Tag: Physiotherapy

Dhanalakshmi.M.R1, Prashanth V Mangalvedhe2, Jibi Paul3 Authors: 1B.P.T. Graduate,  JSS College of Physiotherapy, JSS Hospital Campus, Mysuru, Karnataka,India.    3Professor,Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author: 2Lecturer, JSS College of Physiotherapy, JSS Hospital Campus, Mysuru, Karnataka,India. Mail id:  dhanuphysio7@gmail.com

ABSTRACT

Introduction: Moberg pickup test (MPUT) is a standardized test for hand dexterity developed by Erik Moberg, in 1958. This test also assesses cognition, stereognosis, and comprehension. Aim of the study was to find the normative values for the Moberg pickup test and to find the  impact of gender and handedness on hand dexterity among carpel tunnel syndrome patients. Method: This was aCross-sectional study, conducted at JSS College of physiotherapy, Mysuru, Karnataka for a duration of 2 months. This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Test objects were placed on the table on the same side of right and left hands being tested with eyes open and closed, whereas the container was placed on the opposite side of the hand being tested. Three trials were done and the best out of the three was taken for analysis to obtain the normative values for Mobergpickup test. Result: The results show that the hand dexterity of the subjects was significantly good. Eyes open and close on dominant hand and Non dominant hand with mean values of 7.735, 12.806 and 9.206, 14.327 respectively. Conclusion: Females performed the test faster than males, and task performance with the dominant hand was faster than the non-dominant hand.

Keywords: Hand dexterity, Moberg Pick-Up Test, Carpel tunnel syndrome, Normative values

Received on 26th October 2019, Revised on 22th November 2019,Accepted on 27th November 2019

DOI: 10.36678/ijmaes.2019.v05i04.002

INTRODUCTION

Dexterity is usually defined as a function of control, the coordination of muscle movements usually in synchronization with the eyes, and it can also be defined as the quality of motor skills of hands and fingers.  Dexterity in each person is qualitatively different and unique^1,2.

Moberg pickup test (MPUT) is a standardized test for hand dexterity developed by Erik Moberg, in 1958. This test also assesses cognition, stereognosis, and comprehension. Moberg defines functional sensation as tactile gnosis, specifically sensiti­vity present at the fingertips, which allows a significant awareness of the external object^3,4.

Need For the Study

Normative value for Moberg Pick-Up Test is important to check hand dexterity. Present available are from western population. Characteristics of Indian population may differ from the western population.

Hence, the need of this study was to establish the normative values of Moberg pickup test in young adults of age 17- 25years in Indian population.

Objective:  Primary objective was to find the normative values for the Moberg pickup test. Secondary objective was to find the difference on normative values of Moberg pickup test between male and female on their hand dexterity.

METHODOLOGY

This was a Cross-sectional study conducted at   JSS College of physiotherapy, Mysuru, Karnataka.This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Duration of the study was 2 months.

Inclusion Criteria:  Both genders willing to participate were selected with age group 17 to 25 yrs.

Exclusion criteria: Participants with neurological illness, Any congenital deformity of hand, Participants with recent hand injuries and fractures, Participants with visual impairment, Behavioural abnormality that interferes with the test were excluded from the study.

Materials: Small container, stop watch, screw, safety pin, cap nut, washer, bolt, key, 2 coins, long hexagon nut, square nut, small hexagon nut, nut and bolts.

Procedure: Permission from JSS College of Physiotherapy was obtained.  Informed consent from the participants was taken before including the participants in the study. Based on inclusion and exclusion criteria the participants were recruited for the study. Hand dominance is ascertained by asking each subject which hand they used to perform skilful activities like writing, eating etc.  

Hand dexterity was measured bilaterally. Twelve objects were spread randomly on a table, next to the container. Objects includes – Screw, Safety pin, Cap nut, washer, bolt, key, 2coins, long hexagon nut, small hexagon nut, nut and bolt, square nut. Test objects were placed on a table and a container was kept on the opposite side to the hand being tested. Participants were asked to drop the items as fast as possible in a box placed nearby. Stopwatch was used to record the time for the Performance.

This test was performed in 2 phases: both dominant and non dominant hand has been tested with open and closed Eyes. The test was repeated three times to obtain an average. First tested the writing ability was tested with the dominant hand followed by non dominant hand was tested. In the second phase: first, the participants were asked to hold the container with the opposite hand and they were made to close their eyes.  Second, when only 2 or 3 objects where remaining on the table the participants were informed the number of objects remaining to perform the task.

RESULT

The outcome value obtained from the data collection was tabulated for the statistical analysis of the data; mean, median and standard deviation of the collected data done.

DISCUSSION

The normative values of Moberg pick up test in the Indian population are not available. Hence, this study was done to find the normative values of Moberg pick up test in young adults of JSS College of Physiotherapy, Mysuru.

Previous studies have been conducted on subjects with carpal tunnel syndrome, comparison between young adults and middle aged persons, and older population, and a survey of comparison between button test and Moberg pick up test ^5,6.

This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Three trials were done and the best out of the three was taken for analysis to obtain the normative values for Moberg pickup test. The present study confirmed that the performance of this test shows major difference between the male and the female population.

Many studies have done to find the score grading for pinch strength, grip strength, fine motor skill and depression among population with carpal tunnel syndrome ^7,8,9.

There is clear evidence from earlier studies that females performed faster than males and this study has also showed similar results. It was observed that the dominant hand was faster in executing this test than the non-dominant hand with the eyes open.

CONCLUSION

Moberg pick-up test has been a reliable tool to test hand function. The time duration and the dominance of hand show the comparison of reaction in individuals. The results show that the hand dexterity of the subjects was significantly good. Task performed with dominant hand was faster than the non-dominant hand.  Females performed the test faster than males.

Future Recommendations: The future studies should include individuals with equal number of males and females for better efficacy of results. Standardized setting can be used to perform the Moberg test.

REFERNCES

1. Amirjani N, Ashworth N, Olson J, Morhart M, and Chan K. (2011). “Discriminative validity and test–retest reliability of the Dellon-modified Moberg pick-up test in carpal tunnel syndrome patients”, Journal of the Peripheral Nervous System. 16;51–58.
2. Amirjani N, Ashworth N, Gordon T, Edwards C and Chan K (2007). “Normative Values and the effects of age, gender, and handedness on the Moberg Pick- Up Test ”, Muscle Nerve35;788-792 .
3. Marcolino AM, Barbosa RI, Souza DNA, Rebelo R B, Delgado PM, Mazzer N, et al., (2012). “Correlation between Moberg Pick-Up test and sensation threshold test after median nerve reconstruction”,ActaFisiatrvol 19(4);216-21.
4. Stamm T, AlexanderP, Klaus M, and Josef S. (2003). “Moberg Picking-Up Test in Patients With Inflammatory Joint Diseases: A Survey of Suitability in Comparison With Button Test andMeasures of Disease Activity”, Arthritis & Rheumatism (Arthritis Care & Research), Vol. 49(5); 626-632.
5. Amadio P C, Silverstein M D, Ilstrup D M, Schleck C D, Jensen L M.  (1996). Outcome assessment for carpal tunnel surgery: the relative responsiveness of generic, arthritis-specific, disease-specific, and physical examination measures. J Hand Surg Am., 21: 338– 346. 
6. Atroshi I, Lyrén PE, Gummesson C. (2009). The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res.  18: 347-358.
7. Atalay NS, Sarsan A, Akkaya N, Yildiz N, Topuz O. (1984). The impact of disease severity in carpal tunnel syndrome on grip strength, pinch strength, fine motor skill and depression,120(4): 517-9

• Baker NA, Moehling KK, Desai AR, Gustafson N P.(2013).Effect of carpal tunnel syndrome on grip and pinch strength compared with sex- and age-matched normative data. Arthritis Care Res (Hoboken). ; 65: 2041-2045.
• Bland JD. ( 2000).  A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve., 23: 1280-1283.

Citation:

Dhanalakshmi.M.R, Prashanth V Mangalvedhe, Jibi Paul (2019). Normative values of moberg pickup test in young adults, International Journal of Medical and Exercise Science; 5 (4): 634-638.

P. Sathya1, Hannah D’souza2 Author: 2B.P.T. Intern, D.Y. Patil deemed to be University, School of Physiotherapy, Nerul, Navi Mumbai, India  Corresponding Author: 1Associate Professor, D.Y. Patil deemed to be University, School of Physiotherapy,Navi Mumbai, India. Mail id: drsathyagp@gmail.com

ABSTRACT

Introduction: Musicians just like any other occupation are prone to injuries. Every type of work requires certain bodily movements and positions to be used in a repetitive manner. These injuries/disorders then in turn affect the ability of the musician to play his instrument most efficiently. The purpose of this study was to find out prevalence of Upper Limb Problems in Instrumental Subjects using the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Methodology: A cross sectional survey was conducted on 100 Subjects from Mumbai, aged 15 to 30 years who were right hand dominant and had a minimum of 3 years of experience playing a musical instrument. Demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further analyzed. Result: The subjects playing Keyboards were mostly affected on dominant side by DASH score with mean value 11.086. Symptoms on the dominant and non dominant sides were 40.23% and 45.95% respectively with functional disability on the dominant side 31.42%.Percussionist were most affected in the psychological aspect with 33.33%, where string players were more affected in Music Module Domain with mean value 14.305. Conclusion: The study concluded that the subjects playing Keyboards were mostly affected in most domains of DASH Scale. Percussionist were the most affected in Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain in DASH scale. Methodology: A cross sectional survey was conducted on 100 Subjects from Mumbai, aged 15 to 30 years who were right hand dominant and had a minimum of 3 years of experience playing a musical instrument. Demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further analyzed. Result: The subjects playing Keyboards were mostly affected on dominant side by DASH score with mean value 11.086. Symptoms on the dominant and non dominant sides were 40.23% and 45.95% respectively with functional disability on the dominant side 31.42%.Percussionist were most affected in the psychological aspect with 33.33%, where string players were more affected in Music Module Domain with mean value 14.305. Conclusion: The study concluded that the subjects playing Keyboards were mostly affected in most domains of DASH Scale. Percussionist were the most affected in Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain in DASH scale.

Keywords: Musicians, Upper Limb Problems, Disability of Arm, Shoulder and Hand (DASH) scale

Received on 23rd October 2019, Revised on 20th November 2019, Accepted on 26th November 2019

DOI: 10.36678/ijmaes.2019.v05i04.001

INTRODUCTION

Everybody loves music. Listening to music induces pleasure but making music is a distinct experience in itself. The number of musicians we have now is much more than we ever had before. Being a Musician could be a passion, a hobby or a career. However, musicians just like any other occupation are prone to injuries. Every type of work requires certain bodily movements and positions to be used repetitively. Musculoskeletal occupational disorders result from an interaction between the individual worker, his tools and his environment. In the case of the instrumental musician, his tools are the instruments¹.

Musculoskeletal problems in musician occurs due to the repetition of certain movements, incorrect posture, prolonged practice hours, lifting of heavy instruments, holding the instrument in place for a long time, psychological pressure, etc. Because of these symptoms the musician may not be able to play their instrument effectively. The musician may also have difficulty performing ADLs due to the symptoms.  Several researches have been done in the past on different body sites where in a musician could be affected. Each category of instrument uses the upper limb the most, leading to an increase risk of injury. Examples of these could be tendinitis, weakness, stiffness, etc.

According to Zaza et al., the definition of Playing-Related Musculoskeletal Disorders (PMRDS) is Pain and other symptoms that are chronic, beyond your control, and that interfere with the ability to play your instrument at the usual level².According to Lederman et al., With carefully designed treatment, the majority of instrumental musicians can return to full and pain free playing.³ Correct diagnosis of the problem and physiotherapy techniques to prevent or reduce these symptoms can be given in order for the musician to play his/her instrument in the most optimum way without any hindrance. Hence, the purpose of this study was to find out prevalence of upper-limb problems in musicians.

METHODOLOGY

The Target Population was Instrumental Musicians.A cross sectional survey was conducted on musicians from Mumbai from all categories namely Strings, Keyboards, Brass, Percussions and Woodwind.  100 subjects aged 15 to 30 years who were right hand dominant and had a minimum 3 years experience of playing their instruments were included in the study. The nature and purpose of study was explained and prior consent was obtained from the participants. The demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire  for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further taken for statistical analysis ⁴.

RESULT

According to the Data Obtained, most subjects in the sample were Males.

The Instruments played by the subjects in this research were Trumpet (Brass Category), Keyboard, Piano and Harmonium (Keyboards category), Cajon, Djembe, Drums and Tabla (Percussion Category), Bass Guitar, Guitar, Sitar and Violin (Strings category), Flute and Saxophone (Woodwind category)

There were 41 String players, followed by 21 Keyboard players, 21 Percussionists 15 Woodwind players and 2 Brass players. The subjects had between 3-16 years of training. Sitting position was preferred as compared to Standing. The formula provided in the Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to calculate the scores.

Inference (Table 1) The non-dominant side total score is more than the dominant side. The Keyboards category scored highest followed by percussion, strings, brass, woodwind on the dominant side. Brass was the highest followed by Keyboards, percussions, strings, woodwind on the non-dominant side.

Inference (Table 2.1) Thekeyboard category had the highest percentage followed by percussion, strings, brass, woodwind on the dominant as well as the non-dominant side

Inference (Table 2.2) Thekeyboards category had the highest percentage followed by percussion, strings, brass, woodwind in pain last week, pain on activity, and stiffness. For Tingling- The keyboards had the highest percentage followed by percussions, brass, strings and woodwind. For Weakness- The keyboards had the highest percentage followed by brass, strings, percussions and woodwind.

Inference (Table 3)- Thekeyboard category has the highest percentage followed by percussion, strings, brass, woodwind on the dominant side. Brass was the highest followed by Keyboards, percussions, strings, woodwind on the non-dominant side.

Inference (Table 4) The percussion category has the highest percentage followed by keyboards, strings, brass and woodwind.

Inference (Table 5) The strings category has the highest score followed by percussions, keyboards, strings, brass and woodwind.

DISCUSSION

In this study 100 musician playing different musical instrument were taken. The subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire. The study reveals that the DASH questionnaire scores varied for each instrument category from Dominant to Non-Dominant extremity. Overall the Non Dominant Upper Limb had higher DASH scores compared to the Dominant Upper Limb (Table 1).

The DASH question numbers 24-28 were used to assess the Severity of Symptoms. The questions were based on the symptoms of pain, tingling, weakness and stiffness. On the Dominant as well as the Non-Dominant sides, the subjects playing Keyboards were the most affected. This was followed by the subjects playing Percussions and Strings respectively. The Brass and Woodwind subjects were the least affected on both the sides. Higher the scores, more the intensity of the symptoms experienced. With the Data obtained, it was noticed that each category showed varying symptoms. The analysis was done by comparing the scores of each symptom individually.

The Brass category showed higher symptoms of Pain, Tingling and Weakness. The Keyboardists complained of Pain and Stiffness. The Percussionists had Pain and Tingling while the Woodwind players had the highest scored symptom of Weakness among other symptoms. (Table 2.1 and 2.2) According to a study, musicians due to the competitive work environment felt forced to play despite their symptoms, motivated by a concern for reprisal or dismissal. Despite their symptoms, the professional musicians, therefore, will be inclined to perform at rehearsals and concerts, and play less when practicing alone, where reducing their effort can aid their recovery without compromising their colleagues.⁵ The stress-inducing movements in playing can be Isotonic or Isometric. Isotonic movements are those in which fast movements are done to obtain sound in the instrument. These create stress on the surrounding tendons and over time can lead to pain due to chronic tendinopathy. e.g. striking the keyboard keys, bowing the violin. Isometric movements are those in which there is prolonged  periods of static unstable postures to support the instrument or hold it in place. These result in muscle imbalance, which may further lead to chronic myofascial pain⁶.

The Symptoms in the subjects may have caused difficulty in performing daily functions. This was assessed by DASH question numbers 1-23. This Domain differed based on Dominance. Thesubjects playing Keyboards were the most affected followed by percussion, strings, brass and woodwind on the dominant side.  The subjects playing Brass instruments were most affected followed by Keyboards, percussions, strings and woodwind on the non-dominant side. (Table 3) This suggests that because of the symptoms of pain, tingling, stiffness, weakness, etc. the musician has difficulty performing day to day functions at ease.

According to Rietveld AB et al., Musicians experience upper limb injuries such as impingement syndromes eg. painful arc, supinator syndrome, intersection syndrome. frozen shoulder, tennis elbow, golfers elbow, neuropathies including median and ulnar nerve, trigger finger, hypermobility and focal dystonia.⁷ According to another study done on Orchestra musicians, The musicians reported changed or impaired way of playing, difficulties in daily activities at home, in leisure time activities and in sleep as common consequences of musculoskeletal symptoms⁵

Psychological aspect was assessed by DASH question numbers 29,30. Q. 29 was based on Sleeping difficulty due to symptoms and Q. 30 was based on feeling less confident or useful because of the symptoms. The subjects playing Percussions seemed to be most affected. It was followed by the Keyboards, though there is only a slight difference between scores of Percussion and Keyboards subjects. This was then followed by the subjects playing Strings, Brass and Woodwinds. (Table 4).

Injuries occur as a result of physical stress which in turn induces psychological stress. Fears of a musician are thoughts of missing notes, not playing correctly, leaving a bad impression, losing their job and ending up in poverty. These thoughts produce physical reactions such as sweating, constricted breathing, tense muscles, which lead to the likeliness of a performance being unsuccessful⁸.

According to a study using the Bergen Insomnia Scale (BIS) musicians had higher prevalence of insomnia symptoms compared to the general population⁹. This shows that Psychological factors also play a great role in musicians. Often musicians fail to find help for curing their injuries and this can lead to the end of one’s career, which leads to a downward spiral of anxiety and depression⁸. Challenges faced were related to bad and abusive teachers, entry into a conservatoire, music industry demands, unsupportive environments, comparison and competition socially, injury, psychological aspects, balancing work and personal life⁷.

To assess the Music Module, DASH Music/Sports module was used. The questions were based on the impact of your arm, shoulder or hand problem on playing the musical instrument. The subjects playing Strings were the most affected followed by Percussions, Keyboards, Brass and Woodwind. However, the subjects playing Keyboards and Brass had a minute difference in scores.

Subjects playing Woodwind instruments was the least affected in this domain as well. This shows that a because of the symptoms, the musician is not able to play his instrument in the usual way or in a way in which the musician would like to. This also results in spending lesser time in playing the instrument. Musculoskeletal symptoms resulted in an impaired way of playing the instrument⁵. According to a study; ability to play to their optimum level was affected due to the symptoms associated¹⁰. 

The problems experienced by musicians depend on the physical demands of that particular instrument. Keyboardists play a répertoire of movements that require great amplitude of abduction of the fingers. Techniques of octaves and chords and small hand size were associated with symptoms¹¹.  Intersection syndrome is seen in Drummers⁷. Brass players may have the highest risk of developing carpal tunnel syndrome¹². Prolonged static posture is required such as static abduction of the upper-arm in violin and flute.

In these two instruments the left shoulder is adducted resulting in a ‘wringing out’- phenomenon of the rotator-cuff: the poor blood supply of the ‘critical zone’ in the supraspinatus tendon is further impaired by the squeezing effect of this tendon being stretched over the head of the adducted humerus⁷.   The posture of Guitarists and Bassists provoke an extreme flexion of the fretting wrist and fingers that possibly may result in the fretting hand injuries that is the Non-Dominant hand¹³.

Ethical Clearance:  Clearance was obtained from the Institutional ethical committee ofD.Y. Patil Deemed to be University, School of Physiotherapy, Navi Mumbai.

Conflict of Interest: No conflict of interest to conduct this study.

Source of Fund: It was aSelf financed study.

CONCLUSION

This study concludes that the subjects playing Keyboards were the most affected in most domains of DASH scale except Psychological and Music Module Domains, both in the Dominant and Non Dominant side.

This study also concludes that the subjects playing Percussions were the most affected in the Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain of DASH scale.

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Citation:

P. Sathya, Hannah D’souza (2019). A study to find prevalence of upper limb problems in Musicians, International Journal of Medical and Exercise Science; 5 (4): 625-633.