ADVANCING THE SCIENCE OF RSI, CTS, UPPER EXTEMITY AND FINE MOTOR SKILLS ASSESSMENTS AND REHABILITATION
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After four years of research and development, the Hanoun Upper Extremity System (UE) is taking the medical and rehabilitation fields to an unequaled level. Finally, technology and science are combined to effectively provide comprehensive evaluation and rehabilitation of Repetitive Strain Injuries, Carpal Tunnel Syndrome and an array of other upper extremity conditions. The system also provides over 100 different protocols for fine motor skill evaluations to be used in head, spinal cord and upper extremity injury cases.
The Hanoun Upper Extremity System employs both strength and dexterity testing to allow the professional evaluator the means to assess a wide range of abilities on a job and impairment-specific basis. With its protocols, unique tools and fatigue analysis software, the ability of the patient to perform sustained work is quantified on a more exact basis than ever before. The ability to determine the validity of effort and provide the reproducible evidence necessary to support the evaluator’s opinion is unsurpassed. And, the utility of the system to perform rehabilitation, as well as evaluation activities, enhances the value to the clinic.
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TESTING APPLICATIONS OF THE UE SYSTEM
Manual Dexterity Testing with MTM Standards
Standard and Natural Keyboard Manipulation
Repetitive Wrist, Elbow and Shoulder Flexion and Extension
Handling, Tool Manipulation and Fine Finger Dexterity
Gross Manipulation Testing
Self Perception Clinical Tests
· EPIC Hand Function Sort
· Advanced EPIC Hand Function Sort Classifier
· Tinel’s, Phalen’s, Varus Stress, Valgus Stress Report Templates
· Range of Motion in compliance with AMA 3rd, 4th and 5th editions with automatic impairment calculation
· Single and Bilateral Jamar Grip Testing in Multiple Positions
· Single and Bilateral Pinch Grip Testing in Multiple Positions
· Static Torque Force Testing with Interchangeable Tools
· Wrist Flexion/Extension Strength
· Independent Finger Joint Strength Testing
· Bi-lateral Simultaneous Grip and Pinch Strength Testing
·Thoracic Outlet (Push Together/Pull Apart)
Features and Specifications
Historically, upper extremity strength testing has been limited to the published research protocols for grip and
pinch dynamometry. In a disability or impairment evaluation context, the use of both the researched protocols
and the exact design of the testing device are imperative to the legal acceptability of the findings and the
opinions of the evaluator. However, the applicability of the grip tests to return to work issues has been limited in
cases where the need to sustain the grip or use differing wrist positions is essential to the safety of the worker.
Hanoun Medical has met the challenge with the Multi-Angle Grip Positioner and the customization capabilities of
the ODES-Upper Extremities Software Program. Now, if it is necessary to determine if the patient has the ability
to sustain a 12 second grip with only 1-second interval rest periods, and the grip must be in the position with the
wrist rotated at 90 degrees of pronation and the spread equivalent to vise grips (e.g., Jamar Position 4), the test
can be conducted and recorded on a real-time basis. If it is necessary to determine the minimum grip strength
within a set time period during the test, the software will capture and report the effort to the nearest one-tenth of
a pound. If it is necessary to analyze the extent of the fatigue, the Real-Time Data Analyzer allows the evaluator to
determine the extent of the fatigue between the point of maximum effort during a repetition and the completion
of the test, as well as the extent of the fatigue from the first to the final repetition.
As with grip strength testing, Hanoun Medical has recognized the need to make the pinch strength tests
customizable to the issues of job and impairment specific testing. While the ODES-Upper Extremity Software
Program uses some of the most widely referenced pinch strength protocols, the need to be able to customize
pinch strength testing to exact parameters also exists. Hanoun Medical has met this challenge as well with the
Multi-Angle Pinch Positioner and the customization capabilities of the ODES-Upper Extremities Software
Program. Furthermore, correct positioning during pinch strength testing has been a major problem to the
reliability and validity of the test data. The Multi-Angle Pinch Positioner enhances the ability of the evaluator to
make certain the test subject is correctly positioned for each type of pinch test.The same data analysis and
custom test design features for grip testing are also present for pinch strength testing.
Static Torque Force Testing
Torque force testing has been one of the most difficult areas in the assessment of an individual's ability to
perform a myriad of work related activities. While many have tried, the results have generally been limited to
isokinetic forms of testing. Although isokinetic instruments have been beneficial in the rehabilitation of
individuals, they have significant limitations in the area of evaluation. Furthermore, the types of torque force
applications have been very difficult to replicate on a computer-interfaced basis.
That is until now. Hanoun Medical has developed the most comprehensive static torque force evaluation
system. Now, an individual's strength in association with the ability to turn wheels, valves, twist screw drivers
and push/pull on wrenches of varying sizes and design styles can be accurately measured. No longer will the
test be a crude estimate as to whether an individual can push on a wrench of one set size. The strength in
conjunction with the leverage of the tool will be measured, and a more appropriate estimate of the ergonomic
ability to perform the task will be given.
As with all of the upper extremity strength tests, the ODES-Upper Extremity Software will allow for the
customization of the test to the necessary parameters and allow for the most comprehensive analysis of the
Wrist Flexion/Extension Strength
Wrist flexion and extension strength testing has been another area that has been under-developed in the
functional testing industry. The main problem has been the positioning of the wrist and the isolation of the wrist
joint without the use of support devices that may show a false positive in strength measurements. Hanoun
Medical has solved the problem and developed additional tools that allow the professional evaluator to measure
strength in several different types of hand positions and angles. As with all of the upper extremity strength tests,
the ODES-Upper Extremity Software will allow for the customization of the test to the necessary parameters and
allow for the most comprehensive analysis of the data.
Independent Finger Joint Strength Testing
The ability to measure independently, the strength of digits has been an inaccurate science in functional testing.
Once again, hand positioning and the appropriate testing tool interface has plagued the professional evaluator.
Hanoun Medical has developed the Hanoun Digit Strength System to enable the measurement of the forces that
are sometimes forgotten, but lead to a high number of work-related injuries. Thumb push force with extension is
just one example of the type of critical strength measurement that is possible with the Hanoun Digit Strength
System. The ability to determine the relative strength of each digit and each phalange will enable the evaluator to
determine potential impacts upon overall grip strength capabilities and the extent of improvement that will be
capable with a treatment program. As with all of the upper extremity strength tests, the ODES-Upper Extremity
Software will allow for the customization of the test to the necessary parameters and allow for the most
comprehensive analysis of the data.
Bi-lateral Simultaneous Grip and Pinch Strength Testing
Several practitioners have commenced the simultaneous testing of grip strength on a bi-lateral basis as a means
of having a validity of effort criteria. Initial clinical trials have determined it is more difficult to control grip on one
side versus the other with an invalid effort limited to one extremity. Furthermore, bi-lateral grip strength is an
issue in the performance of real work activities. Hanoun Medical is in agreement with the concept and has
developed the system to allow for the bi-lateral simultaneous testing of grip or pinch strengths. As with all of the
upper extremity strength tests, the ODES-Upper Extremity Software will allow for the customization of the test to
the necessary parameters and allow for the most comprehensive analysis of the data.
Manual Dexterity Testing
Keyboard Manipulation (Standard and Natural Keyboards)
The quantification of keyboard manipulation capabilities in relation to specific impairment processes and
ergonomic corrections has been very limited. Furthermore, the issue of fatigue in performance should not be
affected by the cognitive capabilities of the test subject (i.e., spelling, punctuation and knowledge of the
keyboard). Typing tests are representative of the skills of the test subject, and in some functional testing
platforms the speed of the typist overlooks the subtle possibility of a decrement attributable to a disease or injury
process. Decreasing the level of cognitive function required of the test subject increases the ability to measure
the actual physical abilities of a broad-based range of test subjects without a bias created by the knowledge of the
keyboard. And, with the move toward instituting ergonomically correct workstations with the Natural Keyboard, it
is important to know whether or not the ergonomic adjustment is going to provide a true benefit. By eliminating
the keyboard knowledge requirement and focusing upon the manipulation speed and the fatigue factors
associated with keyboarding, the test has greater validity and reliability as a measurement of physical functioning
capabilities. Hanoun Medical has met the challenge with its series of keyboarding manipulation tests that employ
the use of the MTM standard for time-motion activities. MTM, as the internationally recognized time-motion
standard, will also meet the legal challenges associated with the validity of the test measurement to the
performance of work. Furthermore, the protocols allow for the analysis of work on an occasional, frequent and
constant basis. The ability to create custom length tests also exists for job-specific testing purposes.
Repetitive Wrist, Elbow and Shoulder Flexion and Extension
Measurement of repetitive wrist movement and the impact upon physical function has been strictly
observational or a component of isokinetic systems. Unfortunately, relating the physical movement
performance to work has been severely limited or non-existent with functional testing systems. Hanoun Medical
recognized the problem and has developed the solution with the Hanoun Upper Extremity System.
Wrist, elbow and shoulder flexion and extension activities can vary as widely as the requirements of work. A
painter may use broad strokes on a vertical basis, whereas an assembly line worker may use limited stroke
movements on a horizontal basis.
The Hanoun Upper Extremity System allows the evaluator to use either a set number of standardized protocols or
develop customized protocols to match the nature of the work to be performed. The system allows the evaluator
to set the travel distance as well as the angle for the movement and have MTM scores calculated for the
performance of the test subject. The fatigue associated with the repetition is also displayed in order to help
determine if the test subject has the endurance for the activity and when the breakdown in capabilities has its
onset.The real time display of data also helps to establish the reproducible evidence necessary to establish
opinions necessary for rehabilitation or the extent of recovery or functional decrement associated with the
Handling, Tool Manipulation and Fine Finger Dexterity
While many functional testing systems have attempted to quantify the handling and fine finger dexterity
capabilities of the patient, the results have been poor. Some systems have used an overall MTM score or a
criterion-referenced normal population. Unfortunately, the real value has been overlooked in the test: the ability
to determine the extent of the fatigue in repetitive manipulation activities and when the fatigue had its onset.
Some individuals may have great capabilities at the start of an activity that create a high time-motion
equivalency, but then fatigue to the point manipulation at the end is nearly impossible. However, the overall
score is based upon the total number of manipulations and it does not take into consideration the fatigue effect.
The Odes-Upper Extremity Software Program documents the precise time interval between repetitions and
graphically display the fatigue curve. This is also beneficial in the case situation where fatigue is never
generated and the individual's score is quite low, raising the possibility of greater performance capabilities or
psychomotor limitations. MTM scores are given on an interval basis to also help determine the extent of
employable production during the performance of the physical demand.
Hanoun Medical brings to the professional evaluator the ability to perform standardized protocols that include
over 12 hours of tests. Varying levels of fine finger dexterity, tool manipulation and handling are included in the
tests. All tests are graphically portrayed on a real time basis and include MTM measurements of performance.
It also determines if the rate of the fine motor manipulation is within industry standards, as well as the ability to
duplicate the required tracing activity. The tests are a progressive series that also help to determine the extent of
the manipulative capabilities and whether or not a valid effort is being given. The tests are computer-interfaced,
recorded and scored to provide the reproducibility necessary for the most accurate assessment capabilities.
Gross Manipulation Testing
The ability to create relevant work simulation activities that reflect the nature of work, yet provide viable
medical information is sometimes overlooked by the functional testing systems. Recognizing the fact the
test must truly represent the performance of physical demands without a cognitive overload, Hanoun
Medical has developed a series of gross manipulation tests that employ the use of varying range of motion
activities in the testing process.
On a computer-interfaced basis, the test subject is required to perform a simulated production line activity
that requires the placement of objects into a box. Through the introduction of a progressive series of
obstacles, the worker is required to perform the same transfer process, yet the range of motion and the
nature of the manipulation will change. This will enable the evaluator to observe and report the onset of
postural variances/splinting and the system will record the performance variations using MTM standards
and real-time graphs.
The system is adjustable for all anthropometrical and job-specific considerations necessary to make
certain the results are valid and reliable either on a disability evaluation or industrial consideration basis.
Become a center of excellence
by using the most advanced methods to
evaluate upper extremity and fine motor
skills functional abilities. Technology and
science are combined to effectively
provide the most comprehensive
evaluation, as well as to allow for
rehabilitation of the Upper Extremities
and other conditions affecting fine motor