Specialized Hand Therapy Course Manual Module 2 by jokeresteban

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! REHABTRENDS,! INC.! is! an! accredited! provider! of! continuing! education! by! the! Professional! Regulation! Commission.! It! was! established! on! May! 2011! by! a! group! of! professional! physical! therapists.!The!organization!regularly!conducts!postgraduate!courses!that!provide!its!members! and!other!stakeholders!with!an!opportunity!for!professional!growth!and!advancement!through! current!updates!in!the!practice.!

! ! MISSION!STATEMENT! ! REHABTRENDS,! INC.!commits! itself! in! providing! continuing! education! to! professional! Physical! Therapists! and! Occupational! Therapists! in! order! to! promote! development! and! improvement! in! the! quality! of! its! health! care! practice! in! the! Philippines.! It! aims! to! provide! world! class! lectures! and! seminars,! dealing! with! the! latest! evidenceObased! approaches! to! Physical! Therapy! and! Occupational! Therapy!practices.!Its!ultimate!goal!is!to!contribute!in!the!advancement!of!the!allied!medical!practice! in!the!Philippines.! ! VISION!STATEMENT! ! By!the!end!of!May!2019,!REHABTRENDS,!INC.!envisions!itself!as!the!centre!of!continuing!education!in!the! allied! health! profession! known! for! its! competent! ! and! dedicated! partners! to! provide! unbiased! and! updated!practices!nationwide!whilst!upholding!the!culture!of!excellence.! ! KEY!PRINCIPLES!OF!REHABTRENDS,!INC.! ! • Excellence! • Accessibility! • Affordability! • Innovation! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

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SPECIALIZED!HAND!THERAPIST!CERTIFICATION!COURSE!

! ! SPECIALIZED!HAND!THERAPIST!CERTIFICATION!COURSE ! ! Hand!therapy!is!a!specialized!rehabilitation!program!that!helps!a!patient!regain!normal!function!and!use! of!his!or!her!upper!extremity!after!injury,!postEsurgery!or!the!onset!of!disease.!It!is!usually!performed!by! a! certified! hand! therapist.! A! Certified! Hand! Therapist! is! a! locally! registered! occupational! or! physiotherapist!who,!via!advance!training,!continuing!education!and!experience,!has!!become!proficient! in! the! rehabilitation! of! pathological! upper! extremity! conditions.! Hand! therapists! uses! all! kind! of! techniques! to! treat! the! hand.! They! teach! patients! how! to! use! the! hand! properly,! they! give! specific! exercises!and!apply!different!sorts!of!modalities.!Additionally!a!hand!therapist!has!the!knowledge!how!a! splint! should! be! used/worn.! The! REHABTRENDS’! Hand! Therapist! Certification! Course! is! a! 4Emodule! course!that!provides!a!specialized!training!on!the!fundamental!knowledge!in!hand!therapy!practice.!The! course! offers! an! advance! level! of! studies! on! the! evaluation! and! treatment! of! upper! extremity! injuries! and! dysfunctions.! Particular! focus! is! on! clinical! reasoning,! case! discussion,! handsEon! application! and! evidenceEbased! practice! in! upper! extremity! rehabilitation.! The! course! also! offers! an! avenue! for! active! learning!and!handsEon!application!of!the!fundamental!hand!therapy!principles.! ! ! COURSE!PRE2REQUISITE! Module! 1ELocally! registered! Physical! Therapist! or! Occupational! Therapist! with! 1! year! of! clinical! experience! Module!2ECompleted!the!courses!in!Module!1! Module!3ECompleted!the!courses!in!Module!1!and!2! Module!4ECompleted!the!courses!in!Module!1,!2!and!3! ! ! PROGRAM!OUTCOMES! At!the!end!of!the!course,!the!professionals!are!expected!to:! • explain!and!discuss!the!anatomical!and!physiological!theories!and!principles!of!the!upper! extremity!medical!conditions!including!the!diagnosis! • discuss!the!rehabilitation!outcomes!of!surgical!and!nonEsurgical!interventions!of!the!upper! extremity! • accurately!administer!the!special!tests,!standardized!and!nonEstandardized!assessment!tools!for! the!upper!extremity! • be!able!to!analyze!the!results!of!the!different!evaluation/assessment!tools!used!for!the!upper! extremity!for!the!formulation!of!goals!and!problem!list! • demonstrate!mastery!in!the!execution!of!the!different!management!techniques!for!the!upper! extremity! • compose!an!inEdepth!home!program!that!is!appropriate!to!the!different!clients!with!upper! extremity!conditions!! • construct!goals!that!are!based!on!current!evidence!and!research!! • Perform!evidence!based!practice! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

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SPECIALIZED!HAND!THERAPIST!CERTIFICATION!COURSE!

RESOURCE!SPEAKERS! !

Roi!Charles!Pineda,!OTRP,!OTR,!MSC! CLINICIAN:!Mr.!Pineda!is!currently!a!selfGemployed! occupational!therapist!that!does!home!care!therapy.!He! provides!adult!dysphagia!evaluation!and!intervention!and! adult!hand!rehabilitation!for!orthopedic!conditions!such!as! tendon!injury,!peripheral!nerve!injury!and!fractures!and! neurologic!condition!like!stroke.!He!also!provide!patients!with! upper!and!lower!extremity!orthotics!and!splinting! ACADEMICIAN!Mr.!Pineda!is!also!an!experienced! academician.!Currently,!Mr.!Pineda!is!a!College!Instructor!and!Clinical!Internship!Coordinator!at! Angeles!University!Foundation.!! !

Stephanie!Ann!G.!Balid,!MAPsych,!OTRP!! RESEARCHER:!Ms.!Balid!is!currently!the!Research!Coordinator! of!Department!of!Occupational!Therapy!of!College!of! Rehabilitation!Sciences!of!University!of!Santo!Tomas.!She!is! also!a!Researcher!at!present!at!Benavidez!Cancer!Institute!of! University!of!Santo!Tomas!Hospital!and!Center!for!Health! Research!and!Movement!Sciences.!! CLINICIAN:!Ms!Balid!is!also!an!experienced!occupational! therapist!that!has!been!appointed!as!staff!occupational! therapist!at!different!clinics!here!in!the!Philippines.!At!present!she!is!a!Clinical!Psychologist!at! Benavidez!Cancer!Institute!of!University!of!Santo!Tomas!Hospital.!She!is!also!an!Occupational! Trainee!in!Pain!Management!and!Research!Institute!at!University!of!Sydney!Medical!School.!! ACADEMICIAN:!Ms.!Balid!is!faculty!member!of!the!Department!of!Occupational!Therapist!of! College!of!Rehabilitation!Sciences!of!the!University!of!Santo!Tomas.!She!is!also!a!lecturer!in! Masters!of!Physical!Therapy!at!UST!Graduate!School!and!Masters!of!Pain!Medicine!at!faculty!of! Medicine!and!Surgery!of!University!of!Santo!Tomas.!!

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! Leo!Angelo!Doble,!MD,!CMPAPRAS! RESERACHER:!Dr.!Doble!had!published!several!research!papers;! some!are!about!studies!of!different!intervention!and! management!for!breast!cancer.! CLINICIAN:!Dr.!Doble!is!currently!affiliated!in!different!hospitals! in!Manila,!Valenzuela!and!Olongapo!City,!Zambales.!He!is!also!a! volunteer!surgeon!in!USTGMedical!Missions,!Inc.,!USTGHouse! Staff!Medical!Missions!and!in!Operation!Smile!International/! Operation!Smile!Philippines!Smile!Train!Inc.!He!also!worked!as!a! freelance!personal!trainer!and!physical!therapist!and!physician!before!at!different!clinics!in! metro!manila.! !

Arlene!Chua!â&#x20AC;&#x201C;!Chiong!Maya,!MSPT,!PTRP!! CLINICIAN:!Ms.!Chiong!Maya!is!an!experienced!clinician!for!more! than!8!years.!She!worked!as!Physical!Therapy!Staff!and!later!on! as!Department!Supervisor!of!Department!of!Physical!Medicine! and!Rehabilitation!of!Our!Lady!of!Lourdes!Hospital!from!2007!to! 2014.!She!was!also!appointed!as!Staff!Physical!Therapist!in! Health!Hub!Physical!Therapy!Clinic!last!year.! ACADEMICIAN:!Currently,!Ms.!Chiong!Maya!is!a!faculty!member! of!College!of!Rehabilitation!Sciences!of!University!of!Santo!Tomas.!She!also!facilitated!some! seminars!regarding!Sports!Mobilization!Techniques!and!Athletic!Taping!and!Sports!Medicine.!

! Zyra!Mae!F.!Villamor,!PTRP,!MOH!! CLINICIAN:!Ms.!Villamor!is!a!former!Physical!Therapy!Staff!at! Apolinario!Mabini!Rehabilitation!Center!of!University!of!Santo! Tomas!Hospital.!She!also!worked!as!an!ergonomist!at!Chevron! Holdings!Inc.!! ACADEMICIAN:!Currently,!Ms.!Villamor!is!a!faculty!member!of! Department!of!Physical!Therapy!of!the!College!of!Rehabilitation! Sciences!of!University!of!Santo!Tomas.! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! ! Batch!1!&!2E!June!18,!2016!(Saturday)!to!June!19,!2016!(Sunday)!!

!!!!Day!128AME5PM,!Day!22!8AME2PM! ! !!!!5!!!!!!!!!!!!Room!3,!5th!Floor!Medical!Arts!Building,!Our!Lady!of!Lourdes!Hospital,!Sta.!Mesa,!Manila.! Module!1:!Fundamental!Knowledge!for!Hand!Therapy!Practice! Intended!Learning!Outcomes:! At!the!end!of!the!session,!the!postgraduate!students!are!expected!to!be!able!to:! â&#x20AC;˘ Correlate!the!knowledge!in!anatomy!and!biomechanics!of!the!upper!extremity!to!the!presentation!of!the! essential!medical!conditions!that!affect!the!UE! â&#x20AC;˘ Explain!and!justify!the!surgical!and!nonEsurgical!interventions!of!the!upper!extremity! TIME!

TOPIC!

METHOD!OF! TEACHING!

DAY!1! 8:00E8:30!AM! Registration! 8:30E9:00!AM! Opening!Ceremony!and!Welcome!Remarks! 9:00E9:30!AM! Introduction!to!Hand!Therapy!Certification! 9:30E11:00!AM! Essential!Anatomy!of!the!Wrist!and!Hand! Interactive! Lecture! 11:00E12:30!PM! The!Pathomechanics!and!Diagnosis!of!the! Interactive! Common!Orthopedic!Condition!of!the!wrist! Lecture! and!hand! 12:30E1:30!PM! Lunch! 1:30E2:30!PM! Surgical!and!NonEsurgical!interventions!of!the! Interactive! wrist!and!hand!conditions!and!its!outcome! Lecture! 2:30E3:30!PM! Guidelines!for!Rehabilitation!after!PostE Interactive! operative!procedures!in!the!Wrist!and!Hand! Lecture! 3:30E4:30!PM! Essential!Anatomy!of!the!Elbow! Interactive! Lecture! Day!2! 8:00E8:30!AM! Opening!Ceremony! 8:30E9:30!AM! Essential!Anatomy!of!the!Shoulder! ! 9:30E10:30!AM! The!Pathomechanics!and!Diagnosis!of!the! Interactive! Common!Musculoskeletal!Conditions!of!the! Lecture! Shoulder! 10:30E11:30! Guidelines!in!Rehabilitation!of!the!Shoulder! Interactive! AM! Lecture! 11:30E12:30!PM! Lunch! 12:30E2:00!PM! Upper!Extremity!Neurorehabilitation! Interactive! Lecture! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

RESOURCE!SPEAKER!

Mr.!Mark!Angel!B.!Serra,!PTRP! Mr.!Jose!D.!Ramos,!OTRP! Dr.!Estrella,!MD,!FPOA!

Dr.!John!Hubert!C.!Pua,!MD,! FPOA!

Assist.!Prof.!Valentin!C.!Dones! III,!PhD! Master!of!Ceremony! ! Dr.!Mary!Monica!Bernardo,!MD!

Dr.!Tyrone!Cabrera,!MD!

! ! ! ! Module!2:!Evaluation!and!Assessment!in!Upper!Extremity!Management!

Intended!Learning!Outcomes:! At!the!end!of!the!session,!the!postgraduate!students!are!expected!to!be!able!to:! â&#x20AC;˘ Master!the!utilization!of!the!different!evaluation/assessment!tools!and!measures!to!accurately!acquire!the! necessary!information!from!the!client! !

TIME!

TOPIC!

METHOD!OF! TEACHING!

RESOURCE!SPEAKER!

Day!1! Module!2:!Evaluation!and!Assessment!in!Upper!Extremity!Management! 8:00E8:30!AM! Registration! 8:30E9:00!AM! Opening!Ceremony!and!Welcome!Remarks! Mr.!Mark!Angel!B.!Serra,!PTRP! 9:00E10:30!AM! Assessment!Tools!used!in!Hand!Therapy:! Interactive! Mr.!Roi!Charles!S.!Pineda,!MSc,! Validity!and!Reliability! Lecture! OTR,!OTRP! 10:30E12:00!PM! Assessment!Tools!for!Pain! Discussion!and! Mrs.!Stephanie!Balid!Atwell,! Group!Work! MAPsych,!OTRP! Activity! (Workshop)! 12:00E1:00!PM! Lunch! 1:00E2:30!PM! Assessment!Tools!for!Upper!Extremity! Discussion!and! Mr.!Roi!Charles!S.!Pineda,!MSc,! Function!and!Occupational!Performance! Group!Work! OTR,!OTRP! Activity! 2:30E4:30!PM! Assessment!Tools!for!Sensibility!and!Dexterity! (Workshop)! ! ! ! Day!2! 8:00E8:30!AM! Opening!Ceremony! Master!of!Ceremony! 8:30E10:00!AM! Assessment!Tools!for!Wounds!and!Scars! Interactive! Dr.!Leo!Angelo!D.P.!Doble,!MD! Lecture! 10:00E12:00!PM! Assessment!Tools!for!ROM,!Strength,!Edema! Discussion!and! Mrs.!Arlene!Chua!Chiong!Maya,! and!Vascularity! Group!Work! MSPT,!PTRP! Activity! (Workshop)! 12:00E1:00!PM! Lunch! 1:00E2:30!PM! Special!Test!for!Upper!Extremities! Discussion!and! Mrs.!Arlene!Chua!Chiong!Maya,! Group!Work! MSPT,!PTRP! Activity! (Workshop)! 2:30E4:00!PM! Rapid!Upper!Limb!Assessment!Tools!for! ! Ms.!Zyra!Villamor,!MOH,!PTRP! Ergonomic!Risk!Factors! ! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

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Module!3:!Therapeutic!Interventions!in!Upper!Extremity!Management! Intended!Learning!Outcomes:!

At!the!end!of!the!session,!the!postgraduate!students!are!expected!to!be!able!to:! • Perform!manual!therapy!interventions!in!the!upper!quadrant!of!the!body! • Effectively!apply!sensory!management!techniques! • Utilize!the!appropriate!technologies!in!virtual!!rehabilitation! • Efficiently!utilize!available!treatment!modalities!in!the!treatment!of!upper!extremity!conditions! • Observe!and!demonstrate!knowledge!in!proper!wound!care!and!dressing! • Confidently!prescribe!appropriate!therapeutic!exercise!program!to!surgical!and!nonEsurgical!conditions!of!the!upper! extremity! ! !TIME! TOPIC! METHOD!OF! RESOURCE!SPEAKER! TEACHING! Day!1! 8:00E8:30!AM! Registration! 8:30E9:00!AM! Opening!Ceremony!and!Welcome!Remarks! Mr.!Jose!D.!Ramos,!OTRP! 9:00E11:30!AM! Manual!Medicine!in!Upper!Extremity:!part!1! Discussion!and! Assistant!Professor!Valentin!C.! Group!Work!Activity! Dones!III,!PhD! (Workshop)! 11:30E12:30!PM! Lunch! 12:30E2:00!PM! Manipulative!Therapy!in!Upper!Extremity! Discussion!and! Mr.!Christian!Rimando,!MSPT,! Group!Work!Activity! PTRP! (Workshop)! 2:00E4:30!PM! Upper!Extremity!Neurorehabilitation! Ms.!Christine!Versales,!MSPT,!PTRP! Day!2! 8:00E8:30!AM! Opening!Ceremony! Master!of!Ceremony! ! Parallel!Session! 8:30E!10:30!PM! Physical!Agents!and!Electrotherapy! Discussion!and! Ms.!Arlene!C.!ChiongEMaya,!MSPT,! Group!Work!Activity! PTRP! (Workshop)! Sensory!Management!Techniques! Ms.!Lorena!Igna,!MPH,!OTRP! 10:30E12:00!PM! Orthotics!and!Prosthetics! Discussion!and! Ms.!Anna!Margarita!A.!Lugue,! Group!Work!Activity! PTRP,!BPO! (Workshop)! 12:00E1:00!PM! Lunch! 1:00E2:30!PM! Wound!Care!and!Scar!Management! Discussion!and! Mr.!Thomas!Joseph!Foronda,!PT,! Group!Work!Activity! DPT,!CWS,!WCC! (Workshop)! ! ! !

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! ! ! Module!4:!Professional!Practice!and!Planning!in!Upper!Extremity!Management!

Intended!Learning!Outcomes:! At!the!end!of!the!session,!the!postgraduate!students!are!expected!to!be!able!to:! • Utilize!the!most!reliable!and!valid!!outcome!measures!in!determining!progress!of!clients! • Create!goals!that!are!specific,!measurable,!attainable,!realistic,!timeEbound!and!supported!by!evidence!and! research! • Effectively!design!a!treatment!program!for!upper!extremity!condition!using!the!latest!evidence!!and!research! !

TIME!

2:30E5:00!PM!

TOPIC! Evidence!Based!Practice!in!Upper!Extremity!

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METHOD!OF! TEACHING! Discussion!and! Group!Work! Activity! (Workshop)!

RESOURCE!SPEAKER! Assoc.!Prof.!Janine!Margarita! Dizon,!PhD!

PAIN ASSESSMENT: THE BIOPSYCHOSOCIAL MODEL STEPHANIE!ANN!BALID,!OTR,!OTRP,!Ph.D!(cand.)! ! I.!PAIN! •

•

Defined!by!the!International!Association!for!the!Study!of!Pain!as!unpleasant!sensory!and! emotional!experience!associated!with!actual!or!potential!tissue!damage!(Mersekey,! 1979)! NOT!ALL!PAIN!IS!THE!SAME! o It!is!important!to!classify!the!pain!to!help!us!choose!the!best!treatment! o Pain!can!be!classified!in!three!main!ways:! ! 1.!How!long!has!the!patient!had!pain?! ! 2.!What!is!the!cause?! ! 3.!What!is!the!pain!mechanism?! How!long!has!the!patient!had!pain?! ACUTE!vs!CHRONIC! o DURATION!OF!PAIN! ! The!experience!of!pain!can!be!acute!or!chronic!depending!on!the! duration!of!time,!which!is!usually!persisting!for!more!than!3!to!6!months.!! ! Sometimes,!a!patient!with!chronic!pain!may!experience!additional!acute! pain!(ACUTE!ON!CHRONIC!PAIN)! ! There!is!evidence!that!poorly!treated!ACUTE!pain!is!more!likely!to! become!CHRONIC!pain! !

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! II.!CAUSE! ! • •

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CANCER!PAIN! Often!chronic!but!the!patient!may!get! acute!pain!as!well!! Pain!symptoms!tend!to!get!worse!over! time!so!it!should!be!treated! immediately!(progressive)! Goal!is!to!relieve!of!pain!symptoms!and! improve!quality!of!life!

! III.!MECHANISM! ! NOCICEPTIVE! • Common!type!of!pain!following!tissue! injury! • Sometimes!called!“physiological!pain”! • Caused!by!stimulation!of!pain! receptors!in!the!tissues!that!have!been! injured! • Patients!describe!pain!as!sharp,! throbbing!or!aching!and!it!is!usually! well!localised!! ! IV.!EFFECTS!OF!NERVE!DAMAGE! ! !

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NON!CANCER!PAIN! Pain!may!be!acute!and!last!for!a!limited! time!or!may!become!chronic! The!cause!may!or!may!not!be!obvious! Many!different!causes:! – Surgery!or!injury! – Degenerative!disease!(e.g.! arthritis)! – Cervical!pain!that!radiates!to!UE! – Childbirth! – Nerve!compression! – No!obvious!cause!!

NEUROPATHIC! Caused!by!damage!to!or!abnormal! function!of!the!nervous!system! Sometimes!called!“pathological!pain”! Tissue!injury!may!not!be!obvious! Patients!describe!neuropathic!pain!as! shooting!or!burning.!They!may!also! complain!of!numbness!or!pins!and! needles.!The!pain!is!often!not!well! localized.!!

Abnormal!firing!of!nerves!giving!pain!without!a!stimulus! Increased!number!of!pain!signals!from!the!spinal!cord!to!the!brain!!

V.!IMPACT!OF!PAIN! ! !

Several!studies!explored!how!chronic!pain!affected!patient’s!ability!to!work!(Chan!et!al.,! 2006),!ability!to!do!self!care!(Van!Hooff!et!al.,!2010),!and!even!ability!to!relate!with! other!people!(Lewandowski,!Morris,!Draucker,!&!Risko,!2007).!!

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ENVIRONMENT!

PAIN!BEHAVIORS!

PSYCHOLOGICAL!DISTRESS!

ATTITUDES!AND! BELIEFS!

PAIN!PERCEPTION!

BIOLOGICAL!

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! VI.!IMPLICATION!ON!ASSESSMENT!

BIOLOGICAL! ASSESSMENT!

EMOTIONAL/! PSYCHOLOGICAL! ASSESSMENT!!

FUNCTIONAL! ASSESSMENT!!

! VII.!BIOLOGICAL!FACTORS! • PAIN!HISTORY!! – !Mechanism/!Circumstance!of!onset! – Length!of!pain!complaint! – Indication!of!severity/!effect!on!lifestyle! – Health!professional!seen! – Interventions!attempted!and!efficacy! – Current!treatments! ! VIII.!INVESTIGATIONS! • Indication!of!possible!or!actual!pathology! • Important!step!in!eliminating!RED!FLAGS! – Infection! – Neurological!deficit! – Fracture! – Tumor! ! ! ! ! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! IX.!PHYSICAL!EXAMINATION! • Provides!a!global!indication!of!musculoskeletal!function! • Provides!specific!screening!for!musculoskeletal!red!flags!or!barriers!to!physical!activity! upgrading! • Provides!a!chance!to!further!explore!information!gained!during!the!history! – Beliefs!challenged!during!movement! – Observation!of!anxiety/!fear!during!movement! – Observation!of!pain!behaviors! • •

Information!gained!from!the!physical!assessment!and!from!the!history!is!used!in!the! clinical!reasoning!process!and!in!the!development!of!a!case!formulation! ELEMENTS! o Observation! ! Posture,!function,!guarding! o Active!range!of!movement! ! Range!and!quality!of!movement! o Passive!range!of!movement! o Muscle!length!and!strength!(movement!contributions)! o Neurological!testing! o Neurodynamic!testing! o Palpate! ! Hyperalgesia,!allodynia,!muscle!(spasm/bulk)! o Special!Tests/!Other!testing! o Functional!testing!! o General!health!questionsgrisk!factors! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! FOREARM,!WRIST,!and!HAND! HAND! ! • Most!active!and!intricate!part!of!the!upper!extremity! • Vulnerable!to!injury!! • Considered!as!an!expressive!organ!of!communication,!the!hand!has!a!protective!role! and!acts!as!both!a!motor!and!sensory!organ! • It!provides!information!on!temperature,!thickness,!texture,!depth,!and!shape!as!well!as! the!motion!of!an!object! ! PATIENT!HISTORY! ! • 1.!What!is!the!patient’s!age?!! • 2.!What!is!the!patient’s!occupation?! • 3.!What!was!the!mechanism!of!injury?! • 4.!What!tasks!is!the!patient!able!to!unable!to!perform?! • 5.!When!did!the!injury!or!onset!occur,!and!how!long!has!the!patient!been!incapacitated?! • 6.!Which!hand!is!the!patient’s!dominant!hand?! • 7.!Has!the!patient!ever!injured!the!forearm,!wrist!or!hand!before?!Was!it!the!same!type! of!injury?!Was!the!mechanism!of!injury!the!same?!If!so,!how!was!it!treated?! • 8.!Which!part!of!the!forearm,!wrist!or!hand!is!injured?! ! OREBRO!MUSCULOSKELETAL!PAIN!SCREENING!QUESTIONNAIRES!! FOR!YELLOW!FLAGS! ! • It!can!be!used!to!screen!for!psychological!and!environmental!risk!factors!(yellow!flags)! • To!help!identify!those!injured!workers!with!soft!tissue!injuries!who!are!at!risk!of!failing! to!return!to!work! • Conducted!between!1g6!months!postginjury! • The!maximum!score!is!240!with!24!items!(each!with!10!maximum)!! • It!is!suggested!that!the!105!score!should!act!as!a!trigger!to!check!for!yellow!flags! ! PAIN!INTENSITY!QUESTIONNAIRE! ! • 4!item,!0g10!scale!questionnaire!reporting!highest,!lowest!and!usual!pain!intensity! experienced!at!the!moment!of!answering!and!over!the!last!week.!! • The!items!are!rated!by!encircling!a!number!on!the!11gpoint!scale!from!0!as!having!no! pain!to!10!as!having!worst!pain!imaginable.!! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

MULTIDIMENSIONAL!PAIN!INVENTORY! ! • 3gsection!selfgreport!questionnaire!! • Overall,!this!has!60!items,!the!1st!section!has!28!items,!2nd!section!has!14,!and!the!last! section!has!18!items!having!a!scale!of!0g6.!!! • Section!1!measures!the!importance!of!different!dimensions!of!chronic!pain,!however! the!2nd!section!focuses!on!how!the!spouse!(or!significant!other)!responds!when! experiencing!pain!and!the!last!section!focuses!on!their!engagement!on!activities!of!daily! living.!! ! DISABILITY!QUESTIONNAIRE!(MODIFIED!ROLAND!&!MORRIS)! ! • 24!item!questionnaire!that!contains!statements!that!people!have!used!to!describe! themselves!when!they!experience!pain.!! • If!the!sentence!describes!the!current!feeling!of!the!respondent,!a!check!mark!be!written! against!it,!if!it!does!not!describe!the!feeling,!the!box!will!be!left!blank!and!move!on!to! the!next!number.!! • The!checked!responses!are!scored!as!“1”!and!the!blank!responses!are!scored!as!“0.”!The! results!are!added!up!with!results!ranging!between!0!and!24.!Greater!levels!of!disability! are!reflected!by!higher!numbers.!! • Scores!under!4!and!over!20!may!not!show!significant!change!overtime!in!patients!with! scores!of!less!than!4!and!deterioration!in!patients!who!have!scores!greater!than!20.!! ! EUROPEAN!QUALITY!OF!LIFE!(EUROQOL)! ! • The!first!part!consists!of!five!questions:!mobility,!selfgcare,!usual!activities,! pain/discomfort,!and!anxiety/depression.!For!each!dimension,!the!respondents!will!be! asked!to!rate!from:!no!problems,!some!problems,!and!severe!problems.!Level!1,!Level!2,! and!Level!3!is!coded!as!‘1’,!‘2’,!‘3’,!respectively.!! • If!the!participant!reported!most!answers!in!level!1!it!indicates!no!problems!in! performing!areas!of!occupation,!level!2!indicating!some!problems!in!performing!the! usual!activities,!and!level!3!indicating!severe!difficulties!in!performing!most!of!his!or!her! daily!occupations.! • The!second!part!uses!a!vertical!graduated!VAS!thermometer!where!the!end!points!are! labeled!from!100!(Best!imaginable!health!state)!to!0!(Worst!imaginable!health!state).!! • The!higher!the!score!reported!on!the!VAS!vertical!scale,!the!higher!level!of!their! perceived!health.!! ! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

DEPRESSION!ANXIETY!STRESS!SCALE! ! • The!DASS!is!a!42g!item!selfg!administered!measure!developed!by!Lovibond!and!Lovibond.! • The!purpose!of!this!tool!is!to!measure!the!magnitude!of!three!negative!emotional! states:!depression,!anxiety!and!stress,!each!of!which!consists!of!14!items!each.! • DASS!is!answered!by!using!a!4!–!point!Likert!scale!ranging!from!0,!did#not#apply#to#me#at# all,#to!3,!applied#to#me#very#much#or#all#the#time.!!! • Once!the!measure!is!complete,!the!score!was!attained!by!getting!the!sum!of!each! subscale!g!with!higher!scores!indicating!greater!level!of!distress.! ! TAMPA!SCALE!FOR!KINESIOPHOBIA! ! • The!authors!defined!Kinesiophobia!as,!“an#irrational#and#debilitating#fear#of#physical# movement#and#activity#resulting#from#a#feeling#of#vulnerability#to#painful#injury#or#re8 injury.”!! • It!is!a!17gitem!selfgreport!questionnaire!scored!using!a!4g!point!Likert!scale!ranging!from! 1,!strongly#disagree,!to!4,!strongly#agree.#! • Items!number!4,!8,!12!and!16!are!reversely!scored.!Total!scores!range!from!17!to!68;! high!value!equates!with!high!kinesiophobia.!! ! PAIN!RESPONSE!SELFBSTATEMENT!SCALES! ! • PRSS!is!a!two!ninegitem!subscale!used!to!assess!“catastrophizing.”!! • It!determines!how!an!individual!attempt!to!cope!with!pain!and!how!they!think!when! they!experience!severe!pain.!! • These!items!are!rated!through!a!sixgpoint!scale!(with!0!=!almost!never!to!5!=!almost! always).! • Summation!of!scores!and!interpretation!of!results!would!indicate!that!if!the!patient!gets! a!higher!score,!the!more!the!more!catastrophizing!pain!is.!1!9!10! ! CHRONIC!PAIN!ACCEPTANCE!QUESTIONNAIRE!(CPAQ)! ! • It!assesses!the!pain!acceptance,!which!is!a!component!in!changing!pain!behavior!and! has!a!significant!effect!in!improving!the!quality!of!life!of!patients!with!chronic!pain.! • !It!consists!of!twenty!statements!measuring!chronic!pain!acceptance.!The!respondent! needs!to!rate!the!eleven!statements!that!measure!activity!engagement!and!nine! statements!that!assess!pain!willingness!from!0!(“Never!true”)!to!6!(“Always!true”).!! • It!shows!that!increased!pain!can!result!to!a!decreased!acceptance!and!activity! engagement.!Scores!are!acquired!by!getting!the!sum!of!items!under!activities! engagement!and!the!sum!of!the!reversed!score!items!under!pain!willingness.!The!sum!of! the!two!subscales!would!be!the!total!score!for!CPAQ.! • !Highest!possible!score!is!120!and!lowest!is!0.!A!higher!score!indicates!a!better! acceptance!to!pain.!! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! PAIN!SELFBMANAGEMENT!CHECKLIST!B!SELFBRATED!(PSMCBSR1)! ! • It!is!a!questionnaire!that!assesses!the!frequency!of!unhelpful!selfgmanagement! strategies!of!chronic!pain!patients.! • It!is!an!18gitem!checklist!with!a!5gpoint!scale!(from!0=!“never”!to!4=!“very!often”).!! • The!total!scores!are!computed!and!reported!as!part!of!a!range.!The!higher!total!score! indicates!a!more!frequent!use!of!unhelpful!selfgmanagement!strategies!for!chronic!pain.!! ! PAIN!SELFBEFFICACY!QUESTIONNAIRE!(PSEQ)! ! • It!measures!the!client’s!perceived!selfgefficacy!in!performing!different!occupations! despite!the!experienced!pain.!! • It!is!usually!used!to!determine!the!effect!of!a!person’s!beliefs!in!the!management!of!pain! and!the!achievement!of!a!successful!occupational!performance.! • !It!is!composed!of!10!different!life!activities/quality!of!participation!in!activities!which! are!rated!through!the!use!of!a!7gpoint!Likert!scale!system.!! • They!are!scored!from!0!to!6!with!0!being!not!at!all!confident!and!6!being!completely! confident.!Higher!scores!in!this!questionnaire!means!that!there!is!stronger!functional! levels.!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

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Course Objectives

Assessment Tools for Hand Function

•  Describe the scope of hand function assessment •  For each representative assessment tool:, discuss

Sensibility Dexterity and Occupational Performance

–  Indications –  Procedure for administration and interpretation –  Documentation

Roi Charles S Pineda MSc OTR OTRP

Session Outline

Hand Function

DIDACTICS Hand Function Occupational Performance Sensibility & Dexterity WORKSHOP

FUNCTION

Jebsen Test of Hand Function   DASH, CTSQ, 2-Point Discrimination   Purdue Pegboard & MRMT

Hand Function: ICF (WHO, 2001) Health Condition

Body Structures & Function

Environmental Factors

Activity

Participation

Personal Factors

Brief ICF Core Sets (Hand Conditions) Impairments in Body Structure & Function

Activity Limitations & Participation Restrictions

² Skin, spinal cord, shoulder, and upper extremity ² Emotion ² Touch ² Temperature, pressure, etc. ² Sensation of pain ² Joint Mobility & stability ² Muscle power ² Control of voluntary movement

² Carrying out daily routine ² Lifting and carrying objects ² Fine hand use ² Hand and arm use ² Self-care ² Domestic life ² Interpersonal interactions and relationships ² Work and employment Klaus-Dieter et al. (2010, 2012)

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Hand Function: Assessment

ASSESSMENT OF HAND FUNCTION

Hand Function: Assessment Body Structure & Function

Activity & Participation

Impairments in Body Structure & Function

Activity Limitations & Participation Restrictions

² Goniometry ² Manual Muscle Testing ² Dynamometer ² Monofilament Test ² Aesthesiometer ² Volumeter ² Circumferential Measurement ² Visual Analogue Scale ² Capillary Bed Refill Time

² Box and Block Test ² Jebsen Test of Hand Function ² Purdue Pegboard ² Disabilities of Arm, Shoulder and, Hand (DASH) ² Canadian Occupational Performance Measure (COPM) ² Functional Independence Measure (FIM)

Hand Function: Assessment •  Performance Tests

Goniometry

•  Questionnaires / Self-Reports

Monofilament Test MMT, Dynamometry Jebsen Test of Hand Function FIM, Barthel Index Disabilities of Arm, Shoulder & Hand (DASH) Boston Carpal Tunnel Questionnaire

Impairment

Limitation & Restriction

Hand Function: Assessment

JEBSEN-TAYLOR TEST OF HAND FUNCTION •  Dimension of Function: Activity •  Broad categories of patients with disabilities of hand function •  Performance test

JEBSEN-TAYLOR TEST OF HAND FUNCTION •  7 Subtests –  Writing –  Simulated page turning –  Picking up small objects –  Simulated feeding –  Stacking checkers –  Moving light objects –  Moving heavy objects

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Hand Function: Assessment

DISABILITY OF ARM, SHOULDER, AND HAND •  Dimension of Function: Body Structure/Function, Activity & Participation •  Patients with musculoskeletal disorders of the UE •  Questionnaire

DISABILITY OF ARM, SHOULDER, AND HAND •  30-item self-report questionnaire –  21 physical function items –  6 symptom items –  3 social or role function items

•  High-performance section

Hand Function: Assessment Diagnosis-Specific Tests •  Arthritis – Sollerman Hand Function Test (Sollerman & Ejeskar, 1995); Arthritis Hand Function Test (Backman, Mackie, & Harris, 1991)

•  CVD – Wolf Motor Function Test •  CTS – Carpal Tunnel Syndrome Questionnaire (Levine et al., 1993)

ASSESSMENT OF OCCUPATIONAL PERFORMANCE

Occupational Performance

•  Areas of Occupation (AOTA, 2014)

Assessment Tools •  Functional Independence Measure (FIM) •  Barthel Index •  Canadian Occupational Performance Measure (COPM)

Activities of Daily Living Instrumental Activities of Daily Living Rest and Sleep Education Work Play Leisure Social Participation

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Dexterity •  Skillful manipulation of the hands (Wiesendanger & Serrien, 2001)

ASSESSMENT OF DEXTERITY

Dexterity: Tests STANDARDIZED TESTS •  Jebsen-Taylor Test of Hand Function •  Minnesota Manual Dexterity Test •  Purdue Pegboard •  Crawford Small Parts Dexterity •  O’Connor Finger Dexterity Test •  O’Connor Tweezer Test

•  Many tests were originally designed to predict employment success for jobs requiring manipulation of small parts (Schmitz & O’Sullivan, 2014)

Dexterity: Test Choice Considerations   Intended movement capabilities to be examined   Required tasks needed needed to fully explore movement dexterity for an individual client (Schmitz & O’Sullivan, 2014)

Dexterity: Tests

PURDUE PEGBOARD •  Dimension of Function: Activity •  Used for various populations in the clinical setting, including children and adolescents •  Performance test

PURDUE PEGBOARD •  Includes unilateral and bilateral tasks •  Measures 2 types of dexterity: –  GROSS movements of the fingers, hands, and arms –  FINE fingertip dexterity (Purdue Pegboard User Manual, 2002)

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Dexterity: Tests

•  Testing table height: ~30 in. •  Client seated throughout •  5 Scores:

MINNESOTA RATE OF MANIPULATION TEST •  Dimension of Function: Activity •  Used for various populations in the clinical setting, including children and adolescents •  Performance test

–  (R) hand (30 s) –  (L) hand (30 s) –  Both hands (30 s) –  (R) + (L) + Both hands* –  Assembly (60 s)

Dexterity: Tests MINNESOTA RATE OF MANIPULATION TEST •  Includes unilateral and bilateral tasks •  Measures simple but rapid eye-hand coordination as well as arm-hand dexterity •  5 Subtests (Minnesota Dexterity Test Examiner’s Manual, 2002)

ASSESSMENT OF SENSIBILITY

Sensibility

Sensibility: Testing Prerequisite

SENSATION •  Impression conveyed by an afferent nerve to the sensorium

•  Knowledge of anatomy and physiology

SENSIBILITY •  Ability to feel and perceive •  Involves recognition and discrimination of sensory impression

•  Knowledge of effects medical conditions •  Control of test variables (Callahan, 2002)

(American Society of Hand Therapists, 1992)

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Sensibility: Testing Prerequisite

Sensibility: Test Categories

•  Testing Variables CATEGORIES

Threshold Test

Environment

Examiner

Patient

Method

Functional Test Objective Test Provocative Test

Instrument

(Callahan, 2002) (Callahan, 2002)

Sensibility: Threshold Tests

•  Minimum stimulus the can be perceived •  Measures sensory impairment •  Includes:

SEMMES-WEINSTEIN MONOFILAMENT TEST •  Dimension of Function: Body Structure/Function •  Individuals with PNI •  Performance test

–  Touch/pressure –  Temperature, Vibration sense –  2-point discrimination –  Touch localization (Bell-Krotoski, 2011; Callahan, 2002)

Sensibility: Threshold Tests

Color

Interpretation

Filament Markings

Calculated Force (g)

Green

Normal

1.65–2.83

0.0045–0.068

Blue

Diminished light touch

3.22–3.61

0.16–0.408

Purple

Diminished protective sensation

3.84–4.31

0.697–2.06

Red

Loss of protective sensation

4.56–6.65

3.63–447

Red-lined

Untestable

> 6.65

> 447

SEMMES-WEINSTEIN MONOFILAMENT TEST •  Advantage: –  Consistent force –  Mappings can be predictors of rate of neural return or diminution (Bell-Krotoski, 2011)

(Semmes & Weinstein, 1960)

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Sensibility: Threshold Tests

Sensibility: Functional Tests

Comparison of Touch/Pressure Threshold Testing with Other Sensibility Tests S-W monofilament touch/pressure test

N DLT DPS

o-p Tw

oin

t p Pro

rio

n tio cep cold at/ Pain He

reo Ste

gno

sis Gr

aph

ia hes est

± ±

LPS Loss of protective sensation

NON-STANDARDIZED TEST LIGHT TOUCH •  Item: cotton ball/swab, pencil eraser •  Scoring is based on percentage of correct responses over number of stimulus application (Adam, Victor, & Ropper, 1997)

LPS (DP) Lifted from Bell-Krotoski (2011), p. 141, figure 11-12.

Sensibility: Functional Tests

PIN-PRICK TEST •  Superficial pain •  Item: Sterile needle •  Begin at fingertip and progress distally

PIN-PRICK TEST •  Ask if client feels a sharp or dull stimulus •  Recorded as:

(ASHT, 1992)

•  Randomly apply dull and sharp stimulus (Reese, 1999)

–  Percentage correct answer –  +S, –S, +D, –D, “S”, and “D” (ASHT, 1992; Reese, 1999)

Sensibility: Functional Tests

2-POINT DISCRIMINATION •  Tests innervation density •  Tools:

2-POINT DISCRIMINATION •  Variable force application •  Variation in 2-point discrimination throughout the body •  Mostly tested only in the fingertips

–  Two-point aesthesiometer –  Disk-criminator

(Bell-Krotoski, 2011)

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Sensibility: Functional Tests

2-POINT DISCRIMINATION •  Static and Dynamic •  Norms:

Functional Tests •  Usefulness of sensibility •  Address issue of disability resulting from sensory impairment •  Also referred to as tactile gnosis

Grading

Findings

Normal

< 6 mm

Fair

6–10 mm

Poor

11–15 mm

Protective

One point perceived

Anesthetic

No points perceived

(Callahan, 2002)

Guidelines by American Society for Surgery of the Hand (1978)

Sensibility: Functional Tests DELLON MODIFIED MOBERG PICKUP TEST •  Assesses stereognosis in client with PNI (median and/or ulnar) •  2 subtests: –  Picking up objects –  Identifying objects

Sensibility: Objective Tests

Sensibility: Provocational Tests

Objective Tests •  Require only passive cooperation of the patient and not his or her subjective interpretation of a stimulus •  do not directly correlate with functional sensation after nerve repair

Provocational (or Stress) Tests •  Designed to elicit or increase latent sensory symptoms •  Compare Monofilament test result in “normal posture” and “provocative posture” (Bell-Krotoski, 2011)

(Bell-Krotoski, 2011)

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Online Resources

¥  http://www.rehabmeasures.org ¥  http://www.strokengine.ca ¥  http://www.scireproject.com

References Adams, RD, Victor, M, Ropper, AH. (1997). Principles of neurology (6th ed.). New York: McGraw Hill. American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl 1), S1–S48. America Society of Hand Therapists (1992) Clinical assessment recommendations (2nd ed.). Chicago, IL: The Society. American Society for Surgery of the Hand. (1978). The hand: Examination and diagnosis. Aurora, CO: The Society. Bell-Krotoski, JA. (2011). Sensibility testing: History, instrumentation, and clinical procedures. In TM Skirven, AL Osterman, JM Fedorczyk, & PC Amadio (Eds.), Rehabilitation of the hand and upper extremity (6th ed., pp. 132–151). Philadelphia, PA: Mosby.

References

Callahan, AD. (2002). Sensibility assessment for nerve lesions-incontinuity and nerve lacerations. In EJ Mackin, AD Callahan, TM Skirven, L Schneider, & AL Osterman (Eds.), Rehabilitation of the hand and upper extremity (5th ed., pp. 214–239). St Louis, MO: Mosby. Jebsen, RH, Taylor, N, Trieschmann, RB, Trotter, MJ, & Howard, LA (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50, 311– 319. Klaus-Dieter, R, Kus, S, Coenen, M, Dereskewitz, C, van de VenStevens, LAW, & Cieza, A. (2010). Report on the international ICF consensus conference on the ICF Core Sets for Hand Conditions. Hand Therapy, 15, 73–76.

Klaus-Dieter, R, Kus, S, Coenen, M, Dereskewitz, C, van de VenStevens, LAW, & Cieza, A. (2012). Development of the International Classification of Functioning, Disability and Health core sets for hand conditions—Results of the World Health Organization International Consensus process. Disability and Rehabilitation, 34, 681–693. Purdue pegboard user instruction. (2002). Purdue Pegboard. Lafayette Instrument Company, Inc., Lafayette, IN. Copy in possession of author. Reese, NB. (1999). Muscle and sensory testing. Philadelphia, PA: Saunders. Minnesota dexterity test examiner’s manual. (1998). Minnesota Manual Dexterity Test. Lafayette Instrument Company, Inc., Lafayette, IN. Copy in possession of author.

References Schmitz, TJ & O’Sullivan, SB (2014). Examination of coordination and balance. In SB O’Sullivan, TJ Schmitz, & GD Fulk (Eds.), Physical rehabilitation (6th ed., pp. 206–246). Philadelphia, PA: FA Davis. Semmes, J. & Weinstein, S. (1960). Somatosensory changes after penetrating brain wounds in man. Cambridge: MA: Harvard University Press. Wiesendanger M. & Serrien, DJ. (2001). Toward a physiological understanding of human dexterity. News in Physiological Sciences, 16, 228–233. World Health Organization. (2001). International classification of functioning, disability and health. Geneva: The Organization.

ASSESSMENT TOOLS FOR ROM, STRENGTH, EDEMA and VASCULARITY Arlene!C.!Chiong!Maya!,!MSPT,!PTRP! Objectives! • To!review!the!components!and!indication!of!the!different!examination!tools!for!the!ue!! • To!review!the!correct!interpretation!of!the!results!gathered!in!the!examination!tools! • To!!demonstrate!proper!utilization!of!the!different!evaluation!tools!to!accurately!acquire! the!necessary!information!from!the!client! • To!accurately!administer!evaluation!tools!for!the!ue!! • To!analyze!the!results!of!the!different!evaluation!tools!for!the!ue!for!the!formulation!of! goals!and!problem!list! • Review!of!the!correct!format!for!documentation!of!the!information!gathered!! ! International!Classification!of!Functioning,!Disability!and!Heath!(ICF)!

! ICC!or!K!!

Interpretation!!

.81S1.0!!

Substantial!agreement!!

.61S.8!!

Moderate!agreement!!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

Reliability! • Intraexaminer!! • Interexaminer!! ! ! ! ! ! ! !

.41S.6!!

Fair!agreement!!

.11S.4!!

Slight!agreement!!

.0S.1!!

No!agreement!!

Review!of!MMT!and!ROM! I.

Shoulder! a. Subjective! • Use!of!subjective!complaints!!! • For!labral!tears,!trauma!does!not!seem!clinically!useful! • A!history!of!popping,!clicking!or!catching!may!be!minimally!helpful!in! diagnosing!a!labral!tear!(+LR!=!2.0)!! b. ROM! • Consistently!highly!reliable! • Of!unknown!diagnostic!utility! • Visual!assessments!and!function!tests!of!range!of!motion! • Instrumentation:!Universal!goniometer!and!visual!estimation!of!range!of! motion!(for!elevation,!external!rotation!and!horizontal!adduction)! • Reliability:!Generally!in!substantial!agreement! • In!adhesive!capsulitis,!there!must!be!a!loss!in!ER.! • Loss!of!IR!without!loss!of!IR!=!GIRD! • Glenohumeral!internal!rotation!deficit! c. Functional!ROM! • Instrumentation:!visual!estimation! • Reliability:!Generally!in!fair!to!substantial!agreement!! d. Manual!Muscle!Testing! • Reliable! • Weak!abduction!and/or!external!rotators!may!be!fairly!useful!in! identifying!subacromial!impingement!and/or!fullSthickness!rotator!cuff! tears! • Weak!internal!rotators!appears!to!be!very!helpful!in!identifying! subscapularis!tear!(+LR=!7.5!to!10.0)!! e. Muscle!Length! • Moderately!reliable! • Tight!pectoralis!minor!muscles!in!all!90!participants!regardless!of!whether!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

II.

III.

they!had!shoulder!problems!or!not!(100%!sensitivity,!0%!specificity)! • Lewis!2007!! • Pectoralis!Minor!Length!Test!!

Elbow! a. Subjective! • use!of!subjective!complaints!of!elbow!pain! b. Range!of!Motion! • Consistently!exhibited!good!to!high!reliable!for!assessing!flexion,! extension,!supination!and!pronation!! c. MMT! • Grip!strength!testing!in!patients!with!lateral!epicondylalgia!exhibits!high! interrater!reliability! Wrist!and!Hand! a. Subjective! • Overall!subjective!complaints!do!not!appear!to!be!useful!in!identifying! carpal!tunnel!syndrome.!!! • Only!reports!of!“dropping!objects”!and!“shaking!hand!improves! symptoms”!statistically!altered!the!probability!of!diagnosis!and!then!only! minimally!(+LR!1.7!to!1.9,!SLR.34to.47)! b. Screening! • Scaphoid!fractures! • The!physical!examination!appears!less!effective!at!identifying!other!wrist! fractures,!at!least!in!children! c. ROM! • Wrist!S!highly!reliable!but!is!of!unknown!diagnostic!utility.!! • Finger!and!thumb!ROM!is!less!reliable!even!when!it!is!performed!by!the! same!examiner! d. MMT! • Assessing!strength!with!dynamometry!has!consistently!been!shown!to!be! highly!reliable!but!is!of!unknown!diagnostic!utility.!! • MMT!of!the!abductor!pollicis!brevis!muscle!does!not!appear!to!be!very! helpful!in!identifying!carpal!tunnel!syndrome!

! Range!of!Motion!Requirements!for!UpperDLimb!Activities!of!Daily!Living! (Gates,!et!al.,!2007)! • !−65°/0°/105°!for!humeral!plane!angle!(horizontal!abduction–adduction)! • 0°–108°!for!humeral!elevation! • −55°/0°/79°!for!humeral!rotation! • 0°–121°!for!elbow!flexion! • −53°/0°/13°!for!forearm!rotation! • −40°/0°/38°!for!wrist!flexion–extension! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

•

−28°/0°/38°!for!wrist!ulnar–radial!deviation!

! Wrist!and!Finger!ROM! • Wrist!in!neutral!to!slight!ext! • Compare!flexion!and!ext!of!fingers!with!the!wrist!fully!extended!and!fully!flexed!! – to!determine!whether!extrinsic!tendon!tightness!or!adhesion!are!present! • Screen!ROM!of!each!finger!joint!separately!with!the!proximal!joints!supported!in!neutral!! – to!determine!whether!lom!is!isolated!to!the!joint,!regardless!of!the!position!of! the!proximal!joints! • Perform!PROM!of!the!digits.!! – Comparison!of!prom!to!arom!provides!info!regarding!tendon!adhesion!that!may! be!limiting!active!motion!! ! Factors!in!MMT!! (Cuthbert!&!Goodheart!2007)! • proper!positioning!so!the!test!muscle! is!the!prime!mover!as!much!as! possible! • adequate!stabilization!of!other!joints! • observation!of!the!manner!in!which! the!patient!or!subject!assumes!and! maintains!the!test!position,!trying,! unwittingly,!to! compensate/substitute!for! weakness/!Paralysis! • observation!of!the!manner!in!which! the!patient!or!subject!performs!the! test! • consistent!timing,!pressure,!and!position! • nonSpainful!contacts!(nonSpainful!execution!of!the!test)!! ! Factors!That!May!Compromise!Results! 1.!Pain! 2.!Lack!of!sensation!might!cause!higher!than!expected!values! 3.!Joint!contractures! 4.!Lack!of!control!due!to!spasticity! 5.!Cognitive! 6.!Motivational!! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

Wrist!and!Hand!Movements! I. Abduction!of!Little!Finger! a. Primary!muscle:!abductor!digiti!minimi,!but!all!hypothenar!muscles!are!active;! flexor!digiti!minimi,!opponens!digiti!minimi.! II. Adduction!of!the!Index!Finger! a. Primary!muscle:!first!dorsal!interosseous.! III. IntrinsicSPlus!Position! a. Primary!muscles:!interosseous!and!lumbrical!muscles.! IV. Thumb!Palmar!Abduction! a. Primary!muscle:!abductor!pollicis!brevis!(APB);!secondary!muscles:!the!opponens! pollicis!(OP),!flexor!pollicis!brevis!(FPB),!and!abductor!pollicis!longus!(APL).! V. Thumb!Opposition! a. Primary!muscles:!OPSAPB!and!FPB.! VI. Thumb!MCP!Flexion!Muscles! ! a. Primary!muscle:!FPB.! VII. Wrist!Extension! a. Extensor!Carpi!Radialis!Longus!(ECRL)!and!Extensor!Carpi!Radialis!Brevis!(ECRB)! VIII. Wrist!Flexion! a. Flexor!Carpi!Ulnaris!(FCU)! b. Palmaris!Longus!(PL)! c. Flexor!Carpi!Radialis!(FCR)! IX. Finger!&!Thumb!Flexion! a. Flexor!Digitorum!Profundus!(FDP)! b. Flexor!Digitorum!Superficialis!(FDS)! c. FPL! X. Thumb!Extrinsic!Muscle!Test! a. Extensor!Pollicis!Brevis!(EPB)!and!APL! ! Grip!Strength! • Standard!grip!test! • FiveSlevel!grip!test! • Rapid!exchange!grip!test!! ! Pinch!Grip! • Lateral!pinch!(key!pinch)! • ThreeSpoint!pinch!(three!jaw!chuck!pinch)! • TwoSpoint!pinch!(tip!to!tip!pinch)!! • Grip!strength!and!MMT!are!contraindicated!before!full!healing!following!a!fracture,! ligament!repair,!tendon!laceration!or!tendon!transfer!of!forearm!,!wrist,!or!hand,!r!as! determined!by!referring!physician! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

EDEMA! •

•

Volumetry!! • Document:! • Test!position! • Time!of!day!! • Water!temperature!(cool!or!tepid!(68S95!degrees!F)!! • Procedure! 1. Place!the!volumeter!on!the!same!level!surface!for!each!test! 2. Fill!the!volumeter!with!tepid!water!temp!(91.7!F)!or!no!more!than!95F!to!the! point!of!overflow! 3. Dry!the!collection!beaker!and!place!it!below!the!spout! 4. Remove!jewelry!from!the!patient! 5. The!patient!is!asked!to!keep!the!hand!as!vertical!as!possible!and!to!avoid!contact! with!the!sides!of!the!volumeter!while!slowly!immersing!the!hand!into!the! volumeter!to!avoid!spillage!over!the!rim! 6. The!palm!of!the!hand!should!face!the!patient!(forearm!mid!position)!and!the! thumb!should!face!the!spoout)!! 7. !The!patient!is!asked!to!stop!when!the!third!web!space!makes!contact!with!the! dowel!in!the!volumeter!and!to!wait!until!the!water!stops!spilling!from!the!spout! 8. !The!water!can!then!be!measured!in!a!graduated!cylinder!in!mL!or!weighed.!!If! overflow!is!greater!than!500mL,!it!will!be!necessary!to!pour!the!contents!from! the!overflow!beaker!into!the!graduated!cylinder!twice!and!add!the!sums! together! 9. Record!the!results.!!! 10. Repeat!the!procedure!for!the!contralateral!arm!! ! FigureDofDeight!method! • Subject!is!seated!with!the!arm!abducted!and!externally!rotated!90°,!the!elbow! flexed!90°,!the!wrist!neutral,!the!fingers!adducted!and!extended,!and!the!thumb! abducted!in!the!plane!of!the!hand.!The!examiner!uses!a!measuring!tape!per! instructions!by!Maihafer!et!al.!! • Procedure:! 1. !Begin!on!the!radial/palmar!side!of!the!wrist,!aligning!the!distal!edge!of! the!measuring!tape!with!the!distal!wrist!crease.!! 2. !Wrap!the!tape!measure!in!an!ulnar!direction!across!the!wrist,!staying! proximal!to!the!distal!wrist!crease!until!passing!over!the!tendon!of!the! flexor!carpi!ulnaris.! 3. The!tape!is!then!wrapped!across!the!dorsum!of!the!hand!distally!and! obliquely,!passing!over!the!midpoint!of!the!second!metacarpal!head!with!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

•

the!distal!edge!of!the!tape!aligned!with!the!radial!aspect!of!the!palmar! digital!crease!of!the!2nd!digit.!! 4. At!the!palmar!digital!crease!of!the!2nd!digit,!the!tape!is!drawn!in!an!ulnar! direction!across!the!palmar!surface!with!the!distal!edge!aligned!with!the! palmar!digital!crease!of!the!fifth!digit.! 5. Continuing!over!the!palmar!crease!of!the!fifth!digit,!the!tape!is!drawn! back!across!the!dorsum!of!the!hand!in!a!proximal!oblique!direction,! passing!over!the!tendon!of!the!abductor!pollicis!longus!(APL).! 6. At!the!dorsum!near!the!tendon!of!the!APL,!the!distal!edge!of!the!tape!is! realigned!with!the!distal!crease!and!directed!back!to!the!starting!point! 7. !Record!measurement!and!repeat!on!opposite!side.!! ! Circumferential!measurement! • Using!a!flexible!tape!measure!or!finger!circumference!gauge,!measure!around! the!affected!body!part!being!sure!to!utilize!bony!landmarks!and!document!exact! landmarks!used!for!measurement.!The!tape!measure!should!not!indent!skin!or! validity!of!measurement!will!be!affected!.Reliability!is!improved!by!using!the! same!rater!for!subsequent!measurements!and!by!utilizing!bony!landmark!! Pitting!edema!! • “pit”! • indent! Brawny!edema!!

VASCULARITY! • • • • •

Subclavian!artery!(from!brachiocephalic!artery)!–!Axillary!artery!(level!of!first!rib)!–! Brachial!artery!(below!the!axilla)!–!Radial!and!Ulnar!arteries! Cephalic!(lateral)!and!Basilic!veins!–!median!antecubital!vein! Deep!radial!and!ulnar!vein!–!brachial!vein! Brachial!+!basilic!S!axillary!vein!–!subclavian!vein!! Tests:! • Allen!Test! • Assessment!of!contribution!of!ulnar!and!radial!arteries!to!the!blood!flow! of!the!hand!! • Doppler!ultrasound! • Kohonen!2007! • Sensitivity!73.2,!Specificity!97.1%! • Good!and!valid!screening!test!for!the!circulation!of!the!hand!! • Capillary!Refill!Test! • Place!pressure!on!the!distal!portion!of!the!volar!finger!or!over!the!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

â&#x20AC;˘

fingernail!of!the!digit!until!tissue!turns!white.!!! Must!be!<2!sec!!

References! (ASHT)!ASHT.!Clinical'Assessment'Recommendations.'3'ed.'Chicago,'IL:!ASHT;!2013.! Cleland,!J.,!Koppenhaver,!S.,!Su,!J.!!Netterâ&#x20AC;&#x2122;s!Orthopaedic'Clinical'Examination:'An'Evidence< based'Approach,'3'ed.'2015! Cooper,!C.!Fundamentals'of'of'Hand'Therapy:'Clinical'Reasoning'and'Treatment'Guidelines'for' Common'Diagnoses'of'the'Upper'Extremity,'2ed.'2013'! ! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

SPECIAL TESTS FOR THE UPPER EXTREMITY Arlene!C.!Chiong!Maya!,!MSPT,!PTRP! ! Objectives! • To!review!the!components!and!indication!of!the!different!special!tests! for!the!ue!! • To!review!the!correct!interpretation!of!the!results!gathered!in!the! special!tests! • To!!demonstrate!proper!utilization!of!the!different!special!tests!to! accurately!acquire!the!necessary!information!from!the!client! • To!accurately!administer!special!tests!for!the!ue!! • To!analyze!the!results!of!the!different!special!tests!for!the!ue!for!the! formulation!of!goals!and!problem!list! • Review!of!the!correct!format!for!documentation!of!the!information! gathered!! ! Sensitivity! • Indicates!the!test’s!ability!to!detect!those!patients!who!actually!have!a! disorder!as!indicated!by!the!reference!standard.!!! • TrueNpositive!rate! • Tests!with!high!sensitivity!are!good!for!ruling!OUT!a!particular!disorder! • SnNout!! • Test!with!high!sensitivity!and!a!negative!result!is!good!for!ruling!out!a! disorder!! ! Specificity! • Indicates!the!test’s!ability!to!detect!those!patients!who!actually!do!not! have!the!disorder!as!indicated!by!the!reference!standard! • TrueNnegative! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

• High!specificity!are!good!for!ruling!in!a!disorder! • SpPin!! • High!specificity!and!a!positive!result!is!good!for!ruling!IN!the!disorder!! ! Likelihood!Ratio! • Combines!sensitivity!and!specificity! • +LR!existence!of!a!disorder! • NLR!absence!of!a!disorder!! +LR!!

Interpretation!!

;LR!!

>=!10!!

Large!!

<.1!!

5.0N10.0!!

Moderate!!

.1N.2!!

2.0N5.0!!

Small!!

.2N.5!!

1.0N2.0!!

Rarely!important!!

.5N1.0!!

! I.

Shoulder! a. Shoulder!Instability! i. The!apprehension!test!! • most!useful!test!in!identifying!shoulder!instability,! especially!when!defining!a!positive!test!by!an! “apprehensive!response”!(+LR=71!o!20.2,!NLR=.00! to.29)!vs!“pain”!(+LR!–!1.1!to!3.1,!NLR!=!.69!to!.90).!!! b. Labral!Tear! i. Kim!test!and!the!Jerk!test!! • very!good!at!identifying!labral!tears!(+LR!of!13.3!and! 35.6,!respectively)! ii. Biceps!load!tests!I!and!II!! • very!effective!at!identifying!superior!labrum!anterior! and!posterior!(SLAP)!lesions!(+LR=30!for!both)!! c. Subacromial!Impingement!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

i. Lift!off!test!! • very!effective!at!identifying!subacromial! impingement!(+LR=14)! ii. Hawkins!kennedy!and!Neer!test! • minimally!helpful!for!ruling!in!or!ruling!out! subacromial!impingement.! iii. “painful!arc”!! • minimal!value!in!identifying!the!condition!(+LR=2.3,!N LR=.62)!! ! II.

Elbow! a. The!elbow!extension!test! • excellent!test!for!ruling!out!the!absence!of!bony!or! joint!injury!(sensitivity!values!between!.91!and!.97! and!–LR!values!between!.04!and!.13)! b. Pressure!provocation!test,!the!flexion!test!and!shoulder!internal! rotation!test!and!the!tinel!sign!at!the!elbow!! • useful!for!identifying!the!presence!of!cubital!tunnel! syndrome! c. Moving!valgus!stress!test! • superior!diagnostic!accuracy!when!compared!with! the!valgus!stress!test!for!identifying!a!medial! collateral!tear! d. Varus!stress!test!for!lateral!collateral!tear! • No!studies! e. Hook!test,!the!passive!forearm!pronation!test!and!biceps!crease! interval!test! • 100%!sensitivity!and!specificity!for!identifying!distal! biceps!tendon!rupture!when!the!outcomes!on!all! three!tests!are!positive!! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

III.

Wrist!and!Hand! a. Tinel!sign,!phalen!test!and!ct!comression!test! • Diagnostic!utility!highly!variable! • more!sensitive!and!more!specific!in!identifying! tenosynovitis!than!cts.! b. Ulnar!fovea!sign! • very!useful!at!ruling!in!and!ruling!out!foveal! disruption!of!the!distal!radioulnar!ligaments!and! ulnotriquetral!ligament!injuries!(+LR!=!7.1,!NLR=.06)!! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

APPENDICES • Screening for Yellow Flags using Orebro Musculoskeletal Pain Screening Questionnaire • Pain Assessment Booklet – B • Sample Eval Form • The Barthel Index • Box & Booklet Test Instructions • Carpal Tunnel Syndrome Questionnaire • The DASH • Jebsen • Semmes-Weinstein Monofilaments • RULA Employee Assessment Worksheet • REBA Employee Assessment Worksheet

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

Sample'Evaluation'Form' ROM$ ' Shoulder' ' ' ' Elbow' ' Forearm' ' wrist' ' ' ' Thumb'mp' Thumb'ip' '

' Flex' Ext' Er' Ir' Flex' Ext' Sup' Pron' Flex' Ext' Rd' Ud' ' '

right' ' ' ' ' ' ' ' ' ' ' ' ' ' '

left' ' ' ' ' ' ' ' ' ' ' ' ' ' '

' Index'' ' ' Middle' ' ' Ring' ' ' Small' ' ' Thumb'cmc' '

' Mp' Pip' Dip' Mp' Pip' Dip' Mp' Pip' Dip' Mp' Pip' Dip' Rad'abd' Pal'abd'

Right'' ' ' ' ' ' ' ' ' ' ' ' ' ' '

Strength$ ' Shoulder'Flexors' Anterior'Deltoids' '

Right' ' '

' Right' Grip' ' Lateral'pinch' ' ' Swelling$ Visual'Inspection:'Laterality:'____' ' ' '''Acute'/'Subacute'/'Chronic'/'Severe' ' ' ''+'/'K'lymphorrhea' ''''' ' ''Pitting'/'brawny' ' Volumetric'Measurement'in'mL:' Right' Left' ' ' ' Circumferential'measurement'in'cm:' ' Forearm'(location)' Hand'(MCP)' Wrist' Digit' Proximal'Phalanx' PIP' Middle'Phalanx' DIP' '

Right' ' ' ' Thumb'I'M'R'S' ' ' ' '

Left' ' ' Left' ' '

Difference' '

Left' ' ' ' Thumb'I'M'R'S' ' ' ' '

Vascular$Status$ Color:'Normal'/'Pink'/'Blue'/'White''Remarks:'_______________________' Trophic:'Normal'/'Dry'/'Moist'/'Shiny'/'Dull''Remarks:'____________________'

left' ' ' ' ' ' ' ' ' ' ' ' ' ' '

THE BARTHEL INDEX

Patient Name: Rater Name: Date:

___________________________ ___________________________ ___________________________

Activity

Score

FEEDING 0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent

______

BATHING 0 = dependent 5 = independent (or in shower)

______

GROOMING 0 = needs to help with personal care 5 = independent face/hair/teeth/shaving (implements provided)

______

DRESSING 0 = dependent 5 = needs help but can do about half unaided 10 = independent (including buttons, zips, laces, etc.)

______

BOWELS 0 = incontinent (or needs to be given enemas) 5 = occasional accident 10 = continent

______

BLADDER 0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident 10 = continent

______

TOILET USE 0 = dependent 5 = needs some help, but can do something alone 10 = independent (on and off, dressing, wiping)

______

TRANSFERS (BED TO CHAIR AND BACK) 0 = unable, no sitting balance 5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical) 15 = independent

______

MOBILITY (ON LEVEL SURFACES) 0 = immobile or < 50 yards 5 = wheelchair independent, including corners, > 50 yards 10 = walks with help of one person (verbal or physical) > 50 yards 15 = independent (but may use any aid; for example, stick) > 50 yards

______

STAIRS 0 = unable 5 = needs help (verbal, physical, carrying aid) 10 = independent

______

TOTAL (0â&#x20AC;&#x201C;100): ______

Provided by the Internet Stroke Center â&#x20AC;&#x201D; www.strokecenter.org

The Barthel ADL Index: Guidelines 1. 2. 3. 4. 5. 6. 7.

The index should be used as a record of what a patient does, not as a record of what a patient could do. The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason. The need for supervision renders the patient not independent. A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However direct testing is not needed. Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant. Middle categories imply that the patient supplies over 50 per cent of the effort. Use of aids to be independent is allowed.

References Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Medical Journal 1965;14:56-61. Used with permission. Loewen SC, Anderson BA. “Predictors of stroke outcome using objective measurement scales.” Stroke. 1990;21:78-81. Gresham GE, Phillips TF, Labi ML. “ADL status in stroke: relative merits of three standard indexes.” Arch Phys Med Rehabil. 1980;61:355-358. Collin C, Wade DT, Davies S, Horne V. “The Barthel ADL Index: a reliability study.” Int Disability Study.1988;10:61-63.

Copyright Information The Maryland State Medical Society holds the copyright for the Barthel Index. It may be used freely for noncommercial purposes with the following citation: Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61. Used with permission. Permission is required to modify the Barthel Index or to use it for commercial purposes.

Provided by the Internet Stroke Center — www.strokecenter.org

Box and Blocks Test Instructions General Information (derived from Mathiowetz et al, 1985): The patient is allowed a 15-second trial period prior to testing Immediately before testing begins, the patient should place his/her hands on the sides of the box When testing begins, the patient should grasp one block at a time with the dominant hand, transport the block over the partition, and release it into the opposite compartment The patient should continue doing this for one minute The procedure should then be repeated with the nondominant hand After testing, the examiner should count the blocks If a patient transports two or more blocks at the same time, this should be noted and the number subtracted from the total No penalty should be made if the subjects transported any blocks across the partition and the blocks bounced from the box to the floor or table

Set-up: A test box with 150 blocks and a partition in the middle is placed lengthwise along the edge of a standard-height table The patient should be seated on a standard height chair facing the box 150 blocks should be in the compartment of the test box on the side of the patient’s dominant hand The examiner should face the patient so she or he could view the blocks being transported

Patient Instructions (derived from Mathiowetz et al, 1985): “I want to see how quickly you can pick up one block at a time with your right (or left) hand [point to the hand]. Carry it to the other side of the box and drop it. Make sure your fingertips cross the partition. Watch me while I show you how.” Transport three cubes over the partition in the same direction you want the patient to move them. After a demonstration say the following: “If you pick up two blocks at a time, they will count as one. If you drop one on the floor or table after you have carried it across, it will still be counted, so do not waste time picking it up. If you toss the blocks without your fingertips crossing the partition, they will not be counted. Before you start, you will have a chance to practice for 15 seconds. Do you have any questions?” Downloaded from www.rehabmeasures.org Test instructions provided courtesy of Virgil Mathiowetz, PhD, OTR/L

Page 1

“Place your hands on the sides of the box. When it is time to start, I will say ready and then go.” Trial period: Start the stop watch at the word go. When 15 seconds has passed, say "stop." If mistakes are made during the practice period, correct them before the actual testing begins. On completion of the practice period, transport the cubes to the original compartment. Continued with the following directions: “This will be the actual test. The instructions are the same. Work as quickly as you can. Ready.” [Wait 3 seconds] “Go.” “Stop.” [After 1 minute, count the blocks and record as described above] “Now you are to do the same thing with your left (or right) hand. First you can practice. Put your hands on the sides of the box as before. Pick up one block at a time with your hand, and drop it on the other side of the box.” “Ready.” [Wait 3 seconds] “Go.” “Stop.” [After 15 seconds] Return the transported blocks to the compartment as described above. “This will be the actual test. The instructions are the same. Work as quickly as you can.” “Ready.” [Wait 3 seconds] “Go.” “Stop.” [After 1 minute, count the blocks and record as described above]

Scoring The score is the number of blocks carried from one compartment to the other in one minute. Score each hand separately.

Downloaded from www.rehabmeasures.org Test instructions provided courtesy of Virgil Mathiowetz, PhD, OTR/L

Page 2

Box and Blocks Testing Form Name: ___________________________________________________________

Dominant Hand (circle one): Right

Left

Number of blocks transported in one minute:

Date: ________

Dominant Hand: __________ Non-Dominant Hand: _______

Date: ________

Dominant Hand: __________ Non-Dominant Hand: _______

Date: ________

Dominant Hand: __________ Non-Dominant Hand: _______

Date: ________

Dominant Hand: __________ Non-Dominant Hand: _______

Downloaded from www.rehabmeasures.org Test instructions provided courtesy of Virgil Mathiowetz, PhD, OTR/L

Page 3

Reference: Mathiowetz, V., G. Volland, et al. (1985). "Adult norms for the Box and Block Test of manual dexterity." Am J Occup Ther 39(3160243): 386-391.

Downloaded from www.rehabmeasures.org Test instructions provided courtesy of Virgil Mathiowetz, PhD, OTR/L

Page 4

CARPAL TUNNEL SYNDROME QUESTIONNAIRE ( CTSQ)

Patient Name ________________________________________________

Date_____________________________ ____

Please read carefully: The following questions refer to your symptoms for a typical twenty-four hour period during the past two weeks. Circle one answer to each question. SEVERITY & FUNCTIONAL SCALE:

1 = None or Never

2 = Mild

3 = Moderate

4 = Severe

5 = Very severe

SYMPTOM SEVERITY SCALE 1. How severe is the hand or wrist pain that you have at night?

2. How often did hand or wrist pain wake you up during a typical night in the past two weeks (times/day)?

2-3x

4-5x

5+x

3. Do you typically have pain in your hand or wrist during the daytime?

4. How often do you have hand or wrist pain during the daytime (times/day)?

1-2x

3-5x

5+x

constant

5. How long, on average, does an episode of pain last during the daytime (minutes)?

<10

10-60

>60

constant

6. Do you have numbness (loss of sensation) in your hand?

7. Do you have weakness in your hand or wrist?

8. Do you have tingling sensations in your hand?

9. How severe is numbness (loss of sensation) or tingling at night?

10. How often did hand numbness or tingling wake you up during a typical night during the past two weeks?

2-3x

4-5x

5+x

11. Do you have difficulty with the grasping and use of small objects such as keys or pens?

1. Writing

2. Buttoning of clothes

3. Holding a book while reading

4. Gripping of a telephone handle

5. Opening of jars

6. Household chores

7. Carrying of grocery bags

8. Bathing and dressing

FUNCTIONAL STATUS SCALE

COMMENTS: ______________________________________________________________________________________ ____________________________________________________________________________________________________ EXAMINER: __________________________________________

____________________________________________________________________________________________________ With permission from: Levine DW, Simmons HP, Koris MJ, et al. A self-administered questionnaire for the assessment severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg 1993;75A:1585-1592.

D ISABILITIES

THE

OF THE

A RM , S HOULDER

DA SH

INSTRUCTIONS This questionnaire asks about your symptoms as well as your ability to perform certain activities. Please answer every question, based on your condition in the last week, by circling the appropriate number. If you did not have the opportunity to perform an activity in the past week, please make your best estimate on which response would be the most accurate. It doesnâ&#x20AC;&#x2122;t matter which hand or arm you use to perform the activity; please answer based on your ability regardless of how you perform the task.

AND

H AND

D ISABILITIES

OF THE

A RM , S HOULDER

AND

H AND

Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.

NO DIFFICULTY

MILD DIFFICULTY

MODERATE DIFFICULTY

SEVERE DIFFICULTY

UNABLE

1. Open a tight or new jar.

2. Write.

3. Turn a key.

4. Prepare a meal.

5. Push open a heavy door.

6. Place an object on a shelf above your head.

7. Do heavy household chores (e.g., wash walls, wash floors). 1

8. Garden or do yard work.

9. Make a bed.

10. Carry a shopping bag or briefcase.

11. Carry a heavy object (over 10 lbs).

12. Change a lightbulb overhead.

13. Wash or blow dry your hair.

14. Wash your back.

15. Put on a pullover sweater.

16. Use a knife to cut food.

17. Recreational activities which require little effort (e.g., cardplaying, knitting, etc.).

18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.).

19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.).

20. Manage transportation needs (getting from one place to another).

21. Sexual activities.

D ISABILITIES

OF THE

A RM , S HOULDER

NOT AT ALL

22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? (circle number) 1

NOT LIMITED AT ALL

23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? (circle number)

AND

H AND

SLIGHTLY

MODERATELY

QUITE A BIT

EXTREMELY

SLIGHTLY LIMITED

MODERATELY LIMITED

VERY LIMITED

UNABLE

Please rate the severity of the following symptoms in the last week. (circle number) NONE

MILD

MODERATE

SEVERE

EXTREME

24. Arm, shoulder or hand pain.

25. Arm, shoulder or hand pain when you performed any specific activity.

26. Tingling (pins and needles) in your arm, shoulder or hand. 1

27. Weakness in your arm, shoulder or hand.

28. Stiffness in your arm, shoulder or hand.

NO DIFFICULTY

MILD DIFFICULTY

MODERATE DIFFICULTY

SEVERE DIFFICULTY

SO MUCH DIFFICULTY THAT I CANâ&#x20AC;&#x2122;T SLEEP

AGREE

STRONGLY AGREE

29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? (circle number) 1

STRONGLY DISAGREE

30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. (circle number)

DISAGREE NEITHER AGREE NOR DISAGREE

DASH DISABILITY/SYMPTOM SCORE = [(sum of n responses) - 1] x 25, where n is equal to the number of completed responses. n A DASH score may not be calculated if there are greater than 3 missing items.

D ISABILITIES

OF THE

A RM , S HOULDER

AND

H AND

WORK MODULE (OPTIONAL) The following questions ask about the impact of your arm, shoulder or hand problem on your ability to work (including homemaking if that is your main work role). Please indicate what your job/work is:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ❐ I do not work. (You may skip this section.) Please circle the number that best describes your physical ability in the past week. Did you have any difficulty: NO DIFFICULTY

MILD DIFFICULTY

MODERATE DIFFICULTY

SEVERE DIFFICULTY

UNABLE

using your usual technique for your work?

doing your usual work because of arm, shoulder or hand pain?

doing your work as well as you would like?

spending your usual amount of time doing your work?

SPORTS/PERFORMING ARTS MODULE (OPTIONAL) The following questions relate to the impact of your arm, shoulder or hand problem on playing your musical instrument or sport or both. If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to you. Please indicate the sport or instrument which is most important to you:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

❏

I do not play a sport or an instrument. (You may skip this section.)

Please circle the number that best describes your physical ability in the past week. Did you have any difficulty: NO MILD DIFFICULTY DIFFICULTY

1. 2. 3. 4.

MODERATE DIFFICULTY

SEVERE DIFFICULTY

UNABLE

using your usual technique for playing your instrument or sport?

playing your musical instrument or sport because of arm, shoulder or hand pain?

playing your musical instrument or sport as well as you would like?

spending your usual amount of time practising or playing your instrument or sport?

SCORING THE OPTIONAL MODULES: Add up assigned values for each response; divide by 4 (number of items); subtract 1; multiply by 25. An optional module score may not be calculated if there are any missing items.

Non- dominant hand “Do you require glasses for reading? If so, put them on. Take this pen in your ____ hand and arrange everything so that it is comfortable for you to write with your ____ hand. On the other side of this card (indicate) is a sentence. When I turn this card over and say “go”, write the sentences as quickly and clearly as you can using your ____ hands. Write…do not print. Do you understand? Ready? Go.” Dominant hand “All right, now repeat the same thing, only this time use your ____ hand. I’ll give you a different sentence. Are you ready? Go.”

Subtest #1 Verbal Instructions – Writing

Give the client a ball-point pen and four 8½” x 11” sheets of unruled white paper fastened, one on top of the other, to a clipboard. The sentence to be copied has 24 letters and is of third grade reading difficulty. The sentence is typed in all capital letters and centered on a 5”x8” index card. Present the card with the typed side face down on a bookstand. After the articles are arranged to the comfort of the subject (see verbal instructions), turn the card and give an immediate command to begin. Time from the word “go” until pen is lifted from the page at the end of the sentence. Repeat subtest with the dominant hand using a new sentence.

Subtest #1 Procedure – Writing

!!!

Dominant hand “Now repeat the same thing with the ___ hand beginning with this card (indicate card to the extreme non-dominant side) Ready? Go.”

Non- dominant hand “Place your ___ hand on the table please. When I say “go”, use your ___ hand to turn these cards over one at a time as quickly as you can, beginning with this card (indicate card to extreme dominant side). You may turn them over in any way you wish and they need not be in a neat pattern when you finish. Do you understand? Ready? Go.”

Subtest #2 Verbal Instructions – Simulated Page Turning

Place five 3’’ x 5’’ index cards, ruled on one side only, in a horizontal row two inches apart on the table in front of the subject. Each card is oriented vertically, 5’’ from the front edge of the table. The distance is indicated on the side edge of the table with a piece of tape. Time from the word “go” until the last card is turned over. No accuracy of placement after turning is necessary. Repeat subtest with the dominant hand.

Subtest #2 Procedure – Simulated Page Turning

Subtest #4 Verbal Instructions – Simulated Feeding Non- dominant hand “Take the teaspoon in your ___ hand please. When I say “go”, use your ___ hand to pick these beans one at a time with the teaspoon and place them in the can as fast as you can beginning with this one (indicate bean on the extreme nondominant side). Do you understand? Ready? Go.” Dominant hand “Now repeat the same thing with the ___ hand beginning here (indicate bean on the extreme dominant side) Ready? Go.”

Non- dominant hand “Place your ___ hand on the table please. When I say “go”, use your ___ hand to pick these objects one at a time and place them in the can as fast as you can beginning with this one (indicate paper clip on the extreme non-dominant side). Do you understand? Ready? Go.”

Dominant hand “Now repeat the same thing with the ___ hand beginning here (indicate paper clip on the extreme dominant side) Ready? Go.”

Clamp board 5’’ from the front edge of the table. Place 5 kidney beans of approximately 5/8’’ length on a board. The beans are oriented to the non- dominant side of center, parallel to and touching the upright of the board 2’’ apart. Place an empty 1-lb. coffee can centrally in front of the board. A regular teaspoon is provided. Time from the word “go” until the last bean is heard hitting the bottom of the can. Repeat subtest with the dominant hand, the beans being placed to the dominant hand side of the center.

Subtest #4 Procedure – Simulated Feeding

Subtest #3 Verbal Instructions – Lifting Small Common Objects

!!!

Place an empty 1-lb. coffee can directly in front of the subject, 5” from the front edge of the table. Place two 1” paper clips (oriented vertically), two regular-sized bottle caps (each 1” in diameter, placed with the inside of the cap facing up), and two U.S pennies in a horizontal row to the non-dominant side of the can. The paper clips are the farthest and the pennies nearest the can. The objects are 2” apart. Time from the word “go” until the sound of the last object striking the inside of the can is heard. Repeat subtest with the dominant hand. The layout for the dominant hand is a mirror image of one described, except the objects are placed on the dominant hand side of the can. !!!

Subtest #3 Procedure – Lifting Small Common Objects

Dominant hand “Now repeat the same thing with the ___ hand beginning here (indicate can on the extreme dominant side) Ready? Go.”

Non- dominant hand “Place your ___ hand on the table please. When I say “go”, use your ___ hand to stand these cans on the board in front of you, like this (demonstrate). Begin with this one (indicate can on extreme non-dominant side). Do you understand? Ready? Go.”

Non- dominant hand “Please place your ___ hand on the table. When I say “go”, use your ___ hand to stack these checkers on the board in front of you as fast as you can like this, one on top of the other (demonstrate). You may begin with any checker. Do you understand? Ready? Go.”

Dominant hand “Now repeat the same thing with the ___ hand. Ready? Go.”

Subtest #6 Verbal Instructions – Lifting Large, Light Objects

!!!

Clamp a board 5” from the front edge of the table. Place five empty #303 cans in front of the board. These cans are spaced 2” apart with the open end of the can facing down. Time from the word “go” until the fifth can has been released. Repeat subtest with the dominant hand.

Light Objects

Subtest #6 Procedure – Lifting Large,

Subtest #5 Verbal Instructions – Stacking Checkers

Place four standard sized (1¼” diameter) red wooden checkers in front of the subject, touching a board clamped 5” from the front edge of the table. The checkers are oriented two on each side of the center in 0000 configuration. Time from the word “go” until the fourth checker makes contact with the third checker. The fourth checker need not stay in place. Repeat subtest with the dominant hand.

Subtest #5 Procedure – Stacking Checkers

Dominant hand “Now repeat the same thing with your ___ hand beginning here (indicate can on extreme dominant side). Ready? Go.” Note: The 1-lb. cans may need to be replaced after 36 months if dented or rusting.

Non- dominant hand “Now do the same thing with these heavier cans. Place your ___ hand on the table. When I say “go”, use your ___ hand to stand these cans on the board as fast as you can. Begin here (indicating can on extreme non-dominant side). Do you understand? Ready? Go.”

Subtest #7 Verbal Instructions – Lifting Large, Heavy Objects

Clamp a board 5” from the front edge of the table. Place five full, one-pound #303 cans in front of the board. The cans are spaced 2” apart. Time from the word “go” until the fifth can has been released. Repeat subtest with the dominant hand.

Heavy Objects

Subtest #7 Procedure – Lifting Large,

!!!!

Semmes- Weinstein Monofilaments Test protocol Quiet room All sensibility tests is best performed in a quiet room that has good light and normal room temperature. A quiet testing area is mandatory. The hand/extremity being tested is extended by the patient and comfortably relaxed resting on a rolled towel. A folder or screen is used to block the patientâ&#x20AC;&#x2122;s line of vision from the site tested. Application Monofilament begins with filaments in the normal threshold level and progresses to filament of increasing force/pressure until the patient can identify touch. The filaments 1.65 â&#x20AC;&#x201C; 4.08 are applied three times to the same test spot, with one response out of three considered an affirmative response. All the filaments are applied in a perpendicular fashion to the skin surface in 1 to 1.5 seconds continued in pressure in 1 to 1.5 seconds, and lifted in 1 to 1.5 seconds. The filaments 1.65 to 6.45 should bend to exert the specific pressure. The 6.65 filaments is relatively stiff and found most repeatable if applied just to bending. On initial patient testing, the patientâ&#x20AC;&#x2122;s baseline detection level is established. On subsequent testing, the previous test serves as a comparison to establish the direction of change and improvement or worsening, if any. It is most accurate for the same examiner to repeat successive evaluation, if possible. But if instrument specification, protocol and technique are kept standard, testing can be repeatable among examiners, whether in Japan or California. Testing by other examiners is often used in a double-blind design for studies. Interpretation Scale for Microfilaments

Green Blue Purple Red Red-lined

Normal Diminished light touch Diminished protective sensation Loss of protective sensation Untestable

Filament Markings 1.65-5.83 3.22-3.61

Calculated Force (g) 0.0045-0.068 0.166-0.408

3.84-4.31

0.697-2.06

4.56-6.65

3.63-447

>6.65

>447

Dellon Modified Moberg’s Pick Up Test Procedure: ! Begin with a group of 12 standardized items: wing nut, large nut, hex nut, small square nut, screw, key, nickel, dime, washer, safety pin, paper clip, and nail. ! If ulnar nerve is not involved, tape the ulnar two fingers to the client’s palm if possible Test 1: ! The client places the items one at a time into a box as quickly as possible ! Record time for two trials Test 2: ! (initiate test 2 only if the client’s deficits do not appear to be too severe during test 1). ! With client’s vision occluded, the examiner places the items into the client’s radial three digits one at a time. ! The examiner records the time that it takes to identify each item, with a maximum of 30 seconds for each item ! Each item is placed in the client’s hand two times Response Test 1: The client places the items in a box as quickly as possible with the radial three digits. Test 2: The client manipulates the objects and attempts to identify them as quickly as possible Scoring Test 1: The time it takes to place all items in the box

Test 2: the time that it takes to identify all the items (no norms available) References: Amirjani, N, Ashworth, N, Gordon, T, Edwards, D, & Chan, M. (2007) Normative values and the effects of age, gender, and handedness on the Moberg pick up test. Muscle and Nerve, 35, 788–792. Cooper, C. & Canyock, JD. (2013). Evaluation of sensation and intervention for sensoy dysfunction. In HM Pendleton & W Schultz-Krohn (Eds.), Pedretti's occupational therapy practice skills for physical dysfunction (6th ed., pp. 575–589). St. Louis, MO: Mosby. Rehabilitation Measures Database. Rehab Measures: Jebsen Hand Function Test. Retrieved 6 Dec 2015, from http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1025

PURDUE PEGBOARD TEST TEST BATTERIES AND TIMING The test administrator will compile 5 separate scores from the complete test procedure, one for each test battery 1. Right Hand (30 seconds) 2. Left Hand (30 seconds) 3. Both Hands (30 seconds) 4. Right +Left + Both hands - Note: This is not an actual test; it is a mathematical sum calculation 5. Assembly (60 seconds) The test batteries should be done in this consecutive order, unless the subject is left-handed, where test batteries1 and 2 are reversed: Left Hand first and then Right Hand. Three test trials are highly recommended: the more trials administered, the more test score reliability. Note: The test is well suited for either group or individual testing. EQUIPMENT REQUIRED The following equipment and supplies are required to ensure that the Purdue Pegboard Test is consistent, standardized test: 1. Purdue Pegboard Test (Model #32020) • Instruction Manual • 1 Test board • Pins, Collars, Washers • Score Sheets 2. At least one testing table the approximately 30 inches tall. Note: The subject must be seated throughout the administration of the test 3. Stopwatch or clock that reads in seconds TEST PROCEDURES General Instructions The subject should be comfortably seated at the testing table directly in front of the Purdue Pegboard, which is placed on the table with the row of cups (Under the nameplate) at the top of the board. The far right and far left cups should have 25 pins in each to equal a total of 50 pins. For right-handed subjects, the cup to the right of center should have 40 washers. If the subject is left-handed, the collar and washer locations should be on the reverse side of center. The following directions are for single subject testing and should be approximately modified for group setting. When the subject(s) is seated and ready to begin, say: “This is a test to see how quickly and accurately you can work with your hands. Before you begin each battery of the test, you will be told what to do and then you will have an opportunity to practice. Be sure you understand exactly what to do.” 1. Right Hand (30 seconds) Begin by saying and demonstrating: “Pick up one pin at a time with your right hands from the right handed cup. Starting with the top hole, place each pin in the right-handed row. (Leave the pin used for demonstration in the hole.) Now you may insert a few pins for practice. If during the testing time you drop a pin, do not stop to pick it up. Simply continue by picking another pin out of the cup.

Correct any errors made in placing the pins and answer any questions. When the subject has inserted three or four pins and appears to understand the operation, say: After the subject completes this task, say: “When I says ‘Begin,’ place as many pins as possible in the right-handed row, starting with the top hole. Work as rapidly as you can until I say ‘Stop.” “Are you ready? Begin.” Start timing when you say “Begin.” At the end of exactly 30 seconds, say: “Stop.” Count the number of pins inserted and record the Right Hand score. This is the total number of pins the subject placed with the right hand. Leave the pins in the holes. 2. Left Hand (30 seconds) Begin by saying: “Pick up one at a time with your left hand from the left-handed cup. Place each pin in the left-handed row, starting with the top hole. You may insert a few pins for practice.” When the subject has inserted three or four pins and appears to understand operation, say: “Stop. Now take out the practice pins, and put them back into the left-handed cup.” After the subject completes this task, say: “When I say ‘ Begin,’ place as many pins as possible in the left-handed row, starting with the top hole. Work as rapidly as you can until I say ‘Stop.” “Are you ready? Begin.” Start timing exactly when you say “Begin.” At the end of exactly 30 seconds, say: “Stop.” Count the number of pins inserted and record the Left Hand score. This is the total number of pins the subject placed with the left hand. Leave the pins in the holes. After the Right Hand and Left-Hand test batteries have been completed, the subject returns all pins to their proper cups 3. Both Hands (30 seconds) This test battery tests both hands working together. Begin by saying: “For this part of the test, you will use both hands at the same time. Pick up a pin from the right-handed cup with your right hand, and at the same time pick up a pin from the left-handed cup with your left hand. Then place the pins down the rows. Begin with the top hole of both rows. (Demonstrate. Then replace the pins used for demonstration.) Now you may insert a few pins with both hands for practice.” After the subject has three of four pins of practice pins correctly inserted, say: “Stop. Take out the practice pins, and put them back in their cups.” Then say: “When I say ‘Begin,’ place as many pins as possible with both hands, starting with the top hole of both rows. Work as rapidly as you can, until I say ‘Stop.” “Are you ready? Begin.” Start timing when you say “Begin.” At the end of exactly 30 seconds, say: “Stop.” Count the number of pairs of pins inserted (not the total number of pins), and record the score. The subject then returns the pins to the proper cups. 4. Right + Left+ Both (Sum of scores) This score is not based on a separate test; it is obtained from combining the test scores to the previous three test batteries. Add the scores recorder for Right Hand, Left Hand and Both Hands; this is the score that you record for R + L + Both. !

This score does not have to be recorded during the actual testing period. The Assembly test may begin immediately after the Both Hands score is recorded 5. Assembly (1 minute) This test battery consists of assembling pins, collars, and washers. Demonstrate the following operation while saying: “Pick up one pin from the right-handed cup with your right hand. While you are placing it in the top hole in the right-handed row, pick up a washer with your left hand. As soon as the pin has been placed, drop the washer over the pin. While the washer is being placed over the pin with you left hand, pick up a collar with your right hand. While the collar is being dropped over the pin, pick up another washer with your left hand and drop it over the collar. This completes the first ‘assembly,’ consisting of a pin, a washer, a collar, and a washer. While the final washer for the first assembly is being placed with your left hand, start the second assembly immediately by picking up another pin with your right hand. Place it in the next hole; drop a washer over it with your left hand, and so on, completing another assembly. Now take a moment to try a few practice assemblies.” Emphasize that both hands should be operating at all times: one picking up a pin, one a washer, one a collar, and so on. The subject should be allowed to make four or five complete assemblies before the test is begun to make certain the subject fully understands the “alternating” procedure. The subject must keep both hands moving at the same time. If he or she fails to do this, the administrator should give further instructions. Note: If the subject is left-handed, the washer and collar locations in the cups are switched. The subject begins by picking up the pin with his/her left hand, the collar with his/her right hand, the collar with his/her left hand, another washer with his/her right hand and so on through all assemblies. After the subject has practiced the assemblies say: “Stop. Now return the pins, collars and washers to their proper cups.” Then say: “When I say ‘Begin,’ make as many assemblies as possible, beginning with the top hole. Work quickly until I say ‘Stop.” Start timing when you say “Begin.” After exact 1 minute (60 seconds), say: “Stop.” Count the number of parts assembled and record the Assembly score. Since there are four parts in each assembly, if the subject made eight complete assemblies, the score is 8 multiplied by 4 (parts), or 32. Beyond completed assemblies, if there are additional parts properly placed at the end of the minute, they are also added to the Assembly score. For example, if there is another pin and first washer in addition to these 2 parts, the score is 32+2, or 34. After the test administrator records this score, the subject should return the pins, collars, and washers to the proper cups. Reference: Lafayette Instrument Company, Inc. (2002). Purdue pegboard test user manual. Lafayette, IN: USA

MINNESOTA DEXTERITY TEST Supplies Needed - Complete Minnesota Dexterity Test - Testing Table (between 28 and 32 inches in height) - Stopwatch Scoring - Scores are recorded on the CMDT score sheet where subjectsâ&#x20AC;&#x2122; results can also be compared to the Quick Reference Averages provided Tests 1. Placing Test - To evaluate the speed at which the subject can put the disks from top board into bottom board using dominant hand Starting Position - Place board on table 10 inches from edge with the disks inserted into the holes in the board. - Place second board directly in front of first board about 1 inch from edge of table nearest to subject Procedure - Begin on right side of test board - Pick up bottom disk and insert it into top hole of board closest to subject - Follow with next disk above empty hole on the top board, placing it in the hole below the disk in the bottom board - Continue pattern along the right column - Fill the first column of the bottom board downward and then repeat with consecutive columns moving right to left along boards 2. Turning Test - To evaluate speed subject can pick up disks with one hand and turn them with the other hand before replacing disks into holes of the board Starting Position - Place one board on table 1 inch from edge closest to subject - Insert disks into holes in board with either red or black side facing up Procedure - Pick up disk form upper right-hand corner with left hand - Turn disk over while passing it to the right hand and return it into the original hole with bottom side facing up. Continue across top row of board moving towards the left - Repeat action for second row moving towards the right of the board and using the right-hand to pick up each disk in the row and pass it to the left hand before re-inserted disk to original hole on the board -Move right to left along board for third row (same as first row) and finally, left to right for fourth row (same as second row)

3. Displacing Test - To evaluate how fast one can move blocks from one hole to another with either hand Starting Position - Place one board on table 1 inch from edge closest to subject - Insert disks into holes in board with either red or black side facing up - Remove disk form the upper left-hand corner Procedure - Begin at upper left-hand corner where disk is removed - Fill the top, empty hole with the disk directly below it - Continue until bottom hole in first column is empty - Then fill bottom hole of first column with bottom disk of second column. Fill second column with the disk above empty hole - Continue this pattern across entire board 4. One-Hand Turning And Placing Test - To evaluate how fast one can pick up disks from top board, turn disks over and place them into holes of the bottom board with only dominant hand. Starting Position - Same as Placing Test (Test 1) Procedure - Begin on the right side of top board - Pick up bottom disk and insert it into top hole of bottom board, nearest to the subject, while turning the disk over - Pick up next disk above empty hole of top board and turn it over while placing it in empty hole below first disk in bottom board - Continue pattern along the first right column - Continue same pattern for consecutive columns moving right to left along the board until entire bottom board is filled 5. Two-Hand Turning And Placing Test - To evaluate how fast one can pick up disks from top board, two at a time (1 in each hand), turn the disks over and place them into the holes of bottom board Starting Position - Same as Placing Test (Test 1) Procedure - Begin on the right side of top board - Pick up bottom two disks in the first column (one on top of the other), turn the disks over and insert them into top two holes in the first column of bottom board, nearest to the subject - Pick up next two disks above empty holes on top board, and place them in empty holes in bottom board below previous two disks. Continue until first right column is complete - Repeat sequence in following columns, moving towards the left until entire bottom board is filled

Static Two-Point Discrimination Materials At one time it was popular to use a paper clip to test two-point discrimination, but this is not recommended. The probe tips should be blunt, of the same geometry, and not so sharp that pain is elicited. Commonly available hand-held two-point discrimination test instruments include the two-point aesthesiometer and the disk-criminator Test Protocol Usually only the fingertips are assessed in static two-point discrimination testing, as norms vary widely farther up the extremity. The patientâ&#x20AC;&#x2122;s hand should be fully supported on a towel. The examiner should take care not to touch the patientâ&#x20AC;&#x2122;s hand with anything except the instrument, as touch by the examiner adds extraneous touch stimuli and may confuse the patient. A very light application of two versus one point of the instrument is used. Vision is occluded usually by obscuring the line of vision with folder rather than a blindfold. Results can be recorded on a hand screen form or hand drawing. Testing begins with 5mm of distance between the two points in random sequence with one point applied in a longitudinal orientation to avoid overlapping the innervation zones of the digital nerves. The point of blanching has been suggested as a control for force of application but this is problematic as blanching has been found to occur at different forces on different fingers and tissue areas, somewhat dependent on condition of the skin. Seven of 10 responses is necessary to be considered accurate. If there is no response or inaccurate response, the distance between the ends is increased by increments if 1 mm until 7 of 10 responses are accurate. Testing is stopped at 15mm. Interpretation Normal Fair Poor Protective Anesthetic

< 6 mm 6 to 10 mm 11 to 15 mm Perceives one point Perceives no points

Dellon Moving Two Point Test Protocol In the moving two-point discrimination test, testing is begun with an 8-mm distance between the two instrument tip points. The instrument is moved parallel to the long axis of the finger (testing ends side by side). Testing begins proximal to distal toward the fingertip. For a correct response, the patient has to respond accurately to 7 to 10 stimuli of one or two points, before the distance is narrowed for testing with smaller distance. Testing is stopped at 2 mm, which is considered normal. Interpretation The moving two-point stimulus is more easily detected than the static two-point. Two-point discrimination of 2mm is considered normal. !

Jebsen Taylor Hand Function Test Description: 7 subtests, performed on both non-dominant and dominant hand: 1. Writing a 24-letter, 3rd grade reading difficulty sentence 2. Card turning 3. Picking up small common objects (e.g pennies, paper clips, bottle caps) and placing them in a container 4. Stacking checkers 5. Simulated feeding 6. Moving light objects 7. Moving heavy objects Time to administer: 15 minutes Equipment Required: ! Stopwatch ! Chair (18” seat height), desk/table (30” high) ! Black ball point pen, four 8x11” sheets of unruled white paper staked and fastened to a clipboard ! Sentences typed in all capital letters and centered on a 5x8” index card on a bookstand ! Jebsen Taylor Hand Function ! Five 3x5” index cards (ruled on one side only) ! Empty 1 pound coffee can ! Two 1” paper clips ! 2 regular sized bottle caps (1”diameter) ! 2 U.S Pennies (25 centavos) ! 5 Kidney Beans (5/8”) ! 1 regular teaspoon ! Wooden board (41 ½” long, 11 ¼” wide, ¾” thick), “C” clamp, plywood (20” long, 2” wide, ½” thick) glued to the board ! Four standard size (1 ¼” diameter) red wooden checkers ! Five No. 303 cans RECORD SHEET:

Jebsen Subtests Subtests 1. Writing 2. Simulated page turning 3. Picking up small common objects 4. Simulated feeding 5. Stacking checkers (draughts) 6. Picking up large light objects 7. Picking up large heavy objects

Right hand (Time in seconds)

Left hand (Time in seconds)

Wrist Twist Score

Wrist & Arm Score

Force / Load Score

Muscle Use Score

Posture Score A

Wrist Score

RULA Score

Scoring: (final score from Table C) 1-2 = acceptable posture 3-4 = further investigation, change may be needed 5-6 = further investigation, change soon 7 = investigate and implement change

Scores

+3 +4

Force / Load Score

Muscle Use Score

Posture B Score

Leg Score

Trunk Score

Neck Score

Add values from steps 12-14 to obtain Neck, Trunk and Leg Score. Find Column in Table C. Neck, Trunk, Leg Score

Step 15: Find Column in Table C

If load < .4.4 lbs. (intermittent): +0 If load 4.4 to 22 lbs. (intermittent): +1 If load 4.4 to 22 lbs. (static or repeated): +2 If more than 22 lbs. or repeated or shocks: +3

Step 14: Add Force/Load Score

If posture mainly static (i.e. held>10 minutes), Or if action repeated occurs 4X per minute: +1

Step 13: Add Muscle Use Score

Using values from steps 9-11 above, locate score in Table B

Date:

Step 12: Look-up Posture Score in Table B:

If legs and feet are supported: +1 If not: +2

Step 10a: Adjust… If trunk is twisted: +1 If trunk is side bending: +1

Step 11: Legs:

Step 10: Locate Trunk Position:

Step 9a: Adjust… If neck is twisted: +1 If neck is side bending: +1

Step 9: Locate Neck Position:

B. Neck, Trunk and Leg Analysis

Task Name:

Original Worksheet Developed by Dr. Alan Hedge. Based on RULA: a survey method for the investigation of work-related upper limb disorders, McAtamney & Corlett, Applied Ergonomics 1993, 24(2), 91-99

Add values from steps 5-7 to obtain Wrist and Arm Score. Find row in Table C.

Step 8: Find Row in Table C

If load < .4.4 lbs. (intermittent): +0 If load 4.4 to 22 lbs. (intermittent): +1 If load 4.4 to 22 lbs. (static or repeated): +2 If more than 22 lbs. or repeated or shocks: +3

Step 7: Add Force/Load Score

If posture mainly static (i.e. held>10 minutes), Or if action repeated occurs 4X per minute: +1

Step 6: Add Muscle Use Score

Using values from steps 1-4 above, locate score in Table A

Step 5: Look-up Posture Score in Table A:

If wrist is twisted in mid-range: +1 If wrist is at or near end of range: +2

Step 4: Wrist Twist:

+2 Step 3a: Adjust… If wrist is bent from midline: Add +1

Step 3: Locate Wrist Position: Add +1

Lower Arm Score

Upper Arm Score

Step 2a: Adjust… If either arm is working across midline or out to side of body: Add +1

Step 2: Locate Lower Arm Position:

Step 1a: Adjust… If shoulder is raised: +1 If upper arm is abducted: +1 If arm is supported or person is leaning: -1

‘

Step 1: Locate Upper Arm Position:

A. Arm and Wrist Analysis

RULA Employee Assessment Worksheet

Adjust:

Add +1

Table C Score

Activity Score

REBA Score

Score A

Well fitting Handle and mid rang power grip, good: +0 Acceptable but not ideal hand hold or coupling acceptable with another body part, fair: +1 Hand hold not acceptable but possible, poor: +2 No handles, awkward, unsafe with any body part,

Step 11: Add Coupling Score

Using values from steps 7-9 above, locate score in Table B

Step 10: Look-up Posture Score in Table B

Score B

Coupling Score

Posture Score B

Wrist Score

Lower Arm Score

+1 1 or more body parts are held for longer than 1 minute (static) +1 Repeated small range actions (more than 4x per minute) +1 Action causes rapid large range changes in postures or unstable base

Step 13: Activity Score

Add values from steps 10 &11 to obtain Score B. Find column in Table C and match with Score A in row from step 6 to obtain Table C Score.

Upper Arm Score

Date:

Original Worksheet Developed by Dr. Alan Hedge. Based on Technical note: Rapid Entire Body Assessment (REBA), Hignett, McAtamney, Applied Ergonomics 31 (2000) 201-205

1 = Negligible Risk 2-3 = Low Risk. Change may be needed. 4-7 = Medium Risk. Further Investigate. Change Soon. 8-10 = High Risk. Investigate and Implement Change 11+ = Very High Risk. Implement Change

Scoring

Add values from steps 4 & 5 to obtain Score A. Find Row in Table C.

Step 9a: Adjust… If wrist is bent from midline or twisted : Add +1

Step 9: Locate Wrist Position:

Step 8: Locate Lower Arm Position:

Step 12: Score B, Find Column in Table C

Step 6: Score A, Find Row in Table C

Step 7a: Adjust… If shoulder is raised: +1 If upper arm is abducted: +1 If arm is supported or person is leaning: -1

Step 7: Locate Upper Arm Position:

B. Arm and Wrist Analysis

Unacceptable: +3

Posture Score A

Scores

Task Name:

If load < 11 lbs. : +0 If load 11 to 22 lbs. : +1 If load > 22 lbs.: +2 Adjust: If shock or rapid build up of force: add +1 Force / Load Score

Step 5: Add Force/Load Score

Using values from steps 1-3 above, Locate score in Table A

Leg Score

Trunk Score

Add +2

Neck Score

Step 4: Look-up Posture Score in Table A

Step 3: Legs

Step 2a: Adjust… If trunk is twisted: +1 If trunk is side bending: +1

Step 2: Locate Trunk Position +1 +2

Step 1a: Adjust… If neck is twisted: +1 If neck is side bending: +1

Step 1: Locate Neck Position

A. Neck, Trunk and Leg Analysis

REBA Employee Assessment Worksheet

Guidelines!for!Completion!of!the!Course! (SPECIALIZED!HAND!THERAPY!CERTIFICATE!COURSE)!

! The!continuing!professional!education!(CPE)!council!for!Physical!and!Occupational!Therapy!of!the! Professional!Regulation!Commission!have!revised!the!guidelines!for!awarding!CPE!units!or!newly!called! as!CPD!units!(continuing!professional!development!units).! ! The!participants!of!a!CPE/CPD!accredited!course!should!be!evaluated!to!ensure!that!the!program! outcome!and!intended!learning!outcomes!of!the!course!were!met.!All!participants!of!this!course!are! required!to!complete!the!following!evaluation!method:! ! 1.!Formative!Evaluation! ! The!formative!evaluation!is!a!short!essay!type!of!examination!that!aims!to!reinforce!the!learning!of!the! participants!for!the!aforementioned!course.!This!formative!evaluation!should!be!submitted!at!the!end!of! the!course.!All!participants!are!encouraged!to!finish!the!formative!evaluation!during!the!allotted!time!to! avoid!cramming!and!to!ensure!the!quality!of!their!outputs.!Please!turn!the!page!to!see!the!allotted! pages!for!the!formative!evaluation.! ! 2.!Summative!Evaluation! ! This!evaluation!will!be!given!as!an!online!examination!in!a!multiple!choice!format.!Please!see!page! allotted!for!Summative!Evaluation!Guidelines!for!the!complete!instruction!on!this!one.!

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

FORMATIVE!EVALUATION! Specialized!Hand!Therapy!Certificate!Course!! Module!2! !

! ! COMPLETE!NAME:!________________________________________________________! (Surname,!!! ! First!Name! ! ! !Middle!Initial)! PROFESSION:! (!)!Physical!Therapist!(!)!Occupational!Therapist!(!)!Physician!(!)!Others![Pls.!indicate:!______________]! !

1. Briefly!enumerate!different!assessment!tools!used!in!hand!therapy!and!discuss!the!validity!and! reliability!of!these!tools! ! ! ! ! 2. Briefly!discuss!different!assessment!tools!for!pain!! ! ! ! ! 3. Briefly!enumerate!different!assessment!tools!for!upper!extremity!function!and!occupational! performance! ! ! ! ! ! 4. Briefly!discuss!different!assessment!tools!for!sensibility!and!dexterity! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

! 5. Concisely!discuss!different!assessment!tools!for!wound!and!scars! ! ! ! ! ! ! 6. Briefly!enumerate!and!discuss!different!assessment!tools!used!for!ROM,!Edema!and!Vascularity! ! ! ! ! ! ! 7. Briefly!enumerate!and!discuss!the!different!special!tests!for!upper!extremities!! ! ! ! ! ! ! 8. Concisely!enumerate!and!discuss!rapid!upper!limb!assessment!tools!for!ergonomic!risk!factors! ! ! ! !! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

SUMMATIVE!EVALUATION!METHOD:!Online!Examination! (Specialized!Hand!Therapy!Certificate!Course!Module!2)!

A!day!after!the!course,!the!attendees!will!be!required!to!answer!an!online!examination!that!can!be! found!on!our!website:!http://rehabtrends.com.ph/details/handcertification.php!

*Please&take&note&that&the&online&portal&for&the&exam&will&appear&after&a&day&after&the&course&

*Attendees&will&be&given&5=days&to&finish&the&evaluation&

! !The!online!examination!will!be!in!multiple!choice!format.!And!questions!will!deal!more!on!the! application!the!discussed!topics!during!the!course.!All!resource!speakers!where!given!until!June!15,!2016! to!submit!their!question!to!ensure!quality!their!assigned!questions.!An!8gitem!applied!questions!will!be! asked!for!the!Intended!Learning!Outcome.!! ! The!following!are!the!test!blue!print!for!this!course:!

Intended!Learning!Outcome! •

Master!the!utilization!of!the!different! evaluation/assessment!tools!and!measures!to! accurately!acquire!the!necessary!information!from! the!client!

Focus!of!the!Question! Case!Analysis!on!the! utilization!of!the!different! evaluation/assessment!tools! in!the!upper!extremity!

Weight! 100%!

! PASSING!REQUIREMENT! Participants!should!get!a!General!Weighted!Average!of!not!less!than!75%!in!order!to!pass!the!evaluation.! The!program!outcome!below:! At!the!end!of!the!course,!the!professionals!are!expected!to:! • accurately!administer!the!special!tests,!standardized!and!nongstandardized!assessment!tools!for! the!upper!extremity! • be!able!to!analyze!the!results!of!the!different!evaluation/assessment!tools!used!for!the!upper! extremity!for!the!formulation!of!goals!and!problem!list! ! RESULTS!OF!THE!EXAM! Exam!results!will!be!posted!on!the!link!stated!above.!To!maintain!privacy!of!the!postgraduate!student,! the!serial!number!of!the!certificate,!instead!of!the!name!of!participants!will!be!posted.!These!results!will! also!be!submitted!to!CPD!council!as!part!of!the!postgeval!compliance!report.! ! ! ! ! ! ! ! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

SUMMATIVE!EVALUATION!METHOD:!Practical!Examination! (Specialized!Hand!Therapy!Certificate!Course!Module!2)! ! After!the!course,!the!attendees!will!be!required!to!undergo!practical!examination!that!will!be! determined!by!the!organizers!on!the!conclusion!of!the!course.!

*Please&take&note&that&the&exam&will&be&proctored&after&15=days.&

*Attendees&will&be&given&its&scheduled&time&for&practical&examination&that&will&last&for&1hour&

! Each!student!will!be!given!a!hypothetical!case!and!is!required!to!choose!an!appropriate! evaluation/assessment!tool!appropriate!for!the!assigned!case.!All!students!are!also!expected!to!explain! and!defend!their!chosen!evaluation/assessment!tools.!All!students!will!simulate!the!proper! administration!the!chosen!evaluation/assessment!tool.!Below!is!the!grading!criteria!that!will!be!used!to! evaluate!the!examinee:! ! Grading!Criteria! Grading!Scale! Introduction!and!Briefing! 15pts! 10pts! 5pts! 0pt.! Mentions!! Completely! Incomplete,! Incomplete,! Did!not! Observed! Missed!one! Missed!2! accurately! • what!(name!of!the!tool)! criteria! criteria! mention!all! • why!(reason!for!evaluation)! information! • how!(general!instructions)!of! the!evaluation!tool!correctly! Positioning!of!Client!and!Therapist! 10pts! 5pts! 0pt.! Correctly! Correctly! Inappropriate!and! • Positions!self!correctly!in! positioned!and! positioned!but! ineffective! relation!to!the!client! unable!to!adapt! positioning! according!to!the!assessment! adapted!correctly! tool! • Adapts!correctly!to!certain! situations!during!the! assessment!procedure! Utilization!of!Materials! 10pts! 0pts! Correctly!done! Incorrectly!done! • Places!the!materials! correctly!according!to!the! manual! Application!of!Tests!and!Subtests! 15pts! 10pts! 5pts! 0pt.! Completely! Incomplete,! Incomplete,! Incomplete,! • Completes!all!subtests! and! Missed!one! Missed!2! Improper! • Follows!the!correct! Accurately! criteria! criteria! sequence,! sequence!of!the!different! done! inaccurately! subtests! done! • Accurately!perform!the!test! and!subtests! Instructions!and!Feedback! 15pts! 10pts! 5pts! 0pt.! Correct! Correct! Incomplete! Inappropriate! • Gives!the!correct! instructions! instructions! instructions! instructions! instructions!for!each!subtest! ! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

! •

Follows!the!correct! procedures!provided!

Time!Management! • Mentions!to!the!client!how! much!time!the!tests!will!take!! • Completes!all!subtests!in!the! amount!of!time!required.! Recording!and!Documentation! • Completely!and!correctly! records!the!findings!of!each! subtest! Knowledge! • Displays!confidence!during! the!duration!of!the!testing! • Able!to!answer!any! questions!by!the!proctor!or! client!being!tested!

and! procedures!

and!wrong! procedures!

10pts! Mentioned!and! efficiently!done!

5pts! Did!not!mention! but!efficiently! done!

10pts! Completely!and! correctly!done!

5pts! Incomplete!but! correctly!done!

15pts! Completely! Observed!

5pts! Incompletely! Observed!

or!did!not! provide! instructions! 0pt.! Did!not!mention! and!inefficient!

0pt.! Did!not!or! Incomplete!done! and!incorrectly! done! 0pt.! Did!not!observe!

TOTAL!SCORE!(100!pts)! ! ! PASSING!REQUIREMENT! Participants!should!get!a!General!Weighted!Average!of!not!less!than!75%!in!order!to!pass!the!evaluation.! The!program!outcome!below:! At!the!end!of!the!course,!the!professionals!are!expected!to:! • accurately!administer!the!special!tests,!standardized!and!nongstandardized!assessment!tools!for! the!upper!extremity! • be!able!to!analyze!the!results!of!the!different!evaluation/assessment!tools!used!for!the!upper! extremity!for!the!formulation!of!goals!and!problem!list! ! RESULTS!OF!THE!EXAM! Exam!results!will!be!posted!on!the!link!stated!above.!To!maintain!privacy!of!the!postgraduate!student,! the!serial!number!of!the!certificate,!instead!of!the!name!of!participants!will!be!posted.!These!results!will! also!be!submitted!to!CPD!council!as!part!of!the!postgeval!compliance!report.! !

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends.inc@gmail.com! !

! !

NOTES!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! !

NOTES!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! !

NOTES!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! !

NOTES!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

! !

NOTES!

! !!!!!!!!!!!www.rehabtrends.com.ph!! !!!!!!!!!!!+639178684353! !!!!!!!!!!!rehabtrends!

CERTIFICATION!FEEDBACK(FORM!

Module'2! Batch&1&(June&26,&July&3,&2016)&Batch&2&(July9"10,$2016)!

A. In#a#scale#of#1#to#5#or#NA#(1#=#unsatisfactory,#5#=#very#satisfactory,#na=not#applicable),#encircle#one#number#to#rate#your#degree$of$ satisfaction)with)the)following)statements.! !

Score!

Comments!

Visual'aides! Readability*of*text!

1"–!2"–!3"–!4"–!5"%!na! !

Clarity(of(diagrams!

1"–!2"–!3"–!4"–!5"%!na! !

Content!

1"–!2"–!3"–!4"–!5%!na##! !

Overall'quality'of'presentation!

1"–!2"–!3"–!4"–!5%!na##! !

Voice&and&projection! Clarity(of(speech(!

1"–!2"–!3"–!4"–!5%!na##! !

Good$general$impression!

1"–!2"–!3"–!4"–!5%!na! !

Good$contact$with$audience!

1"–!2"–!3"–!4"–!5%!na! !

Venue%/%Physical%arrangement! Cleanliness(of(the(room!

1"–!2"–!3"–!4"–!5%!na##! !

Clarity(of(the(sound(system!

1"–!2"–!3"–!4"–!5–!na! !

Enough'chairs'were'allotted'to'the'participants!

1"–!2"–!3"–!4"–!5%!na##! !

Accessibility*of*the*venue!

1"–!2"–!3"–!4"–!5%!na! !

! !

Content! The$seminar$covered$what$I$was$expecting!

1"–!2"–!3"–!4"–!5%!na!

Did!we!achieved!the!program!outcome?!

•

Accurately*administer*the*special*tests,* standardized*and*non%standardized*assessment* tools%for%the%upper%extremity!

1"–!2"–!3"–!4"–!5%!na!

•

Analyze(the(results(of(the(different( evaluation/assessment-tools-used-for-the-upperextremity(for(the(formulation(of!goals&and& problem(list!

1"–!2"–!3"–!4"–!5%!na!

Did!we!achieved!the!intended!learning!outcomes?! •

Master'the'utilization'of'the'different' evaluation/assessment-tools-and-measures-toaccurately)acquire)the)necessary)information) from%the%client!

! 1"–!2"–!3"–!4"–!5%!na!

CERTIFICATION!FEEDBACK(FORM!

Module'2! Batch&1&(June&26,&July&3,&2016)&Batch&2&(July9"10,$2016)! Significance/usefulness-of-topic-in-the-profession!

1"–!2"–!3"–!4"–!5%!na!

Sufficient)duration)for)demonstration)to)fully)understand) the$application!

1"–!2"–!3"–!4"–!5%!na!

Value&for&MONEY!(Worth'it?)!

1"–!2"–!3"–!4"–!5%!na!

Overall!rate%of%satisfaction!

1"–!2"–!3"–!4"–!5"–!na!

SUGGEST&TOPICS&FOR&FUTURE&SEMINARS!

! ! !

Please&comment&on&how&the&seminar&was&helpful&to&you.! ! !

Please!specify!topics!presented!in!the!seminar!that!were!specifically!interesting.! ! !

! D. How$did$you$know$about$the$seminar?$(check$the$appropriate$choice/s)! ! ____Facebook)Ads)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))_____)RehabTrends)Email! ____Facebook)Groups))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))_____)RehabTrends)Website! !!!!!!!!!(Pls.&Specify&the&group:____________________)&&&&_____Others&&&&&&&&&&(Pls.&Specify:&_______________________)! ____Facebook)Events! ____RehabTrends,Like,Page! E. Are!you!a!REHABTRENDS!Member?!(!)!Yes!(!)!Not!yet!