establish handgrip data for right hand dominant normal Chinese subjects. Sixty-four males were studied for their power grip and lateral pinch strengths. They were categorized into non-manual and manual workers. Standardized procedure and instructions were used for handgrip testing. Results showed that both the non-manual and manual workers demonstrated stronger power grip and lateral pinch strengths in their dominant hands. The 10% rule was applicable only for power grip strength of non- manual workers and lateral pinch strength of manual workers. No significant difference was found between the dominant grip strengths in these two groups of subjects. It was recommended that when assessing the progress and outcome of hand rehabilitation, the occupation and demand level of hand use of the patient must be taken into consideration when using the uninjured hand for comparison.     

Effectiveness of the five-handle position grip strength test in detecting sincerity of effort in men and women

OBJECTIVE: The five-handle position (five-rung) test is used to determine sincerity of effort of grip strength. However, there is a controversy in the literature concerning its validity and effectiveness. The purpose of the study was to investigate whether test results are affected by the amount of strength exerted by the gripping hand and to determine the test's effectiveness. DESIGN: A total of 30 hand therapy patients performed the five-rung grip test both maximally and submaximally with both the injured and uninjured hands. The standard deviation across the five strength trials was used to measure the shape of the curve. Sensitivity and specificity values were calculated for each sex. RESULTS: The repeated measures analyses of variance revealed that average strength and the standard deviation were greater for men than for women, for maximal effort than for submaximal effort, and for the injured hand in comparison with the healthy hand. The most optimal standard deviation cutoff value was 8.5 (sensitivity, 0.70; specificity, 0.83), and the proportional area under the receiver operator characteristic curve was greater for the men (89%) than for women (80%). CONCLUSIONS: The shape of the curve generated by the five-rung test was strength dependent; thus, the test may yield biased results when assessing sincerity of effort in people with weakened hands. The five-rung test was less effective for women than for men. Thus, we recommend that the five-rung test not be used to detect sincerity of effort.     

A comparison of two methods of assessing disease activity in the joints

BACKGROUND: Considerable debate has occurred concerning the utility of different methods of obtaining joint counts and their usefulness in predicting outcomes in persons with rheumatoid arthritis. OBJECTIVE: The purpose of this study was to compare two methods of assessing disease activity in the joints (clinician joint count, self-reported joint count), and to compare their relative utility in predicting two methods of assessing outcomes (self-reported ratings of impairment and pain, objective performance index) with and without controlling for negative affectivity. METHOD: Data for this study were obtained during home visits from 185 persons diagnosed with rheumatoid arthritis. Individuals completed a series of self-report measures including the joint count. Trained research assistants completed a 28-joint count and timed participants on a series of measured performance activities (e.g., grip strength, pinch strength, walk time). RESULTS: The self-report joint count was highly correlated with the clinician joint count and also accounted for as much, if not more, variance in the subjective outcome measures than did clinician assessments. Both types of indicators predicted unique variance in the objective performance index. CONCLUSIONS: For most research purposes, measures such as self-report joint counts have sufficient validity to be used in place of more costly clinician assessment of joint counts.     

两种标准化的握力测试方式对健康青年握力测试结果的影响

目的比较美国手部疗法协会和国民体质测定标准手册所推荐两种标准化的握力测试方式对健康青年握力测试结果的影响。方法采用Dynamometer G100型握力器,用两种方法分别测量32名右利手健康青年左手和右手的握力,各测试3次,取平均值。结果采用美国手部疗法协会标准测试方式所测得的左、右手的握力小于国民体质测定标准测试的左、右手的握力(P<0.05)。结论两种标准化测试方式有显著差异。建议临床研究握力需统一测试方式,并建议采用美国手部疗法协会推荐的测试方式。     

Optimal scoring methods of hand-strength tests in patients with stroke

The purpose of this study was to determine the optimal scoring methods for measuring strength of the more-affected hand in patients with stroke by examining the effect of reducing measurement errors. Three hand-strength tests of grip, palmar pinch, and lateral pinch were administered at two sessions in 56 patients with stroke. Five scoring methods were used to present the strength scores. The smallest real difference was used to provide information on the measurement error. The smallest real difference percentage was used to compare the effect on minimizing the error. Using mean score of tests for nonspastic patients carried out at least twice was found to be advisable to minimize measurement errors in the grip, palmar pinch, and lateral pinch tests. However, the use of hand-strength tests for patients with spasticity is limited because of the relatively high measurement errors.     

Measurement of hand grip strength in the elderly: A scoping review with recommendations

IntroductionHand grip strength has been widely used as a lead measure in geriatric conditions such as frailty. However, diversity in assessment protocols and methodologies creates uncertainty in the comparison of outcome measurements. The aim of this study was to review the literature relating to the measurement of hand grip strength in older adults, in order to develop further consensus in relation to the use of existing protocols in clinical and community settings, with an emphasis on practicality and suitability for frail persons.MethodsFive electronic English databases were searched using keywords such as ‘hand grip strength’, ‘clinimetric assessment’, and their synonyms. Age-related trends in adults aged ≥65 years were assessed, and comparisons were made of the following variables: dynamometer model and handle setting, hand positioning, warm-up trials, grip duration, number of repeated tests, rest periods, laterality of tested hand, and whether encouragement was given to the subjects.ResultsThirty-four research papers met the inclusion criteria and were included. A Jamar hand dynamometer was most frequently used. Variations were found in the positioning of the subject and in the duration of the rest period, which ranged from 10 to 20 s to 1 min. Grip strength was typically measured three times in the dominant hand, with the strongest grip being recorded and no encouragement being provided during assessment.ConclusionsBased on the scoping review, we propose a detailed and standardised protocol that is suitable for the assessment of hand grip strength in frail older adults.     

Dynamometric Grip Strength Assessment of Subjects Sixty Years and Older

Grip strength is important in the performance of nearly all activities of daily living as it allows individuals to maintain fuuctional independence. The purpose of this study was to examine grip strength in individuals 60 years of age and older. Forty-eight healthy subjects (24 men and 24 women) between the ages of 61 and 85 participated in this study. A Jamar Adjustable Handle Dynamometer was used to measure grip strength of the right (dominant) hand and the left (non-dominant) hand while subjects were seated in the recommended test position by the American Society of Hand Therapists. The additional variables of age, height, weight and walking time were analyzed in addition to grip strength. Results showed that the dominant hand of both men and women was statistically significantly stronger than the non-dominant hand. The older elderly had less grip strength than the younger elderly. This study suggests that men lose a greater percentage of grip strength as they age and that the decline in grip strength for both men and women may be greater than previously documented.     

Force tracking system for the assessment of grip force control in patients with neuromuscular diseases

Background. The majority of hand functionality assessment methods consist of the maximal voluntary grip force measurement. Additional knowledge on sensory-motor control can be obtained by capturing functional grip force in a time frame. Tracking methods have been successfully used for the assessment of grip force control in stroke patients and patients with Parkinson’s disease.

Methods. A novel tracking system for the evaluation of grip force control is presented. The system consists of a grip-measuring device with the end-objects of different shapes which was used as input to a tracking task where the patient applied the grip force according to the visual feedback. The grip force control was assessed in 20 patients with neuromuscular diseases and 9 healthy subjects. The performance of two tracking tasks was analysed in five grips. The ramp-tracking task was designed to assess the grip strength and muscle fatigue. The sinus-tracking task was used to evaluate grip force control during periodic muscle activation.

Findings. The results suggest that in some patients the disease did not affect their grip force control despite evident muscular weakness. Most patients produced larger tracking errors in precision grip while the healthy subjects showed less significant differences in performance among the grips tested.

Interpretation. The current study investigated force control in patients with neuromuscular diseases where detection of small changes in motor performance is important when following the progress of disease. The presented evaluation method can provide additional information on muscle activation and fatigue as compared to traditional grip strength testing.     

健康教育对手外伤患者术后应用自制互动式手功能训练器康复效果的影响

目的探讨健康教育对手外伤患者术后应用自制互动式手功能训练器康复效果的影响。方法选取2016年9月至2018年10月西安医学院附属宝鸡医院收治的78例手外伤患者作为研究对象,根据不同干预方式分为对照组与观察组,每组39例。两组均使用自制互动式手功能训练器进行康复训练,对照组患者采用常规教育干预,观察组患者采用健康教育干预。比较两组干预后的手握力、功能独立性评定(FIM)量表评分、手指功能评分及依从率。结果干预后,观察组的手握力、FIM评分均显著优于对照组,差异具有统计学意义(P<0.05)。干预后,观察组的手指功能评分显著高于对照组,差异具有统计学意义(P<0.05)。观察组的总依从率为94.9%,显著高于对照组的76.9%,差异具有统计学意义(P<0.05)。结论健康教育应用于手外伤患者术后采用自制互动式手功能训练器进行康复训练过程中,可有效提高患者的依从性,同时还能显著改善患者手部功能的康复效果,值得临床推广应用。     

Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users

BackgroundRepetitive movements and poor posture are associated with over-use of smartphones when texting or playing games and significantly contribute to the symptoms of pain and discomfort in the upper extremities.ObjectiveThis study investigated the effect of exercise training and postural correction on disabilities of the arm, shoulder, and hand (DASH), hand grip and key pinch strength among smartphone users.MethodsOne hundred university students were randomly divided into two groups; the experimental group participated in a 12-week programme of exercise training and postural corrections. The control group were instructed to follow their usual routine for smartphone utilization. Measurements of DASH scores, hand grip strength, and key pinch grip strength were conducted before and after 12 weeks for both groups.ResultsThere were no significant differences between the start values of both groups for DASH scores, hand grip strength, and key pinch strength (p > 0.05). However, there was a significant improvement in all outcomes measured in the experimental group (p < 0.05), with significant changes in the outcomes of the control group.ConclusionPostural correction combined with a selected exercise training programme improved the hand grip, key pinch grip strength, and upper extremity disability and symptoms associated with smartphone use among university students.     

Direct, quantitative clinical assessment of hand function: usefulness and reproducibility

Methods of assessing functional impairment in arthritic hands include pain assessments and disability scoring scales which are subjective, variable over time and fail to take account of the patients' need to adapt to deformities. The aim of this study was to evaluate measures of functional strength and joint motion in the assessment of the rheumatoid (RA) and osteoarthritic (OA) hand. Ten control subjects, ten RA and ten OA patients were recruited for the study. All underwent pain and disability scoring and functional assessment of the hand using measures of pinch/grip strength and range of joint motion (ROM). Functional assessments including ROM analyses at interphalangeal (IP), metacarpophalangeal (MCP) and wrist joints along with pinch/grip strength clearly discriminated between patient groups (RA vs. OA MCP ROM P<0.0001), pain and disability scales were unable to. In the RA there were demonstrable relationships between ROM measurements and disability (R2=0.31) as well as disease duration (R2=0.37). Intra-patient measures of strength were robust whereas inter-patient comparisons showed variability. In conclusion, pinch/grip strength and ROM are clinically reproducible assessments that may more accurately reflect functional impairment associated with arthritis.     

健康青年握力与人体计量资料的相关性

目的探讨健康青年的握力与人体计量资料的相关性。方法采集32名右利手健康青年的年龄、身高、体重、前臂长、前臂围、手长、手宽和掌厚等人体计量资料,用Dynamometer G100型握力器测试右手握力。结果所有受试者的握力与除年龄(r=-0.009)以外的人体计量资料均有明显相关性(r=0.479～0.754,PP<0.01),且与手长和手宽的相关性更密切(r=0.850,P<0.01)。逐步回归分析结果显示手长和手宽是握力主要预测因素(R²=0.723)。结论健康青年的握力与手部的人体计量资料密切相关,其中手长和手宽可以较好地预测握力大小。     

Grip strength and hand dominance: challenging the 10% rule

The purpose of this study was to test the utility of the 10% rule in hand rehabilitation. The 10% rule states that the dominant hand possesses a 10% greater grip strength than the nondominant hand. This rule has been used for many years to assist therapists in setting strength goals for patients with injured hands. The sample for this study consisted of 310 male and female students, faculty, and staff from a small, private liberal arts college located in Pennsylvania. Grip strength was measured with a factory-calibrated Jamar dynamometer. Results showed an overall 10.74% grip strength difference between dominant and nondominant hands. This finding verified the 10% rule. However, when the data were separated into left-handed and right-handed subjects, a 12.72% difference for right-handed subjects and a -0.08% difference for left-handed subjects was found. In conclusion, this study showed that the 10% rule is valid for right-handed persons only; for left-handed persons, grip strength should be considered equivalent in both hands.     

Identification of feigned grip effort using isokinetic dynamometry.

OBJECTIVE: To investigate the feasibility of applying isokinetic dynamometry for identifying submaximal grip strength. DESIGN: Measurement of maximal and feigned concentric and eccentric strength at high and low contraction velocities. BACKGROUND: Identification of feigned grip strength is a highly problematic issue which has been challenged using various techniques, invariably related to isometric efforts. This study is based on recent research which has indicated that isokinetic dynamometry was highly efficient in identifying feigned efforts in other major muscle groups. METHODS: Seventeen healthy women aged 20-25 took part in the study. Prior to executing the feigned effort, subjects were told to exert lower than the maximal grip strength in an attempt to obtain financial compensation for a simulated injury to hand musculature which in fact did not result in weakness of grip. RESULTS: Findings indicated that based on a parameter termed DEC which was defined as the difference between the ratios of the eccentric to concentric strength at the high and low velocities, feigned efforts could very effectively be identified (P<0.0001). Furthermore, a multivariate model enabled this identification to be described in terms of the level of confidence by which a claim concerning weakness of grip may be proclaimed as genuine or insincere. CONCLUSIONS: Though the neuromotor mechanisms responsible for grip strength may differ from those acting with respect to other muscle groups, the inability to adjust the eccentric and concentric force components during submaximal efforts is probably a general feature. RELEVANCE: Isokinetic dynamometry is a powerful method for quantifying various aspects of muscle performance. However, its application in the medicolegal area of muscle weakness has only recently been explored. Combined with previous research, this study strongly indicates that if certain trauma or pathology-related weakness does not result in variations in the force-velocity characteristics of the affected muscles, than this technique has the potential to validly differentiate between patients who have a genuine reason for compensation and those ('symptom magnifiers') who do not.     

The clinical relevance of hand preference and laterality

Abstract

Handedness is not a unidimensional trait but rather part of a multifactorial system best described as one of the aspects comprising human laterality of the whole body and including associated neural mechanisms. In this review, different methods for assessing and classifying handedness are examined and three major models – genetic, pathological and environmental factors – are explored as a possible rationale for an individual's handedness. The relationship between handedness and turning preferences due to the underlying link between hemispheric dopamine asymmetries in the brain and turning preferences and their fundamental implications for right- and left-handed individuals and their turning preference is also examined. The clinical relevance of turning preference in right- and left-handed individuals for therapists and the scope for further research in the areas of ergonomics, neurological rehabilitation and hand therapy is given emphasis.     

Construction of a simple test for assessment of hand function in primary care. Theories and experimental trials for the test situation

This paper describes a hand test consisting of three steps to test the subject's ability to grasp firmly another person's hand to hold a pencil firmly with fingers II-V with straight knuckles and maximally flexed finger joints, while the investigator pulls the pencil to hold on to a piece of paper with a rounded pinch grip between thumb and index finger while the investigator pulls the paper with a rounded pinch grip with submaximal strength. All three steps must be performed with each hand without causing pain. The test was an adequate parameter for the grip function, and at the same time could register work-load elicited pain, strength, and mobility. The test can be carried out by healthy subjects, but not by patients with rheumatoid arthritis. The test is logically constructed and has a high validity and reliability.     

辅助任务导向训练对老年类风湿性关节炎患者手功能康复以及生存质量的影响

目的探讨对老年类风湿性关节炎(RA)应用辅助任务导向训练的干预对其手功能康复以及生存质量的影响。方法选取佛山市第五人民医院治疗的老年RA患者80例,根据入院先后顺序,通过随机数字表分为治疗组40例与对照组40例,入组患者均给予规范抗风湿药物常规治疗,对照组采取常规手部抗阻训练方式,治疗组则在对照组的基础上给予辅助任务导向训练干预,对两组干预1个月,比较干预前后两组患者手指总主动活动度(TAM)、握力、改良Barthel指数评分以及生活质量评价量表(SF-36)评分情况。结果①两组患者治疗前双侧手指TAM、握力、改良Barthel指数评分以及SF-36评分比较差异无统计学意义(P>0.05)。②治疗后,两组双侧手指TAM、握力、改良Barthel指数评分以及SF-36评分分别较组内治疗前明显改善(P<0.05)。治疗后治疗组左手TAM(268.25±20.62)°与右手TAM(259.93±23.44)°分别高于对照组左手TAM(235.56±25.21)°与右手TAM(224.37±21.86)°(P<0.05);治疗后治疗组左手握力(75.12±8.09)mmHg(1 mmHg=0.133 kPa)与右手握力(79.62±7.86)mmHg分别高于对照组左手握力(62.56±7.78)mmHg与右手握力(65.13±8.10)mmHg(P<0.05);治疗后治疗组改良Barthel指数评分(35.25±4.60)分高于对照组改良Barthel指数评分(31.56±5.25)分(P<0.05);治疗后治疗组SF-36评分(88.25±11.62)分高于对照组SF-36评分(80.56±16.21)分(P<0.05)。结论对老年RA进行辅助任务导向训练干预可提高患者手部关节活动度,增强手部握力,提高日常生活手功能活动能力以及改善生存质量水平。     

Reference Values for Handgrip Strength Among Healthy Adults in Nigeria

Handgrip strength (HGS) measurements provide an objective index of the functional integrity of the upper extremity. Motivated by the paucity of reference values for HGS for an African population, this study sought to establish reference values for HGS in healthy Nigerian adults. The HGS of 745 (409 male and 336 female) healthy volunteers from the ages of 20–70 years was measured using a Takei Kiki Kogyo handgrip dynamometer in accordance with the American Society of Hand Therapists protocol. Men exhibited higher HGS than that in women in both dominant (35.2 kilogram force [kgf] vs. 24.9 kgf) and non-dominant (31.6 kgf vs.22.8 kgf) hands. Using percentile values cut points, less than 25^th (poor grip strength), 25^th–75^th (moderate grip strength), and > 75^th (good grip strength) percentile were < 29.0 kgf, 29.0–34.0 kgf, and > 34.0 kgf, respectively, for the dominant hand and < 24.0 kgf, 24–36.0 kgf, and > 36.0 kgf, respectively, for the non-dominant hand. These findings suggest that males have a significantly higher HGS than females. HGS decreases with increasing age for both dominant and non-dominant hands. The reference values derived in this study would be useful in assessing impairment in functional ability of the upper extremities in both healthy and patients' populations.