Katie Yancosek OTR/L, CHT - Handwriting for Heroes

1 Hand dominance Re training following or limb lossKatieYancosek, OTR/L, CHTK atie Yancosek , OTR/L, CHTO bjective RaiseawarenessofhanddominanceanddiscussR aise awareness of hand dominance and discuss treatment options for re training/transfer. Ultimate Goal: IMPROVE functional OUTCOMES iRELEVANTCLINICALCAREPATHWAYSvia RELEVANT CLINICAL CARE PATHWAYSWHAT What is hand dominance ?Hand dominance is the preferential use of one hand over the other for single limb or bi manual tasksiIn bi manual tasks one hand is the main texecutorand one is the dominance Thedominanthandisaffected(acuteorThe dominant hand is affected (acute or chronic) more often than the non dominant handhand Traditional medical disability ratings consider handdominanceasamainfactorhand dominance as a mainfactorHandDominanceHand dominance LimbdominanceisevidentinmostprimatesLimb dominance is evident in most primates and in some lower animals (ex.))

2 Frogs, rabbits) Whydoweexhibithanddominance?unknownWhy do we exhibit hand dominance ? unknown and still debated HanddominancemaybeacontinuousvariableHan d dominance may be a continuous variable rather than a dichotomous variable (left ambidextrous right vs. left or right) Edinburgh Handedness Inventory=Laterality QuotientHandDominance 9/10peoplearerighthandedHand Dominance9/10 people are right handed Greater than 60% of the 10% of lefties are malemale One theory relates to in utero exposure to testosteronetestosterone Dexterity comes from the root word dthi hihtid ddexterous which means right sidedHANDDOMINANCEHAND DOMINANCEI stheperipheralmanifestationofcerebralIs the peripheral manifestation of cerebral dominanceStronglyLINKED TO LANGUAGE.

3 Gesturing, hdiispeech, and writingHand dominance primarily defined by the writing handWHO WhWhoshould receive hand dominance re training? WHOWHOB rachialplexopathiesHemiparesisfollowings trokeBrachial plexopathies, Hemiparesisfollowing stroke, Chronic Regional Pain Syndrome, Mutilating hand Injuries: burns, crush injuries, multi tissue injury, AttiAmputationWHY WhWhyaddress hand dominance re training? of dexterity in dominant hand means many Afunctionalstateofsingle handednessA functional state of singlehandedness Limited dexterity, strength, endurance, speed (awkwardandslowmovement)(awkward and slow movement) Loss of occupational/social roles Hand shaking, embracing, self expression: jewelry (bracelets, watches, wedding rings), nail painting Work Sports/leisure ADLW hyretrain hand dominance ?

4 YCurrent functional Goal: functional IndependenceandStatus: ImpairedIndependence and participationWHYWHYB ecause hand dominance ishifhdthepervasive use of one hand overtheotherandweneedtoover the other, and we need to be purposeful, not passive, in our approach!WHYWHYO ffer your clients POWER and CONTROLHOWHOWHOW dowefacilitateahandHOW do we facilitate a hand dominancetransfer? dominance transfer?CanweactuallyHDT?Can weactually HDT?YESNO Hand dominance changesacrosstime CNS stability:Ilfhdchanges across time Lateralized practice Innate left handers Obstetrical Erbs Environmental influencesPalsy Neuroplasticity: dynamic systems yycapable of CHANGEOne handed ADLSee Backpack list under Resources Ta bp Adaptiveequipment Adaptive equipment You tubevideos:hair tying,shoe Youtube videos.

5 Hairtying, shoetying, neck tie tying, jewelry applicationTwostudiesTwo studies Efficacytrial(withnon impaired Efficacy trial (with non impaired participants) made statistically significant itiddtiblfimprovements in dependent variables of legibility, letters per minute, velocity (xand yaxes) Clinicaleffectivenesstrial(withimpairedC linical effectiveness trial (with impaired military members) show similar resultsDescriptionofInterventionDescript ion of Intervention 42daymassed practicetask oriented 42 day massed practice, task oriented approach with focus on Handwriting ti itith tfiltactivities that progress from simple to complex.))

6 Four main sections: 1. daily exercises/writingactivities, ,exercises/writing activities, 2. homework, 3. therapist s tips, and 4. web site :Participantswrote32minutesperday1st Study: Participants wrote 32 minutes per day Clinical effectiveness study: COPM: writing in college (taking notes, taking tests), paying bills, filling out forms in the hospital, journaling, writing to do lists, writing letters, signing one s nameREHABREHABITRE HABITL anguage basedactivitiesLanguagebased activities *Writing *Writing Drawing/Painting Drawing/Painting Texting/TypingTexting/TypingPower basedPowerbased Hammering Hammering Washingmirrors Washing mirrors WeighttrainingWeight trainingIntegrate ProsthesisWHEN doyoustart?

7 Consider: Co morbiditiesandconcomitantinjuriesWHEN do you start? Consider:Comorbidities and concomitant injuries Prior level of function (PLOF) and current occupationaldemands(B)and(I)ADLoccupatio nal demands (B) and (I)ADL Patient s goals Time since loss of dominant hand function (in non amputee population) PROGNOSIS of (ppp)recovery of function LateralityLateralityReferences1. Ficke JR, Pollak AN. Extremity war injuries: Development of clinical treatment principles. J Am AcadOrthop Surg. 2007;15(10):590 595. V, Dockrell JE, Barnett J. The Slow Handwritingof Undergraduate Students Constrains Overall yggPerformance in Exam Essays.

8 Educational Psychology. 2005;25(1) Smits Engelsman BCM, Niemeijer AS, van Galen GP. Fine motor deficiencies in children diagnosed as DCD based on poor grapho motor ability. Human Movement Science. 2001;20(1 2):161 S, Werner P. Assessing the Handwriting process in healthy elderly persons using a computerized system. Aging Clinical Experimental Research. 2006;18(5):433 MJ, Kreulen M, Bos KE. Fine motor assessment in chronic wrist pain: the role of adaptedmotor control. Clinical Rehabilitation. 2001;15(2):133 DR, Barnes, , Batterham, Assessment of bias in comparing measurements: A reliability example.

9 Measurement in Physical Education and Exercises Science. 1999;3(4):195 L, Henneberg M. Writing with the non dominant hand: cross handedness trainability in adultidiid lL t lit2007 12(2) 12130individuals. Laterality. 2007;12(2):121 Fitts PM, Posner Human Performance: Brooks/Cole Publishing; Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175 JC, F. Assessment of Handwriting speed and factors influencing written output of universitydiiiAliOilThJl2003 50 14857studentsin examinations.

10 AustralianOccupationalTherapyJournal. 2003;50:148 S, Harris KR. Improving the writing performance of young struggling writers: Theoretical and programmatic research from the center on accelerating student learning. The Journal of Special Education. 2005;39(1):19 Deuster PA, O Connor FG, Henry KA, Martindale VE, Talbot L, Jonas W, Friedl K. Human Performance Optimization:AnevolvingchargetotheDepart mentofDefenseMilitaryMedicine2007;172(11 ):40 Optimization: An evolvingchargeto theDepartment of Defense. Military Medicine. 2007;172(11): 1133 1137.