Patients and Methods After approval of the Institutional Review Board and after

Patients and methods after approval of the

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Patients and Methods After approval of the Institutional Review Board and after informed consent of the parents, children from a local primary school without upper limb impairment were approached for participation. One hundred one children between 4 and 12 years old participated. Hand domi- nance and upper extremity problems that could influence hand strength were determined by evaluating parents’ responses to a questionnaire. Children with a history of upper extremity trauma or abnormalities were excluded (Appendix 1). Ninety-four percent of the children were right-handed (Table 1 ). The RIHM (Fig. 1 ) is a dynamometer that measures strength by means of muscle resistance in a break test. This break test is performed while pulling with the RIMH at an easily controllable angle [ 9 ]. The examiner and subject are seated opposite each other at a table and the subject is shown and instructed how to keep his or her finger or thumb in place. Slowly, while the subject is instructed to hold the position of the fingers, force is increased, and after a few seconds, the examiner pulls to break the position. The RIHM is reportedly reliable in adults and children. The interrater and intrarater reliabilities were 0.94 and 0.93, respectively, in patients with Charcot-Marie-Tooth disease [ 18 ] and 0.94 in patients with peripheral nerve injury [ 15 ]. The intraclass coefficient values for a group of children (4–12 years old) were greater than 0.97 for thumb mea- surements, greater than 0.94 for the index finger, and greater than 0.90 for the little finger when analyzed for the whole group, whereas no relation was found between age and reliability [ 11 ]. We focused on strength measurements of the thumb, index finger, and little finger because the thumb together with the index and little fingers form the outer anatomic boundaries for different prehension functions of the hand. We measured abduction of the index finger (initiated by the first dorsal interosseous muscle) and little finger (initiated by abductor digiti quinti muscle). In addition, for the thumb, we measured thumb palmar abduction (primarily the abductor pollicis brevis muscle), thumb opposition (primarily the opponens pollicis muscle, but functionally guided by abductor pollicis brevis muscle) [ 19 ], and thumb flexion in the metacarpophalangeal joint (primarily the intrinsic flexor pollicis brevis muscle) [ 17 , 20 ]. The mea- surements were repeated three times and the mean of the three tests was registered [ 2 ]. After each measurement, the dynamometer was reset. All measurements were performed in a randomized order by the same researcher (HMM). To develop the growth curves, we first estimated the percentiles for each strength measurement using Altman’s Table 1. Number of participants divided by gender and age Age (years) Boys (number) Girls (number) Total (number) 4 6 2 8 5 3 5 8 6 5 8 13 7 6 5 11 8 4 9 13 9 10 4 14 10 5 8 13 11 5 9 14 12 5 2 7 Total 49 52 101 Volume 469, Number 3, March 2011 Growth Diagrams for Finger Strength in Children 869 123
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method of absolute scaled residuals [ 1 ]. Because visual inspection did not reveal skewness or nonnormal kurtosis, we decided not to transform the dependent variable. In a first model, strength was modeled as a function of age. To
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  • Spring '17
  • H. M. Molenaar PhD

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