October 27, 2016

Researchers Dismiss Treatment If They Use the Wrong Outcome

I cannot die in peace until hand recovery is evaluated with tests that have a good basement.  Good basements detect changes before substantial recovery appears.  Researchers may find no significant improvement after treatment even though subjects report using their hemiplegic hand more at home.  When subjects report they use the hemiplegic hand to shower, it has been called subjective data.  Why is there a discrepancy between formal hand tests and subject report?  Do researchers find a lack of progress because they provided poor treatment or because they used tests loaded with difficult test items that were not a good match for the subjects they recruited?  The table below compares the Arm Motor Ability Test (AMAT) and the Test of Early Bilateral Hand Use (TEBHU).  The AMAT has many high level skills while the TEBHU (1) has five levels of hand use.  My hemiplegic hand cannot do any of the AMAT items listed below but it makes me independent during over 100 bimanual ADLs.  Not fair!
  
           AMAT                                      TEBHU
Finger mobility                                  Finger mobility                        
    Cut with knife                                    Cut with knife                        
    Button                                                Button                                    
    Draw line with pen & ruler                 Tie shoelaces                         
    Dial phone                                         
    Squeeze toothpaste on brush
    Wipe eyeglasses                                  
                                                                         
Wrist/forearm mobility                    Wrist/forearm mobility              
    Unscrew jar lid                                 Peel carrot
    Comb hair                                        Stir pot
    Scoop up beans                               Zip coat
    Turn door knob
    Take sandwich to mouth
    Take phone to ear

                                                         Reach for object and hold it still*
                                                              Reach for and hold carrot while sound hand peels   
                                                              Reach for and hold pot handle while sound hand stirs
                                                              Reach for/hold scraper while sound hand rakes up food

                                                         Hand-to-hand transfer and hold object still*
                                                              Put deodorant in hemi hand so sound hand can remove cap
                                                              Put t. paste tube in hemi hand so s. hand can remove cap
                                                              Put remote in hemi hand & carry so s. hand can use cane
                                                            
                                                         Trap object on surface and hold it still*
                                                              Trap toilet paper on thigh so sound hand can tear paper    
                                                              Trap return stub for bill on table so s. hand can tear off stub
                                                              Trap envelope on table so s. hand can tear open envelop

*When I was able-bodied I did not know I used both hands for hundreds of tasks.  Many bimanual tasks are so brief or simple that they fall below the awareness of people who design hand evaluations.

1. Dutton R. My Last Degree: A Therapist Goes Home After a Stroke, 2nd ed. Bangor, Maine:
    Booklocker; 2013:55-65.

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