Hand Dexterity in Children: Administration and Normative Values of the Functional Dexterity Test

Gorgola, G.R., Velleman, P.F., Xu, S., Morse, A.M., Lacy, B., & Aaron, D.H. (2013)


Purpose To document normative values from the Functional Dexterity Test (FTD) for typicallydeveloping children and to optimize test administration and interpretation.

Methods A total of 175 typically developing children aged 3 to 17 years participated in thestudy. Children completed the 16-peg FDT with both hands, and elapsed time was recorded inseconds. Data were analyzed as 16/time, interpreted as speed (pegs per second). A linearregression analysis predicted speed from age and hand dominance.

Results Functional Dexterity Test speed increased linearly in typically developing children by0.04 pegs/s for each year of age. This rate of increase was the same for dominant andnondominant hands. Dominant hands were faster than nondominant hands by 0.09 pegs/s atall ages. There was no sex difference.

Conclusions This study provides age-specific normative values for functional dexterity intypically developing children in 2 formats: as a growth chart of FDT speed versus age and as aregression model that calculates expected speed given a child’s age and tested hand dominance.Recommended pediatric modifications to the FDT are to use speed (pegs per second)instead of time (seconds) to report results, and to not assess penalties. The norms presentedallow clinicians to compare both speed and rate of change over time of pediatric patients withtypically developing children, which makes it possible to distinguish developmental changefrom intervention.


Welcome to our world of hand therapy...dare to make waves!
Aaron, D.H. (2013)
AHST Presidential Address
Physical Agent Modalities

McPhee, S.D., Braccicano, A.G., & Rose, B.W. (2013)


The American Occupational Therapy Association (AOTA) asserts that physical agent modalities (PAMs)

may be used by occupational therapists and occupational therapy assistants in preparation for or concurrently
with purposeful and occupation-based activities or interventions that ultimately enhance engagement
in occupation (AOTA, 2008a, 2008b). AOTA further stipulates that PAMs may be applied only by
occupational therapists and occupational therapy assistants who have documented evidence of possessing
the theoretical background and technical skills for safe and competent integration of the modality into
an occupational therapy intervention plan (AOTA, 2008b). The purpose of this paper is to clarify the
appropriate context for use of PAMs in occupational therapy. It is the professional and ethical responsibility
of occupational therapy practitioners to be knowledgeable of and adhere to applicable state laws.

 Does hand therapy literature incorporate the holistic view of health and function promoted by the world health organization?
Winthrop Rose, B., Kasch, M.C., Aaron, D.H., & Stegink-Jansen, C.W. (2011)

The International Classification of Function (ICF), asformulated by the World Health Organization (WHO), is an acceptedinternational standard for categorizing health and disability.We examined the frequency that ICF domains have beenincluded in 788 Journal of Hand Therapy articles and 78 hand therapyarticles from other sources using a scoring system based onthe WHO ICF definitions. We found emphasis on body functionsand body structures, with less emphasis placed on activities, participation,and environmental factors. This trend has remained stableover time despite the emergence of patient-centered disabilitymeasures. We recommend that scientists increasingly incorporateall of the WHO ICF domains in their scientific investigations todemonstrate the societal and personal impact of the profession ina language that is understood and appreciated by a wide arrayof health care users, policy makers, and third-party payers.


Trends in Dexterity and Normative Values for the Functional Dexterity Test (FDT)

Gray, S.S., Velleman, P.F., Aaron, D.H., & Rose, B.W. (2011)


The purpose of this study was to search and appraise the current evidence related to the psychometric properties of the Patient-rated
Wrist Evidence (PRWE). Medline, CINAHL, andEmbase databases were searched forretrieving the relevant studies. In addition,hand searching of the retrievedstudies also identified relevant studies.Sixteen studies were included inthe review. Two raters independentlyfollowed standardized guidelines fordata extraction and appraisal of theincluded studies. Descriptive summaryof the psychometric propertieswas prepared.

 Hand dexterity values
Gorgola, G.R., & Aaron, D.H. (2010)

The Functional Dexterity Test (FDT) is a timed pegboard test of dexterity. Validated in adults, it has been shown to directly correlate to ability to perform ADLs. Its advantage is providing clinically relevant functional data with an easily performed test that does not require a significant amount of time or equipment to administer, and is suitable for very young children. The purpose of this study is to document age specific normative values for functional dexterity in typically developing children.

Gateway to the world of hand therapy
Aaron, D.H., Coverdale, J.J., Boineau, P., & Colditz, J.C. (2010)


Symptoms and Clinical Measures of Hands and Feet of Patients with Diabetes Mellitus

Stegnick-Jensen, C.W. & Rose, B.W.(2010)


Patients with Diabetes Mellitus (DM) may show similaritiesin symptoms due to diabetic neuropathyas do patients with Carpal Tunnel Syndrome (CTS). The purposeof this preliminary study wasto investigate differential diagnosisfeatures of symptoms in hands ofDMpatients as compared to patients withCTS.We tested the following hypotheses:Symptom severity of DM subjectsdoes not differ from CTS values,2) symptoms in hands and feet do notdiffer, 3) DM subjects have normalhand and foot sensation, and 4) correlationsbetween symptoms andclinical measures of hand and footfunction and sensation are good,exceeding 0.7.


Physical Agent Modalities: A Position Paper (2008)

McPhee, S.D., Braccicano, A.G., & Rose, B.W. (2008)


The American Occupational Therapy Association (AOTA) asserts that physical agent modalities (PAMs)may be used by occupational therapists and occupational therapy assistants in preparation for or concur-rently with purposeful and occupation-based activities or interventions that ultimately enhance engage-ment in occupation (AOTA, 2002, 2003). AOTA further stipulates that PAMs may be applied only byoccupational therapists and occupational therapy assistants who have documented evidence of possess-ing the theoretical background and technical skills for safe and competent integration of the modality intoan occupational therapy intervention plan (AOTA, 2003). The purpose of this paper is to clarify the appro-priate context for use of PAMs in occupational therapy.

A Qualitative Assessment of Need for Ethnic & Cultural Diversity among Hand Therapists

Stegink-Jansen, C.W., Fess E., Rose, B.W.,& Williams, M. (2006)


Both the American Physical Therapy Association(APTA) and the AmericanOccupational Therapy Association(AOTA) have organizational entitiesthat promote growing diversityamong their members. The AmericanSociety of Hand Therapists (ASHT)welcomes therapist cultural diversityby including international participation,but it currently does not havean organization entity to promoteethnic and cultural diversity amongits members. The purpose of this preliminarystudy is to investigate theperceived facets of diversity amonghand therapists by completing aqualitative analysis of answers tofour open-ended questions.


 Development of the functional dexterity test (FDT): Construction, validity, reliability, and normative data
Aaron, D.H. & Stegink Jansen C.W.(2003).


Dexterity tests take time to administer; however, the information obtained is an important component of a comprehensive

examination of the hand. This article introduces a dexterity test suitable for use as part of routine examination of the hand. The Functional Dexterity Test (FDT) was developed as a measure of dexterity that takes a minimum amount of time to administer, yet provides information regarding the patient’s ability to use the hand for daily tasks requiring a 3-jaw chuck prehension between the fingers and the thumb. The test was developed over 20 years. Interrater and intrarater reliability ranges between good and excellent. Construct validity was confirmed in 2 clinical studies. Preliminary normative data were obtained in 6 samples of convenience. Along with statistical data, this article provides equipment standards and instructions.


Physical Agent Modalities: A Position Paper (2003)

McPhee, S.D., Braccicano, A.G., & Rose, B.W. (2003)


The American Occupational Therapy Association, Inc.(AOTA) asserts that physical agent modalities may beused by occupational therapists and occupational therapyassistants as an adjunct to or in preparation for interventionthat ultimately enhances engagement in occupation(AOTA, 1997, 2002a). The AOTA further stipulates thatphysical agent modalities may only be applied by occupationaltherapists and occupational therapy assistants whohave documented evidence of possessing the theoreticalbackground and technical skills for safe and competentintegration of the modality into an occupational therapyintervention plan (AOTA, 1997). The purpose of this paperis to clarify the appropriate context for use of physical agentmodalities in occupational therapy.

 Measuring normal hand dexterity values in normal 3-, 4-, and 5-year-old children and their relationship with grip and pinch strength
Lee-Volkov, P.M., Aaron, D.H., Eladomikadochi, F., Thornby, J., & Netscher,D.T. (2003).


After surgery for trauma or correction of congenital anomaly, hand function is difficult to evaluate in children because

there are no reference norms on children 3 to 5 years old. The purpose of this study was to determine whether reproducible normative values for hand dexterity and grip and pinch strength could be obtained in young children using simple tests that could be
administered quickly within the attention span of a 3- to 5-yearold. The Functional Dexterity Test (FDT), a pegboard test validated for adults and older children, seemed to meet our requirements for dexterity. The FDT was administered to a convenience sample of normal children in a prekindergarten school who were grouped according to age: 3-year-olds (n = 17), 4-year-olds (n = 24), and 5-year-olds (n = 22). Hand dominance was determined. The task was demonstrated by 1 of the 2 testers. The child was asked to turn the pegs over in the pegboard without using the free hand or balancing the peg against the chest. Both hands were tested. Grip and pinch strengths were measured in both hands in a consistent manner. All the children were tested with the arm at the side and the elbow at 90°. A dynamometer was used for grip strength and a pinch meter was used to measure key (lateral) and tripod pinch strengths. Means and SDs were calculated for each age group, and the dependent values of dexterity, strength, and dominance were correlated. Dexterity and strength scores were significantly different by age group. Agood FDT score in the dominant hand was predictive of a good score in the nondominant hand. Grip and pinch strength correlated poorly with functional dexterity. The normative values established in this study for children in the 3- to 5-year-old range can be referenced for disability estimates and establishing goals for children after surgery or hand injury.




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