Assembly Tool Usage and Upper Extremity Disorders

1. Assembly Tool Usage and Upper Extremity Disorders Group 12 Katie Bragnalo Maaz Malik Jimmy Warner

2. Hand Tool Dexterity • There are two different names for the test that is performed using this tool: • Minnesota Hand Tool Dexterity Test • Bennett Hand Tool Dexterity Test

3. Minnesota (Bennett) Hand Tool Dexterity Test • Description: Twelve nut/bolt/washer assemblies of three different sizes in a wooden frame are loosened with tools, disassembled, transferred to the other side of the frame, and tighten with tools.

4. Minnesota (Bennett) Hand Tool Dexterity Test • Objective: The test can be used as a general assessment of an individuals skill in using ordinary mechanics tools. Results of the test have been used to determine vocational interest and as an indicator of success where jobs/tasks require the use of these and similar tools.

5. Minnesota (Bennett) Hand Tool Dexterity Test • Before administering test: • Check apparatus to ensure all bolts are on the same side of apparatus with all heads on the inside. • Ensure nuts cannot be removed with fingers, yet are not too tight to be easily removed with wrenches • Ensure that once loosened, nuts can be removed easily with fingers • Close jaws of adjustable wrench completely • Place tools between uprights • Set the frame with the bolts at the left of the examinee

6. Minnesota (Bennett) Hand Tool Dexterity Test • Procedure: • Normal setup – standing with the frame securely clamped to work surface 34” in height. • Instruct according to Bennett Hand Tool Dexterity Test Administration Manual • NOTE – this is not a test of ability to follow directions therefore additional instruction and demonstrations may be given to ensure the examinee understands the task • Score using the Administration Manual

7. Minnesota (Bennett) Hand Tool Dexterity Test • A series of instructions are then read to the examinee • These instructions include: • The best way to go about test • To loosen all nuts in the row with the tools the remove fully with fingers • To remove all nuts and bolts before transferring to second upright • Once removing the bottom row do not place bolts on table, place them in holes on opposite upright • Tighten all nuts with fingers then with tools • Ensure heads of bolts are on the inside of the upright • To work as rapidly as possible • The examiner starts timing as soon as the examinee picks up the first wrench

8. Minnesota Hand Tool Dexterity Test • Procedure (con’t): • Check bolts to make sure they cannot be removed with fingers – they must be loosened with tool first • Close jaws to adjustable wrench and place in box • Set frame with bolts to left of examinee • Objective: remove all bolts from one sire and assemble on the other side • Nuts inside to start then outside to finish • Loosen all nuts first then spin off nuts • Remove middle row then lay on the bench • Start at the top and work to the bottom • Work left to right • Start with small then medium then large • Tighten to point where fingers cannot remove

9. Minnesota (Bennett) Hand Tool Dexterity Test • Evaluates: • Manipulative skill independent of intellectual factors such as understanding of mechanical principles or the ability to plan a task or follow directions • Medium dexterity • Simple tool handling capabilities • Physical tolerances: • Standing with some bending • Sustained horizontal reaching • Bilateral light to moderate pushing/pulling • Torquing with hand tools • Bilateral fingering

10. Minnesota (Bennett) Hand Tool Dexterity Test • Special Instructions: • Workstation modifications may include: • Positioning of examinee seated, for severe intolerance of standing. • Adjustment of the work height to minimize bending or neck flexion, if necessary for lower back or cervical pain disorders. • Document workstation modifications

11. Minnesota (Bennett) Hand Tool Dexterity Test • Observations: • Ability to tolerate about 10 minutes of standing with some bending • Posture and positioning – standing on one leg, slouching/bending, lateral bending, rocking from side to side • Avoidance of use of one hand or arm • For severe hand injuries, resourcefulness in performing the task partially or completely one-handed • Interpretive Issues: • Difficulty tolerating pushing/pulling of tools needed to loosen/tighten assemblies • Severe cervical, shoulder or lower pain disorders • Inability to maintain a symmetrical, stationary standing position for short duration comfortably • Severe lower back pain disorders, or disorders involving the knee(s) or ankle(s)

12. Minnesota Hand Tool Dexterity Test • Scoring: The score on this test is the amount of time that it takes the examinee to remove the nuts and bolts from the left upright and mount them on the right upright. The timing starts when the examinee picks up the first wrench and stops when the last bolt is tightened.

13. Minnesota (Bennett) Hand Tool Dexterity Test • Scoring is a time percentile based on: • Gender • Employment • Physical capabilities/limitations • Race/ethnicity • Age

15. Where/when the test is used • Automotive or aviation mechanics and students in these areas • Welders • Maintenance positions • Vocational institutes • For workers with back or other injuries • Aviation mechanics/students • Rehabilitation • Machine/tool operators • Assembly line workers

16. Disabilities of the Arm, Shoulder and Hand (DASH) • The DASH Outcome Measure is a 30-item, self-report questionnaire designed to measure physical function and physical symptoms in people with any one of several musculoskeletal disorders of the upper limb. The tool gives clinicians, researchers, and ergonomists the advantage of having a single, reliable instrument that can be used to assess any or all joints in the upper extremity. • Prior to using the tool, an intent to use form must be filled out and sent to the Institute for Work and Health located in Toronto, ON Canada.

17. Disabilities of the Arm, Shoulder, and Hand (DASH) • The disabilities of the arm, shoulder and hand (DASH) outcome measure was developed by the American Academy of Orthopedic Surgeons as a region-specific instrument for measuring upperextremity disability and symptoms (Hudak et al.1996).

18. Disabilities of the Arm, Shoulder and Hand (DASH) • Instructions: • Every question is to be answered based on the client’s condition in the last week by circling the appropriate number • If a certain activity was not performed in the past week, client is to estimate to the best of their ability which response would be the most accurate • It does not matter which hand or arm is used to perform the activity, client must still answer based on their ability regardless of how the task is performed

19. Disabilities of the Arm, Shoulder and Hand (DASH) • Some examples of questions relate to: • Opening a jar • Writing • Sexual activities • Gardening/yard work • The questions are to be answered choosing one of five options provided by the Likert scale questionnaire. • DASH DISABILITY/SYMPTOM SCORE = [(sum of n responses) - 1] x 25, where n is equal to the number of completed responses.

20. DASH cont’d • A dash score may not be calculated if there are greater than 3 missing items (questions). • There are two other optional modules contained within the questionnaire called The Work Module and the Sports/Performing Arts Module. • The Work Module asks questions about the impact of arm, shoulder, or hand problems while at work and the Sports/Performing Module does the same but asks questions about playing the instrument or sport.

21. Test Reliability and Validity • Reliability and Validity: A Swedish version of the test was studied by Isam Atroshi, Christina Gummesson, Bodil Andersson, Elsa Dahlgren and Anita Johansson (2000). The participants completed the DASH and SF-12 generic health questionnaires before elective surgery or physical therapy. Internal consistency of the DASH was high (Cronbach alpha 0.96). Test-retest reliability, evaluated in a subgroup of 67 patients who completed the DASH on two occasions, with a median interval of 7 days, was excellent (intraclass correlation coefficient 0.92). Construct validity was shown by a positive correlation of DASH scores with the SF-12 scores. • DASH is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in upper-extremity musculoskeletal conditions.

22. Test Reliability and Validity • The DASH has been shown to be reliable and valid in a patient population with elbow disorders (Turchin et al. 1998) and another with various upper-extremity disorders (McConnel et al. 1999). • However, obtaining population norms for the DASH will enhance the interpretability of the scores. • The original DASH was administered to 368 patients with different upper-extremity conditions, and the results showed a mean DASH score of 38 (SD 22) and a median score of 35 (McConnel et al. 1999).