title: Relationships among manual body functions, manual capacity, and bimanual performance using the prosthetic upper extremity functional index in children with congenital hand differences.
abstract: BACKGROUND
  Most surgical techniques intervene at the level of body functions of the upper limb, aiming to improve manual capacity and activity performance. However, the nature of the relationships among these levels of functioning and evidence for hand function variables predicting performance have scarcely been investigated.
  
  
  OBJECTIVE
  The primary aim of this study was to assess aspects of hand function and manual capacity that influence bimanual performance in children with congenital hand differences (CHDs), ranging from surgically corrected polydactyly or syndactyly to radial dysplasia. A secondary aim was to assess whether the number of items on the Prosthetic Upper Extremity Functional Index (PUFI) can be reduced without losing information on bimanual performance in this population.
  
  
  METHODS
  A cross-sectional design was used.
  
  
  METHODS
  One hundred six 10- to 14-year-old children with CHD participated in the study, which was conducted in a university hospital's outpatient clinic. Bimanual performance was evaluated with child self-reports on an adapted version of the PUFI, calculating ease of performance and actual use of the affected hand. Additionally, hand function and manual capacity were assessed.
  
  
  RESULTS
  The median score on ease of performance was high, and, on average, the children used their affected hand actively in 97% of all activities. Manual capacity of the nondominant hand and lateral pinch strength of the dominant hand predicted attainment of maximum PUFI scores. Nonmaximum PUFI scores were predicted by opposition strength of the nondominant hand and lateral pinch strength of the dominant hand. In addition, in this patient group, only 6 items of the PUFI explained all variance in PUFI scores.
  
  
  CONCLUSIONS
  The generalizability of the results is limited by the carefully selected age range. Second, the cross-sectional design of the study limits statements on causality on the relationships found.
  
  
  CONCLUSIONS
  Children with a CHD generally have good bimanual performance and, on average, perform activities with active use of the affected hand. Therapy directed toward increasing manual capacity and finger muscle strength might assist in improving bimanual performance in children with CHD. Furthermore, the number of items on the PUFI could be reduced from 38 to 6 items in children with CHD.
authors.affiliation: M.S. Ardon, PT, MSc, Department of Rehabilitation Medicine, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. m.ardon@erasmusmc.nl.
authors.forename: Monique S
authors.initials: MS
authors.lastname: Ardon
authors.affiliation: W.G.M. Janssen, MD, PhD, Department of Rehabilitation Medicine, Erasmus University Medical Center.
authors.forename: Wim G M
authors.initials: WG
authors.lastname: Janssen
authors.affiliation: S.E.R. Hovius, MD, PhD, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center.
authors.forename: Steven E R
authors.initials: SE
authors.lastname: Hovius
authors.affiliation: H.J. Stam, MD, PhD, Department of Rehabilitation Medicine, Erasmus University Medical Center.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.affiliation: M. Murawska, MSc, Department of Biostatistics, Erasmus University Medical Center.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Murawska
authors.affiliation: M.E. Roebroeck, PhD, Department of Rehabilitation Medicine, Erasmus University Medical Center.
authors.forename: Marij E
authors.initials: ME
authors.lastname: Roebroeck
authors.affiliation: R.W. Selles, PhD, Department of Rehabilitation Medicine and Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Centre.
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
mesh_terms: D000293:Adolescent; D001186:Artificial Limbs; D002648:Child; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006228:Hand Deformities, Congenital / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D019736:Prostheses and Implants; D013647:Task Performance and Analysis