Biomechanical
characterisation of the hand and wrist in daily life activities
oriented to the functional assessment in rehabilitating practice.
Abstract:
The hand is a complex musculoskeletal
system providing the necessary manipulative capacity so that the
human being can carry out the activities of daily living (ADL), key
for autonomy. There are many pathologies and injuries that can
affect this manipulative capacity, from injuries or supervening
pathologies, to pathologies inherent to the degenerative process
associated with the passing of time, thus affecting a high
percentage of an increasingly aging population. According to the
WHO, functional assessment should be carried out according to the
ability to carry out ADL, but the clinical and rehabilitative
reality is very different. Quantitative evaluations are very rarely
applied, and are in most cases limited to measuring ranges of motion
or maximum force in cylindrical and pinch grasps. More rarely,
dexterity tests developed for certain neurological pathologies are
used. However, the relationship of the results of these tests with
the actual ability to perform ADL remains unknown, as is the case
with ranges of motion or grasp capabilities. Clarifying these
relationships would make possible the improvement of current
evaluations, which would further improve rehabilitation processes.
Some tests that try to analyze the ability to perform ADL have
been proposed in the literature, but in general they are highly
subjective questionnaires. There is a reduced number of functional
tests, such as the Sollerman Hand Test, although this is limited to
studying the grasps used and the execution time used in a series of
tasks, without observing more biomechanical data. The rest of
functional tests such as the Jebsen & Taylor are further limited by
considering only time. However, the biomechanical characterization
is complex, due to two main causes: (1) the lack of consensus in
establishing a set of representative ADLs, and (2) the difficulty in
obtaining and interpreting biomechanical measurements of the hand
during the realization of real tasks given the complexity of the
structure of the hand and its interaction with objects.
This project proposes to delve into the relationships of hand
biomechanics with the ability to perform ADL. In the first place,
through the hand kinematic recording while performing dexterity and
functional tests, such as the SHFT, to obtain objective parameters
that could be comparable with those of patients, either directly or
through the application of dimensional reduction techniques. Second,
it is intended to extend the kinematic characterization of the
wrist, studying the use of circumduction as an alternative to the
flexion-extension and radial-ulnar deviation ranges. Third, the
force in different types of grasps will be characterized, and its
effect on the ability to perform ADL will be analyzed based on the
relevance of the grasps. The experiments will be carried out
extensively on healthy hands to establish normality parameters, and
in addition, they will be attempted in patients, with the intention
of testing the goodness of its use in functional evaluation by
providing more information than the currently recorded measures. All
this thanks to the contact established with the Castellón Provincial
Hospital Consortium for projects in which the research team
participates.
