Palmar Arch of the Hand During Feeding Tasks

 

Kyoung-Hee Park¹, Kyoung-Young Park^*2

¹Department of Physical Therapy, Masan University, 2640, Hamma-daero, Yongdam-ri,

Naeseo-eup, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, 51217, Korea

²Department of Occupational Therapy, Jungwon University, 85 Munmu-ro, Geosan-eup,

Geosan-gun, Chungcheongbuk-do, 367700, Korea

 

ABSTRACT:

Background/Objectives: The purpose of this study is to investigate hand shape modulation during feeding task. The research of dynamic palmar arch can help understand of hand function and determine the therapeutic plan. Also, it will be useful that therapists assess therapeutic effectiveness of persons with loss of hand dexterity following pathology. Methods/Statistical analysis: Thirty two healthy college students were selected and the experiment tasks were designed to hand posture related to eating, such as spooning, forking, chopsticks, and three types grasping the mug cup. Three-dimensional palmar arch was measured with the Zebris CMS20 ultrasound-based motion analysis system. A repeated measures ANOVA was used to confirm the effect of feeding task to thenar arch, hypothenar arch and palmar arch. Post-hoc comparisons were used Bonferroni’s correction. Findings: The results of this study showed that the transeverse palmar arch required mean 34.3° of movement for using a spoon, 36.6° for using a fork, and 39.4° for using chopsticks. Significant differences were shown in necessary movements of the thenar arch, the hypothenar arch, and the transeverse palmar arch based on the tableware types. Improvements/Applications: In this study, we measured the changes shown in performing tasks using actual tableware to present more useful data for hand rehabilitation, a data that can be suggested as the significance of this study. Meanwhile, further studies are needed to provide basic data for effective hand treatment by comparing the transeverse palmar arch movements between patients with damaged hands in terms of musculoskeletal or nervous system and normal people.

 

 

 

1. INTRODUCTION

Hand function is very important in activities of daily living. A precise and controlled coordinated movement of hand and arm allows us to hold and manipulate various objects. This control of hand shape is made by three palmar arch, longitudinal arch, distal transverse arch, oblique arch¹. Longitudinal arch of hand is formed the rays that extends from the carpals of the hand to the tip of the 2^ndand the 3^rd finger.

 

 

Distal transverse arch is formed at the metacarpal heads of the four(2^nd~5^th) fingers. Oblique arch is made up of the opposable thumb with the 2^nd~5^th fingers. These arches are maintained by the intrinsic muscles of the hand. Several studies have described three palmar arch as hand shape modulation and most previous studies have been investigated how the grasp pattern changes during reaching or the angular movements of finger joints during grasping and described by general six grasp patterns (spherical grasp, cylindrical grasp etc.). But, few studies have investigated palmar arch during real activities. Therefore, we need to know and compare maximal grip aperture using real tools in activities of daily living for effective hand treatment. The research of dynamic palmar arch can help understand of hand function and determine the therapeutic plan. Also, it will be useful that therapists assess therapeutic effectiveness of persons with loss of hand dexterity following pathology.

2. MATERIALS AND METHODS:

2.1. Subjects:

Thirty two healthy college students were participated this study based upon a power calculation (p>0.05, 80% power) for clinical significance with a detectable difference of 0.5˚. The subjects included 14 males and 18 females with a mean age of 23.32 ages (SD 3.28), mean height of 168.23 cm (SD 6.89) and mean weight of 58.37 kg (SD 5.58). These subjects were right-handed and no history of injury to the upper extremities. All participants were informed of the aim of the study and signed an informed consent form approved by the Inje University Ethics Committee for Human Investigations before their participation.

 

2.2 Procedures:

The experiment tasks were designed to hand posture related to eating, such as spooning, forking, chopsticks, and three types grasping the mug cup. Feeding tools were spoon (plastic made, 17cm length) and fork (plastic made, 18cm) and mug cup (china, diameter 8.5 cm, length 9.5 cm, handle length 7cm). The subjects grasped the spoon, fork, and chopstick in his familiar way and the mug cup in three ways; finger grip on the cup handle, thumb adduct and the other finger place the cup handle, thumb abduct and the palm of the hand to grasp the cup [Figure 1].

 

Subjects were sitting in a comfortable chair with a back rest and rested the hand on adjustable table that was positioned in the sagittal plane in front of the right shoulder. The feeding tools were placed on the table, 5 cm medial side the initial hand position. The subjects grasped the feeding tool and lifted it to the mouth during 3 seconds. Movement was initiated to verbal cue ‘starts’ and the speed were controlled using a metronome. These procedures were repeated 5 times and replicate each tool.

 

Figure 1. Grasp task using feeding tools: spooning (1), forking (2), chopstick (3), mug cup (4~6); finger grip on the cup handle (4), thumb adduct and the other finger place the cup handle (5), thumb abduct and the palm of the hand to grasp the cup (6).

 

2.3 Instrumentation and data recording:

Three-dimensional palmar arch was measured with the Zebris CMS20 ultrasound-based motion analysis system (Zebris Medizinetechnik GmbH. Isny, Germany). Cylindrical active markers were placed on the capitate bone and dorsum of 1^st, 2^nd, 3^rd and 5^th metacarpophalangeal joint [Figure 2]. Data were recorded using Windata version 2.20 at 30 Hz during each task.

 

The palmar arch was defined by thenar and hypothenar component articulating with a middle plane formed by capitates-index MCP-middle MCP ². Thenar component was defined by capitates-1^st MCP-2^nd MCP and hypothenar component was formed by capitates-3^rd MCP, 4^th MCP. The biomechanical formulation of palmar concave arch was summed the the thenar and hypothenar arch and mean arch was calculated during middle 1 second.

 

 

Figure 2. A dorsal view show the markers used for the arch definition and the biomedical formular of the palmar arch.

2.4 Statistical analysis:

The Kolmogrov-Smirnov test was used to assess the homogeneity of variance of the palmar arch of each feeding tasks. A repeated measures ANOVA was performed to measure the changes of thenar arch, hypothenar arch and palmar arch during feeding task. Post-hoc comparisons were used Bonferroni’s correction. The Statistical Package for the Social Sciences version 18.0 (SPSS Inc, Chicago, IL, USA) was used to conduct all statistical analysis. A p-value is less than 0.05 and it is used to indicate statistical significance.

 

 

 

3. RESULTS AND DISCUSSION:

3.1 Change of transverse palmar arch using each feeding utensils:

When subjects perform feeding task using spoon, average degree of transverse palmar arch needed 34.3°.  The results of this study showed that the transeverse palmar arch required mean 34.3° of movement for using a spoon, 36.6° for using a fork, and 39.4° for using chopsticks. The task of grasping a mug was divided into three types of grasp patterns. The movement of the transeverse palmar arch required 30.8° of movement when all the fingers and the thumb were used to grasp the mug, 16.8° when the fingers wrapped up the mug while the thumb shrank, and 34.5° when the thumb spread to the maximum to wrapped the mug [Table 1].

 

Table 1. Changes of Each arch during feeding tasks (unit: degree)

Variables		Mean±SD
Spoon	Thenar arch a	22.9 ± 6.9
	Hypothenar archb	11.4 ± 6.8
	Transverse palmar archc	34.3
Fork	Thenar arch a	25.4 ± 7.6
	Hypothenar archb	11.2 ± 6.6
	Transverse palmar archc	36.6
Chopstick	Thenar arch a	25.1 ± 8.4
	Hypothenar archb	14.3 ± 6.8
	Transverse palmar archc	39.4
Mug cup1	Thenar arch a	20.5 ± 8.9
	Hypothenar archb	10.3 ± 6.7
	Transverse palmar archc	30.8
Mug cup2	Thenar arch a	9.4 ± 7.7
	Hypothenar archb	7.3 ± 8.2
	Transverse palmar archc	16.8
Mug cup3	Thenar arch a	21.9 ± 6.1
	Hypothenar archb	12.7 ± 5.8
	Transverse palmar archc	34.5

Mug cup1: finger grip on the cup handle                                                              Mug cup 2:thumb adduct and the other finger place the cup handle

Mug cup3 : thumb abduct and the palm of the hand to grasp the cup             Thenar arch ^a: composed by capitates-thumb MCP-index MCP

Hypothenar arch^b : composed by capitates-middle MCP-little MCP                                Transverse palmar arch^c: summed the the thenar^aand hypothenar arch^b

 

3.2  Movements of transeverse palmar arch based on tableware types

According to the results of this study, significant differences were shown in necessary movements of the thenar arch, the hypothenar arch, and the transeverse palmar arch based on the tableware types [Table 2]. In movements of the transeverse palmar arch in grasping tableware, it showed significantly different movements between in using a fork, a spoon, or chopsticks and in wrapping up a mug while the thumb shrank. Significant differences were also shown between in using chopsticks and in grasping a mug handle with all the fingers and the thumb. Holding a mug handle with the thumb shrunk displayed significant difference from all the other grasping patterns. Significant differences in movements in the thenar arch, in particular, were found between holding a mug with the thumb shrunk and using a fork, a spoon, or chopsticks. For the hypothenar arch, significant differences in movement were observed from holding a mug with the thumb shrunk, using chopsticks, and wrapping up a mug with the thumb spread to the maximum [Table 3].

 

Table 2. Comparison of changes of each arch during feeding utensils^a

	R2	F	p
Thenar arch	0.51	30	<0.0001***
Hypothenar arch	0.14	4.7	0.0002***
Transverse palmar arch	0.44	22	<0.0001***

 

Table3. Comparisons of degree of transverse palmar arch, thenar and hypothenar arch using each feeding utensilsb

	Transverse palmar arch		Thenar arch		Hypothenar arch
	95% confidence intervals	t	95% confidence intervals	t	95% confidence intervals	t
forkvs spoon	-4.5 ∼9.0	1.0	-1.7 ∼6.8	1.9	-4.9 ∼4.3	0.20
forkvs chopstick	-9.6 ∼3.9	1.3	-3.9 ∼4.6	0.25	-7.8 ∼1.4	2.1
forkvs mug cup1	-0.96 ∼13	2.6	0.63 ∼9.2	3.5*	-3.7 ∼5.5	0.59
forkvs mug cup2	13 ∼27	9.1***	12 ∼20	12***	-0.76 ∼8.4	2.6
forkvs mug cup3	-4.7 ∼8.8	0.94	-0.69 ∼7.9	2.6	-6.1 ∼3.1	1.0
spoonvs chopstick	-12 ∼1.6	2.3	-6.5 ∼2.0	1.6	-7.5 ∼1.7	1.9
spoonvs mug cup1	-3.2 ∼10	1.6	-1.9 ∼6.6	1.7	-3.4 ∼5.8	0.79
spoonvs mug cup2	11 ∼24	8.0***	9.2 ∼18	9.7***	-0.47 ∼8.7	2.8
spoonvs mug cup3	-7.0 ∼6.5	0.096	-3.2 ∼5.3	0.74	-5.8 ∼3.4	0.83
chopstickvs mug cup1	1.9 ∼15	3.9**	0.29 ∼8.8	3.3*	-0.53 ∼8.6	2.7
Chopstick vs mug cup2	16 ∼29	10***	11 ∼20	11***	2.4 ∼12	4.7***
chopstickvs mug cup3	-1.9 ∼12	2.2	-1.0 ∼7.5	2.3	-2.9 ∼6.2	1.1
mug cup1 vs mug cup2	7.3 ∼21	6.4***	6.8 ∼15	8.0***	-1.6 ∼7.5	2.0
mug cup1 vs mug cup3	-10 ∼3.0	1.7	-5.6 ∼3.0	0.95	-7.0 ∼2.2	1.6
mug cup2 vs mug cup3	-25 ∼-11	8.1***	-17 ∼-8.1	9.0***	-9.9 ∼-0.76	3.6**

Mug cup1: finger grip on the cup handle                                                                    Mug cup2: thumb adduct and the other finger place the cup handle

Mug cup3 : thumb abduct and the palm of the hand to grasp the cup                ^b Bonferroni correction test            *p<0.05,          ***p<0.001

 

 

In this study we investigated movements of the transeverse palmar arch that required during performing the whole tasks, rather than identifying controlling of hand shapes of each phase. Controlling hand shapes is displayed for three phases, including “transport shaping” in which the arm stretches out with the maximum speed to hold an object, “preshaping” in which the speed of reaching is reduced when the hand approaches the object, and "contact shaping” in which the hand grasps the object³. According to some existing researches, 60 to 70% of all the hand movements are shaped in the first phase of the transport shaping, the speed of the arm is reduced immediately before touching the object, and the rest movements are controlled during holding an object^3,4,5,6. Many existing researches focused on changes in the transeverse palmar arch movements by measuring standardized spherical grip and cylindrical grip^1,7,8,9,10.  Further studies may be needed to research not only movements of the arms and the hands but also control of hand shapes in rehabilitation of hand movements, in order to contribute to identifying natural patterns of movements with better coordination.

 

4.CONCLUSION:

In this study, we measured the changes shown in performing tasks using actual tableware to present more useful data for hand rehabilitation, a data that can be suggested as the significance of this study. Meanwhile, further studies are needed to provide basic data for effective hand treatment by comparing the transeverse palmar arch movements between patients with damaged hands in terms of musculoskeletal or nervous system and normal people.

 

5. REFERENCES:

1.       Sangole AP, Levin MF, Palmar arch dynamics during reach-to-grasp tasks. Experimental Brain Research, 2008, 190, pp. 443-452.

2.       Levangie PK, Norkin CC, The wrist and hand complex. In: Joint structure and function, 3rd ed., F. A. Davis Company, Philadelphia, 2001. pp. 251-289.

3.       Sangole AP, Levin MF, Arches of the hand in reach to grasp. Journal of. Biomechanics, 2008, 41, pp.829-837.

4.       Paulignan Y, MacKenzie C, Marteniuk R, Jeannerod M, The coupling of arm and finger movements during prehension. Experimetal Brain Research, 1990, 174(2), pp.431-435.

5.       Mason CR, Gomez JE, Ebner TJ, Hand synergies during reach-to-grasp. Journal of Neurophysiology, 2001, 86(6), pp.2896-2910.

6.       Ansuini C, Santello M, Massaccesi S, Castiello U, Effects of end-goal on hand shaping. Journal of Neurophysiology, 2006, 95, pp.2456-2465.

7.       Desmurget M, Prablanc C, Arzi M, Rossetti Y, Paulignan Y, Urquizar C, Integrated control of hand transport and orientation during prehension movements. Experimental Brain Research, 1996, 110, pp.265-278.

8.       Stelmach GE, Castiello U, Jeannerod M, Orienting the finger opposition space during prehension movements. Journal of Motor Behavior, 1994, 26(2), pp.178-186.

9.       Kamper DG, Cruz EG, Siegel MP, Stereotypical fingertip trajectories during grasp. Journal of Neurophysiology, 2003, 90(6), pp.3702-3710

10.     Sangole AP,  Levin MF, A new perspective in the understanding of hand dysfunction following neurological injury. Topics in Stroke Rehabilitation, 2007, 14(3), pp.80-94.

 

 

 

 

 

 

Received on 02.07.2018         Modified on 19.08.2018

Accepted on 20.10.2018      © RJPT All right reserved