Remote Desktop Redirected Printer Dochandfoundation.org/wp-content/uploads/2015/02/cs... · Surgery & Rehabilitation of the Hand: With Emphasis on Trauma Fess: Concurrent Session

Surgery & Rehabilitation of the Hand:With Emphasis on TraumaFess: Concurrent Session 16: Hand Assessment - Where Is the Evidence? ©

Sheraton Philadelphia Downtown HotelPhiladelphia, PA

March 7-10, 2015

Page 1 of 20

Upper Extremity Clinical Assessment:

Methods & Tools

Elaine Ewing Fess, MS, OTR, FAOTA, CHT

INTERVIEW

Qualitative Assessment“In an era of managed care that encourages shortened patient encounters, large group practices that limit a consistent primary care physician, and a reliance upon self-report inventories, it is easy to lose the essence of the doctor-patient relationship. Important information seems limited to that which can be entered into a database field. “

“Fortunately, Dr. George L. Engel continues to remind us that it is the dyad of patient and physician that forms the substrate whereby meaningful data can be observed and obtained from a suffering individual. This special article emphasizes the importance of the medical interview not only as a human encounter but also as a rigorous instrument to better understand the patient and help explain the data that the patient presents. Subjective experiences such as sadness, grief, and fear are not soft signs but essential elements of a patient history. “

Qualitative Assessment

“Dr. Engel is an internist with psychoanalytic training whose impact upon consultation-liaison psychiatry has been immense. His seminal paper on the biopsychosocial model became an organizing principle for psychiatric education in medical settings. “

“It is the challenge--yet the reward--of the physician to empathically make meaningful connections between the patient's life history and presenting problems to diagnose the difficulties with which the patient presents. This essay demonstrates the rigor involved in such a task.”

Thomas N. Wise, M.D., Editor-in-Chief (Psychosomatics 1997; 38:521-528)– Engel, G. L. (1997). From biomedical to biopsychosocial. Being scientific in the

human domain. Psychosomatics, 38(6), 521-528.

Qualitative Assessment:Trauma Story Assessment & Therapy (TSAT)– Narrative of Event(s)

Four Elements–Factual Accounting–Cultural Meaning–Revelations (“Looking Behind the

Curtain”)–Storyteller-Listener Relationship

Qualitative Assessment:TSAT (continued)

– Narrative of Event(s)Self-Healing

–What traumatic events have happened?–How are your body and mind repairing the

injuries sustained from those events?–What have you done in your daily life to

help yourself recover?–What justice do you require from society to

support your personal healing?



March 7-10, 2015

Page 2 of 20

CLINICAL EXAMINATION

Clinical ExaminationReferral & interview informationPostureSkin & subcutaneous tissueBoneJointMuscle & tendonNerveVascular statusFunction

Clinical Examination Tips: Hand

Wrist, forearm, elbow, and shoulder are not included in this brief review

See other scheduled workshops & panels


Finger convergence


Extrinsic vs. Intrinsic involvement


Intrinsic muscle tightness



March 7-10, 2015

Page 3 of 20


Intrinsic muscle loss


Sensibility loss

Assessment Instruments

Identify baseline pathology

Predict rehabilitation potential

Compare subsequent measurements

Evaluate treatment techniques

Evaluate treatment programs

Assessment Instruments

Guide treatment priorities

Motivate patients and staff

Define total functional capacity

Allow professional communication

“Grow” the profession

INSTRUMENT REQUIREMENTS

Instrument Requirements

Reliability/repeatabilityPrimary:



March 7-10, 2015

Page 4 of 20


ReliabilityStatistical proof of accuracy– Correlation coefficient

Range from +1.0 to -1.0

Jamar Dynamometer– +0.9994 minimum


Reliability/repeatability

Validity

Primary:

ValidityStatistical proof that the test measures what it was designed to measure– Compared to known test with

established validity– Correlation coefficient

Range from +1.0 to -1.0Usually less than reliability




Validity

Statement of Purpose

Primary:



Validity


Equipment Criteria

Primary:



Validity


Equipment Criteria

Administration, Scoring & Interpretation Instructions

Primary:



March 7-10, 2015

Page 5 of 20


Normative Data

Secondary:

Normative DataDivided into appropriate subcategories– Sex– Age– Handedness, etc.Appropriate number of subjects in each subcategory



Sensitivity

Tertiary Options:

SensitivityStatistical measure– Ability to accurately assess the

presence or absence of the target condition

– Negative test result rules out the diagnosis

– “SnNout”


Portney & Watkins, 1993


Sensitivity

Specificity

Tertiary Options:

SpecificityStatistical measure– Ability to obtain a negative result when

the condition is absent– Positive test result rules in the condition– “SpPin”


Portney & Watkins, 1993



March 7-10, 2015

Page 6 of 20


Range

Additional Considerations:


Range

Scale

Additional Considerations:

Computerized Instruments

Must meet same measurement criteria

“Black box”More difficult to evaluate– Engineers– Computer programmers– Statisticians

IMPAIRMENT MEASURES

MASS / INFLAMMATION

Impairment Measures:

Mass

Volumeter

Tape measure

Truncated Surface Measurements



March 7-10, 2015

Page 7 of 20

MOTION


ROMGoniometerDistal palmarcreaseAbove tabledistance

STRENGTH



StrengthPinchometer– MIE digital pinch

grip analyzer– Elongated “C”– Hydraulic

SENSIBILITY



March 7-10, 2015

Page 8 of 20

Sensibility Testing:

Sympathetic Response Tests

Detection

Discrimination

Quantification

Identification

Robert LaMotte, PhD,1980



Detection

Discrimination

Quantification

Identification




March 7-10, 2015

Page 9 of 20



Detection

Discrimination

Quantification

Identification



References:

Bell-Krotoski & Buford, 1988, 1997

Bell-Krotoski & Tomancik, 1987

Bell-Krotoski, et al, 1995



March 7-10, 2015

Page 10 of 20

Semmes-Weinstein Monofilaments

Protocol– Normative studies by Weinstein and

Bell-Krotoski et al:1 positive response out of 3

Other response criteria invalid for use with these norms

Gelberman, et al(JBJS 65A, 1983)

100

80

60

40

20

10 20 30 40 50Time (minutes)

4.31(2.05F[gm])

4.17(1.48F[gm])

4.08(1.20F[gm])

3.84(0.693F[gm])

3.61(0.408F[gm])

3.22(0.166F[gm])

2.83(0.068F[gm])

2.44(0.0276F[gm])

S-Wmonofilaments

Amplitude

Paresthesias


AMA Impairment Guide 2002



March 7-10, 2015

Page 11 of 20




Detection

Discrimination

Quantification

Identification


Gelberman, et al(JBJS 65A, 1983)

18

16

12

8

4

10 20 30 40 50

Time (minutes)

3.84(0.693F[gm])

3.61(0.408F[gm])

3.22(0.166F[gm])

2.83(0.068F[gm])

2.44(0.0276F[gm])

S-Wmonofilaments

Two-pointdiscrimination

Paresthesias



March 7-10, 2015

Page 12 of 20



Detection

Discrimination

Quantification

Identification


PAIN


Pain

Visual Analog Scale

Joint tenderness count

FUNCTION MEASURES



March 7-10, 2015

Page 13 of 20

Function Measures

Handedness– Instrument

Waterloo Handedness Questionnaire (WHQ)

PROBLEM: Multiple Versions

PubMed Search (Title or Abstract)

– Handedness 4865Waterloo Handedness Questionnaire (WHQ) 44

–Multiple Versions»5 – 64 Questions

–32 Question WHQ»Best Evidence

Five WHQ GroupsMean Differences: Dominant Minus Non-Dominant Grip Strengths

Handle Position 2

Mean GripDifference(Pounds)

WHQ Group

HNDL-2

-64 to -50n = 1

-45 to -23n = 7

-15 to +18n = 4

+21 to +45n = 48

+46 to +64n = 44

Always Left Always Right

Jamar & Waterloo Handedness Questionnaire

Function Measures:Dexterity, Coordination

Jebsen Hand Function TestMinnesota Rate of ManipulationPurdue PegboardCrawford Small PartsValparFlinn Performance Screening Test

Flinn Performance ScreeningTool (FPST):

Function Measures:Diagnosis Specific Dexterity, Coordination:

Rheumatoid ArthritisSequential Occupational Dexterity Assessment (SODA)Sollerman Test of Hand GripArthritis Hand Function TestGrip Ability TestKeitel Function TestJebsen Hand Function Test



March 7-10, 2015

Page 14 of 20


StrokeWolf Motor Function Test– Reliability = +0.86 to +0.97– 15 functional tasks– Video demonstration:

http://www.youtube.com/watch?y=SIJk88Nd-ZM

Morris et al 2001


StrokeUE Motor Activity Log-14– Validity +0.70 to +0.91– Reliability = +0.81(ic); +0.91 (t-rt)– Structured ADL interview

QOM Scale (Quality of Movement)AOU Scale (Amount of Use)

Uswatte et al 2005

PATIENT SATISFACTION

Patient Satisfaction Measures:

UE Disabilities of Arm, Shoulder, and Hand (DASH)

Michigan Hand Outcomes Questionnaire (MHQ)

Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome questionnaire

PROBLEMS

Problems:

Poor Reliability

– No validity = No test

Poor Scoring or Interpretation

– No validity = No test



March 7-10, 2015

Page 15 of 20

Problems:

StrengthDynamometer– Grippit– Pneumatic devices

SphygmomanometersBulb dynamometers

Problems:

Sphygmomanometers:“Bags of different diameter and volume were seen to give statistically significantly different pressure readings when squeezed by the same subjects.”

Unsworth, et al

BTE Work Simulator

Problems:

Endurance

BTE Work Simulator

No intra- or inter-machine reliability

BTE Work Simulator:SPEEDTRAP II: BTE CONSOLE PRINT-OUTMEAN TORQUE FOR 50 DROP SERIES, 92%

BTE Work Simulator:SPEEDTRAP II: MEAN DROP TIME FOR

50 DROP SERIES, 92%



March 7-10, 2015

Page 16 of 20

Problems:SW Monofilaments

& CTS Questionnaire

Self-Administered Questionnaire for the Assessment of Severity of

Symptoms and Functional Status in Carpal Tunnel Syndrome

Levine, et al: JBJS 1993

© Material

The following includes current research being conducted by Fess, et al.

Do not disseminate



March 7-10, 2015

Page 17 of 20

Problems:

8 SW monofilaments– Range: 1.65 to 6.65

Count of filaments perceived– Not forces of filaments

Problems:

CTS study results:– Filament correlation

Symptom severity +0.17

Functional status: +0.24

Grip strength: +0.23

Pinch strength: +0.24

NCV: +0.33

Problems:

Filament force values not considered

Count – All filaments given equal value

Ranking – All filaments equidistant

Problems:

Functional tasks:– Selected by group of “experts”.

– Not selected via reliable and valid test.

Problems:

Skewed results– Failure to understand / use filament

force values– Failure to use reliable/valid test for

functional task selection– Flawed information– Flawed conclusions

Problems:

Influences – Patient treatment

– Future research



March 7-10, 2015

Page 18 of 20

References: Impairment, Function, Satisfaction

Summary– Fess, E. (2002). Documentation: essentials of an upper

extremity assessment battery. In E. Mackin, A. Callahan, T. Skirven, L. Schneider & A. L. Osterman (Eds.), Rehabilitation of the hand and upper extremity (5th ed., Vol. 1, pp. 263-284). Philadelphia: Mosby.

– Fess, E. (2011). Functional tests. In T. M. Skirven, A. L. Osterman, J. Fedorczyk & P. C. Amadio (Eds.), Rehabilitation of the hand and upper extremity (6th ed., Vol. 1, pp. 152-162). Philadelphia: Elsevier Mosby.

References: Impairment, Function, SatisfactionDetail

– Amadio, P. C. (1994). Outcomes research and the hand surgeon. J Hand Surg Am, 19(3), 351-352.

– Amadio, P. C. (1997). Outcomes assessment in hand surgery. What's new? Clin Plast Surg, 24(1), 191-194.

– American Academy of Orthopaedic Surgeons, A. (1965). Joint motion: method of measureing and recording. Chicago: The academy.

– American Medical Association, A. (2000). The upper extremities. In L. Cocchiarella &

– G. Andersson (Eds.), Guides to the evaluation of permanent impairment. Chicago: AMA Press.

– American Society for Surgery of the Hand, A. (1978). The hand: examination and diagnosis. Aurora, Colorado: The Society.

– American Society for Surgery of the Hand, A. (1983). The hand: examination and diagnosis. New York: Churchill Livinghouse.

– American Society of Hand Therapists, A. (Ed.). (1981). American Society of Hand Therapists clinical assessment recommendations. Garner, NC: The Society.

– American Society of Hand Therapists, A. (1992). American Society of Hand Therapist clinical assessment recommendations. Chicago: The Society.

– American Society of Hand Therapists, A. (1992). American Society of Hand Therapists splint classification system. Chicago: The Society.

– Amis, A., & Miller, J. (1983). The elbow. Clin Rheum Dis, 8, 571.

– Anderson, P. A., Chanoski, C. E., Devan, D. L., McMahon, B. L., & Whelan, E. P. (1990). Normative study of grip and wrist flexion strength employing a BTE Work Simulator. J Hand Surg Am, 15(3), 420-425.

– Ashford, R. F., Nagelburg, S., & Adkins, R. (1996). Sensitivity of the Jamar Dynamometer in detecting submaximalgrip effort. J Hand Surg Am, 21(3), 402-405.

– Ashton, B. B., Pickles, B., & Roll, J. W. (1978). Reliability of goniometric measurements of hip motion in spastic cerebral palsy. Dev Med Child Neurol, 20(1), 87-94.

References: Impairment, Function, SatisfactionDetail (continued2)

– Aszmann, O. C., & Dellon, A. L. (1998). Relationship between cutaneous pressure threshold and two-point discrimination. J Reconstr Microsurg, 14(6), 417-421.

– Aveque, C., Mugnier, C., Jeay, F., & Moutet, F. (1994). [The evaluation of the Artem grip in its function assessment]. Ann Chir Main Memb Super, 13(5), 334-344.

– Backous, D. D., Farrow, J. A., & Friedl, K. E. (1990). Assessment of pubertal maturity in boys, using height and grip strength. J Adolesc Health Care, 11(6), 497-500.

– Barbay, S., Peden, E. K., Falchook, G., & Nudo, R. J. (1999). Sensitivity of neurons in somatosensory cortex (S1) to cutaneous stimulation of the hindlimb immediatelyfollowing a sciatic nerve crush. Somatosens Mot Res, 16(2), 103-114.

– Barr, J. T. (1995). The outcomes movement and health status measures. J Allied Health, 24(1), 13-28.

– Bechtol, C. (1954). Grip test: use of a dynamometer with adjustable handle spacing. Journal of Bone and Joint Surgery, 36A.

– Bell-Krotoski, J. (1988). The force/time relationship of clinically used sensory testing instruments. Journal of Hand Therapy, 1.

– Bell-Krotoski, J. (1991). Advances in sensibility evaluation. Hand Clin, 7(3), 527-546.

– Bell-Krotoski, J. (1995). Threshold detection and Semmes-Weinstein monofilaments. Journal of Hand Therapy, 8.

– Bell-Krotoski, J., & Tomancik, E. (1987). The repeatability of testing with Semmes-Weinstein monofilaments. J Hand Surg Am, 12(1), 155-161.

– Bell-Krotoski, J., Weinstein, S., & Weinstein, C. (1993). Testing sensibility, including touch-pressure, two-point discrimination, point localization, and vibration. J Hand Ther, 6(2), 114-123.

– Bell-Krotoski, J. A., & Buford, W. L., Jr. (1997). The force/time relationship of clinically used sensory testing instruments. J Hand Ther, 10(4), 297-309.

– Bell-Krotoski, J. A., & Fess, E. E. (1995). Biomechanics: the forces of change and the basis for all that we do. J Hand Ther, 8(2), 63-67.

References: Impairment, Function, SatisfactionDetail (continued3)

– Bessette, L., Keller, R. B., Lew, R. A., Simmons, B. P., Fossel, A. H., Mooney, N., & Katz, J. N. (1997). Prognostic value of a hand symptom diagram in surgery for carpal tunnel syndrome. J Rheumatol, 24(4), 726-734.

– Bessette, L., Keller, R. B., Liang, M. H., Simmons, B. P., Fossel, A. H., & Katz, J. N. (1997). Patients' preferences and their relationship with satisfaction following carpal tunnel release. J Hand Surg Am, 22(4), 613-620.

– Bhambhani, Y., Esmail, S., & Brintnell, S. (1994). The Baltimore Therapeutic Equipment work simulator: biomechanical and physiological norms for three attachments in healthy men. Am J Occup Ther, 48(1), 19-25.

– Bieliauskas, L., et al. (1197). Use of the odds ratio to translate neruopsychologicals test scores into real-world outcomes: from statistical significance to clinical significance. J Clin Exp Neuropsychol, 19.

– Bird, H. A., & Stowe, J. (1982). The wrist. Clin Rheum Dis, 8(3), 559-569.

– Blevins, L., & McDonald, C. J. (1985). Fisher's Exact Test: an easy-to-use statistical test for comparing outcomes. MD Comput, 2(1), 15-19, 68.

– Bohannon, R. W. (1998). Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients. J Hand Ther, 11(4), 258-260.

– Boone, D. C., Azen, S. P., Lin, C. M., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Phys Ther, 58(11), 1355-1390.

– Brand, P. (1977). Hand volumeter instruction sheet. Carville, LA: U.S. Public Health Services Hospital.

– Bridge, P. D., & Sawilowsky, S. S. (1999). Increasing physicians' awareness of the impact of statistics on research outcomes: comparative power of the t-test andand Wilcoxon Rank-Sum test in small samples applied research. J Clin Epidemiol, 52(3), 229-235. doi: S0895435698001681 [pii]

– Brosseau, L., Tousignant, M., Budd, J., Chartier, N., Duciaume, L., Plamondon, S., . . .Balmer, S. (1997). Intratesterand intertester reliability and criterion validity of theparallelogram and universal goniometers for active knee flexion in healthy subjects. Physiother Res Int, 2(3), 150-166.

– Capodaglio, P., Strada, M. R., Lodola, E., Grilli, C., Panigazzi, M., Bazzini, G., & Bernardo, G. (1997). Work capacity of the upper limbs after mastectomy. G Ital Med Lav Ergon, 19(4), 172-176.

– Carlson, J. D., & Trombly, C. A. (1983). The effect of wrist immobilization on performance of the Jebsen Hand Function Test. Am J Occup Ther, 37(3), 167-175.


Detail (continued4)– Casanova, J., & Grunert, B. (1989). Adult prehension: patterns and nomenclature for pinches. Journal of Hand

Therapy, 2.

– Cetinok, E. M., Renfro, R. R., & Coleman, E. F. (1995). A pilot study of the reliability of the dynamic mode of one BTE Work Simulator. J Hand Ther, 8(3), 199-205.

– Chengalur, S. N., Smith, G. A., Nelson, R. C., & Sadoff, A. M. (1990). Assessing sincerity of effort in maximal grip strength tests. Am J Phys Med Rehabil, 69(3), 148-153.

– Chung, K. C., Hamill, J. B., Walters, M. R., & Hayward, R. A. (1999). The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Ann Plast Surg, 42(6), 619-622.

– Chung, K. C., Pillsbury, M. S., Walters, M. R., & Hayward, R. A. (1998). Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am, 23(4), 575-587.

– Coleman, E. F., Renfro, R. R., Cetinok, E. M., Fess, E. E., Shaar, C. J., & Dunipace, K. R. (1996). Reliability of the manual dynamic mode of the Baltimore Therapeutic Equipment Work Simulator. J Hand Ther, 9(3), 223-237.

– Cooke, C., Dusik, L. A., Menard, M. R., Fairburn, S. M., & Beach, G. N. (1994). Relationship of performance on the ERGOS work simulator to illness behavior in a workers' compensation population with low back versus limb injury. J Occup Med, 36(7), 757-762.

– Curtis, R. M., & Engalitcheff, J., Jr. (1981). A work simulator for rehabilitating the upper extremity-preliminary report. J Hand Surg Am, 6(5), 499-501.

– Davies, C. W., Jones, D. M., & Shearer, J. R. (1984). Hand grip--a simple test for morbidity after fracture of the neck of femur. J R Soc Med, 77(10), 833-836.

– De, A. K., Bhattacharya, A. K., Panda, B. K., & Das Gupta, P. K. (1980). Respiratory performance and grip strength tests on the basketball players of inter-university competition. Indian J Physiol Pharmacol, 24(4), 305-309.

– De, A. K., Debnath, P. K., Dey, N. K., & Nagchaudhuri, J. (1980). Respiratory performance and grip strength tests in Indian school bodys of different socio-economic status. Br J Sports Med, 14(2-3), 145-148.

– Dellon, A. L. (1978). The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg Am, 3(5), 474-481.


Detail (continued5)– Dellon, A. L., Curtis, R. M., & Edgerton, M. T. (1974). Reeducation of sensation in the hand after nerve injury and

repair. Plast Reconstr Surg, 53(3), 297-305.

– Dellon, A. L., Mackinnon, S. E., & Crosby, P. M. (1987). Reliability of two-point discrimination measurements. J Hand Surg Am, 12(5 Pt 1), 693-696.

– Dellon, E. S., & al., e. (1995). The relationships between skin hardness, pressur perception and two-point discrimination in the fingertip. Journal of Hand Surgery, 20B.

– Desrosiers, J., Bravo, G., Hebert, R., & Dutil, E. (1995). Normative data for grip strength of elderly men and women. Am J Occup Ther, 49(7), 637-644.

– Desrosiers, J., Hebert, R., Bravo, G., & Dutil, E. (1996). Hand sensibility of healthy older people. J Am Geriatr Soc, 44(8), 974-978.

– Dunipace, K. R. (1990). [Personal Communication].

– Dunipace, K. R. (1995). Reliability of the BTE work simulator dynamic mode. J Hand Ther, 8(1), 42-43.

– Dusik, L. A., Menard, M. R., Cooke, C., Fairburn, S. M., & Beach, G. N. (1993). Concurrent validity of the ERGOS work simulator versus conventional functional capacity evaluation techniques in a workers' compensation population. J Occup Med, 35(8), 759-767.

– Dyck, P. J., O'Brien, P. C., Bushek, W., Oviatt, K. F., Schilling, K., & Stevens, J. C. (1976). Clinical vs quantitative evaluation of cutaneous sensation. Arch Neurol, 33(9), 651-655.

– Ekstrand, J., Wiktorsson, M., Oberg, B., & Gillquist, J. (1982). Lower extremity goniometric measurements: a study to determine their reliability. Arch Phys Med Rehabil, 63(4), 171-175.

– Esmail, S., Bhambhani, Y., & Brintnell, S. (1995). Gender differences in work performance on the Baltimore Therapeutic Equipment work simulator. Am J Occup Ther, 49(5), 405-411.

– Esser, M. J., & Sawynok, J. (1999). Acute amitriptyline in a rat model of neuropathic pain: differential symptom and route effects. Pain, 80(3), 643-653.

– Fairfax, A. H., Balnave, R., & Adams, R. D. (1995). Variability of grip strength during sometric contraction. Ergonomics, 38(9), 1819-1830.



March 7-10, 2015

Page 19 of 20


Detail (continued6)– Ferraz, M. B., Ciconelli, R. M., Araujo, P. M., Oliveira, L. M., & Atra, E. (1992). The effect of elbow flexion and time of

assessment on the measurement of grip strength in rheumatoid arthritis. J Hand Surg Am, 17(6), 1099-1103.

– Fess, E. (1987). A method of checking Jamar dynamometer reliability. Journal of Hand Therapy, 1.

– Fess, E. (1988). Letter to the editor: response - reliability and validity. Journal of Hand Therapy, 1.

– Fess, E. (1988). Research for the clinician: using research terminology correctly -- reliability. Journal of Hand Therapy, 1.

– Fess, E. (1988). Research for the clinician: using research terminology correctly -- validity. Journal of Hand Therapy, 1.

– Fess, E. (1994). Research for the clinician: how to avoid being misled by statements of average. Journal of Hand Therapy, 7.

– Fess, E. (1994). Research for the clinician: why trial-to-trial reliability is not enough. Journal of Hand Therapy, 7.

– Fess, E. (1995). Guidelines for evaluating assessment instruments. Journal of Hand Therapy, 8.

– Fess, E. (1997). Research for the clinician: human performance - an appropriate measure of instrument reliability? Journal of Hand Therapy, 10.

– Fess, E. (2002). Documentation: essentials of an upper extremity assessment battery. In E. Mackin, A. Callahan, T. Skirven, L. Schneider & A. L. Osterman (Eds.), Rehabilitation of the hand and upper extremity (5th ed., Vol. 1, pp. 263-284). Philadelphia: Mosby.

– Fess, E. (2011). Functional tests. In T. M. Skirven, A. L. Osterman, J. Fedorczyk & P. C. Amadio (Eds.), Rehabilitation of the hand and upper extremity (6th ed., Vol. 1, pp. 152-162). Philadelphia: Elsevier Mosby.

– Fess, E. (Ongoing study). Instrument reliability of new and used Jamar and Jamar design dynamometers.

– Fess, E. E. (1986). The need for reliability and validity in hand assessment instruments. J Hand Surg Am, 11(5), 621-623.

– Flinn, S., & Ventura, D. (1997). The Flinn performance screening tool. Cleveland: Functional Visions.

– Fraser, A., Vallow, J., Preston, A., & Cooper, R. G. (1999). Predicting 'normal' grip strength for rheumatoid arthritis patients. Rheumatology (Oxford), 38(6), 521-528.


Detail (continued7)– Gelberman, R. H., Szabo, R. M., Williamson, R. V., & Dimick, M. P. (1983). Sensibility testing in peripheral-nerve

compression syndromes. An experimental study in humans. J Bone Joint Surg Am, 65(5), 632-638.

– Giampaoli, S., Ferrucci, L., Cecchi, F., Lo Noce, C., Poce, A., Dima, F., . . . Menotti, A. 1999). Hand-grip strength predicts incident disability in non-disabled older men. Age Ageing, 28(3), 283-288.

– Gilbert, J. C., & Knowlton, R. G. (1983). Simple method to determine sincerity of effort during a maximal isometric test of grip strength. Am J Phys Med, 62(3), 135-144.

– Goldman, S., Cahalan, T. D., & An, K. N. (1991). The injured upper extremity and the JAMAR five-handle position grip test. Am J Phys Med Rehabil, 70(6), 306-308.

– Grime, P. D. (1996). A pilot study to determine the potential application of the pressure specified sensory device in the maxillofacial region. Br J Oral Maxillofac Surg, 34(6), 500-503.

– Hackel, M. E., Wolfe, G. A., Bang, S. M., & Canfield, J. S. (1992). Changes in hand function in the aging adult as determined by the Jebsen Test of Hand Function. Phys Ther, 72(5), 373-377.

– Hage, J. J., van der Steen, L. P., & de Groot, P. J. (1995). Difference in sensibility between the dominant and nondominant index finger as tested using the Semmes-Weinstein monofilaments pressure aesthesiometer. J Hand Surg Am, 20(2), 227-229.

– Hamilton, A., Balnave, R., & Adams, R. (1994). Grip strength testing reliability. J Hand Ther, 7(3), 163-170.

– Hamilton, G. F., & Lachenbruch, P. A. (1969). Reliability of goniometers in assessing finger joint angle. Phys Ther, 49(5), 465-469.

– Hanten, W. P., Chen, W. Y., Austin, A. A., Brooks, R. E., Carter, H. C., Law, C. A., . . .Vanderslice, A. L. (1999). Maximum grip strength in normal subjects from 20 to 64 years of age. J Hand Ther, 12(3), 193-200.

– Hargens, A. R., Botte, M. J., Swenson, M. R., Gelberman, R. H., Rhoades, C. E., & Akeson, W. H. (1993). Effects of local compression on peroneal nerve function in humans. J Orthop Res, 11(6), 818-827.

– Harkonen, R., Piirtomaa, M., & Alaranta, H. (1993). Grip strength and hand position of the dynamometer in 204 Finnish adults. J Hand Surg Br, 18(1), 129-132.

– Harris, S. R., Smith, L. H., & Krukowski, L. (1985). Goniometric reliability for a child with spastic quadriplegia. J Pediatr Orthop, 5(3), 348-351.


Detail (continued8)– Hildreth, D. H., Breidenbach, W. C., Lister, G. D., & Hodges, A. D. (1989). Detection of submaximal effort by use of

the rapid exchange grip. J Hand Surg Am, 14(4), 742-745.

– Hillenbrandt, F., Duval, E., & Moore, M. (1949). The measurment of joint motion: III reliability of goniometry. Phys Ther Rev, 29.

– Hines, m., & J, O. C. (1926). A measure of finger dexterity. Personnel J, 4.

– Jaskolska, A., & Jaskolski, A. (1997). The influence of intermittent fatigue exercise on early and late phases of relaxation from maximal voluntary contraction. Can JAppl Physiol, 22(6), 573-584.

– Jebsen, R. H., Taylor, N., Trieschmann, R. B., Trotter, M. J., & Howard, L. A. (1969). An objective and standardized test of hand function. Arch Phys Med Rehabil, 50(6), 311-319.

– Jeng, S. F., Schenkman, M., Riley, P. O., & Lin, S. J. (1990). Reliability of a clinical kinematic assessment of the sit-to-stand movement. Phys Ther, 70(8), 511-520.

– Joughin, K., Gulati, P., Mackinnon, S. E., McCabe, S., Murray, J. F., Griffiths, S., & Richards, R. (1993). An evaluation of rapid exchange and simultaneous grip tests. J Hand Surg Am, 18(2), 245-252.

– Kahn, J. F., Favriou, F., Jouanin, J. C., & Monod, H. (1997). Influence of posture and training on the endurance time of a low-level isometric contraction. Ergonomics, 40(11), 1231-1239.

– Kaiser, H., Kersting, M., & Schian, H. M. (2000). [Value of the ERGOS work simulator as a component of functional capacity assessment in disability evaluation]. Rehabilitation (Stuttg), 39(3), 175-184.

– Katz, J. N., Fossel, K. K., Simmons, B. P., Swartz, R. A., Fossel, A. H., & Koris, M. J. (1995). Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg Am, 20(4), 549-555.

– Katz, J. N., Keller, R. B., Simmons, B. P., Rogers, W. D., Bessette, L., Fossel, A. H., & Mooney, N. A. (1998). Maine Carpal Tunnel Study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am, 23(4), 697-710.

– Katz, J. N., Punnett, L., Simmons, B. P., Fossel, A. H., Mooney, N., & Keller, R. B. (1996). Workers' compensation recipients with carpal tunnel syndrome: the validity of self-reported health measures. Am J Public Health, 86(1), 52-56.

– Kendall, J., Kendall, F., & Wadsworth, G. (1993). Muscle testing and function (4 ed.). Baltimore: Williams & Wilkins.


Detail (continued9)– Kennedy, L. E., & Bhambhani, Y. N. (1991). The Baltimore Therapeutic Equipment Work Simulator: reliability and

validity at three work intensities. Arch Phys Med Rehabil, 72(7), 511-516. doi: 0003-9993(91)90198-R [pii]

– Kersten, K., et al. (1995). A correlational study between self-reported hand preference and results of the Waterloo Handedness Questionnaire, Occupational Therapy. New York: Columbia University.

– Kirkpatrick, J. (1957). Evaluation of grip loss: a factor of permanent partial disability in California. Industrial Medical Surgery, 26.

– Koris, M., Gelberman, R. H., Duncan, K., Boublick, M., & Smith, B. (1990). Carpal tunnel syndrome. Evaluation of a quantitative provocational diagnostic test. Clin Orthop Relat Res(251), 157-161.

– Kuipers, M., & Schreuders, T. (1994). The predictive value of sensation testing in the development of neuropathic ulceration on the hands of leprosy patients. Lepr Rev, 65(3), 253-261.

– Kumar, S., Fernando, D. J., Veves, A., Knowles, E. A., Young, M. J., & Boulton, A. J. (1991). Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract, 13(1-2), 63-67.

– LaMotte, R. (1980). Testing sensibility. Symposium: assessment of levels of cutaneous sensibility. Carville, LA: United States Public Health Service Hospital.

– LaStayo, P., Chidgey, L., & Miller, G. (1995). Quantification of the relationship between dynamic grip strength and forearm rotation: a preliminary study. Ann Plast Surg, 35(2), 191-196.

– LaStayo, P., & Hartzel, J. (1999). Dynamic versus static grip strength: how grip strength changes when the wrist is moved, and why dynamic grip strength may be a more functional measurement. J Hand Ther, 12(3), 212-218.

– Levine, D. W., Simmons, B. P., Koris, M. J., Daltroy, L. H., Hohl, G. G., Fossel, A. H., & Katz, J. N. (1993). A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am, 75(11), 1585-1592.

– Lindahl, O. A., Nystrom, A., Bjerle, P., & Bostrom, A. (1994). Grip strength of the human hand--measurements on normal subjects with a new hand strength analysis system (Hastras). J Med Eng Technol, 18(3), 101-103.

– Low, J. L. (1976). The reliability of joint measurement. Physiotherapy, 62(7), 227-229.


Detail (continued10)– Lui, P., & Fess, E. (presented at ASHT annual meeting1998). Comparison of dominant and nondominant grip

strength: critical role of the Waterloo Handedness Questionnaire.

– Lui, P., & Fess, E. (presented at ASHT annual meeting 1997). Establishing hand dominance: self-report versus the Waterloo Handedness Questionnaire.

– MacDermid, J. C., Chesworth, B. M., Patterson, S., & Roth, J. H. (1999). Intratester and intertester reliability of goniometric measurement of passive lateral shoulder rotation. J Hand Ther, 12(3), 187-192.

– MacDermid, J. C., Kramer, J. F., & Roth, J. H. (1994). Decision making in detecting abnormal Semmes-Weinstein monofilament thresholds in carpal tunnel syndrome. J Hand Ther, 7(3), 158-162.

– Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil, 66(2), 69-74.

– Mathiowetz, V., Rennells, C., & Donahoe, L. (1985). Effect of elbow position on grip and key pinch strength. J Hand Surg Am, 10(5), 694-697.

– Mathiowetz, V., Rogers, S. L., Dowe-Keval, M., Donahoe, L., & Rennells, C. (1986). The Purdue Pegboard: norms for 14- to 19-year-olds. Am J Occup Ther, 40(3), 174-179.

– Mathiowetz, V., Wiemer, D. M., & Federman, S. M. (1986). Grip and pinch strength: norms for 6- to 19-year-olds. Am J Occup Ther, 40(10), 705-711.

– Mayerson, N. H., & Milano, R. A. (1984). Goniometric measurement reliability in physical medicine. Arch Phys Med Rehabil, 65(2), 92-94.

– McAuley, D. M., Ewing, P. A., & Devasundaram, J. K. (1993). Effect of hand soaking on sensory testing. Int J LeprOther Mycobact Dis, 61(1), 16-19.

– McGill, M., Molyneaux, L., Spencer, R., Heng, L. F., & Yue, D. K. (1999). Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of insensate foot and workload requirements. Diabetes Care, 22(4), 598-602.

– McMeekan, E., & Lishman, W. (1975). Retest reliabilities and interrelationship of the Annett hand perferencequestionnaire and the Edinburgh handedness inventory. British Journal of Psychology, 66.


Detail (continued11)– Mielke, K., Novak, C. B., Mackinnon, S. E., & Feely, C. A. (1996). Hand sensibility measures used by therapists. Ann

Plast Surg, 36(3), 292-296.

– Mitchell, E. (1980). Symposium: assessment of levels of cutaneous sensibility. Carvill, LA: United States Public Health Service Hospital.

– Mitchell, P. D., & Mitchell, T. N. (2000). The age-dependent deterioration in light touch sensation on the plantar aspect of the foot in a rural community in India: implications when screening for sensory impairment. Lepr Rev, 71(2), 169-178.

– Mitterhauser, M. D., Muse, V. L., Dellon, A. L., & Jetzer, T. C. (1997). Detection of submaximal effort with computer-assisted grip strength measurements. J Occup Environ Med, 39(12), 1220-1227.

– Montoye, H. J., & Lamphiear, D. E. (1977). Grip and arm strength in males and females, age 10 to 69. Res Q, 48(1), 109-120.

– Montpetit, R. R., Montoye, H. J., & Laeding, L. (1967). Grip strength of school children, Saginaw, Michigan: 1899 and 1964. Res Q, 38(2), 231-240.

– Murray, J. F., & Mills, D. (1982). Presidential address--American Society for Surgery of the Hand. The patient with the injured hand. J Hand Surg Am, 7(6), 543-548.

– Newman, D. G., Pearn, J., Barnes, A., Young, C. M., Kehoe, M., & Newman, J. (1984). Norms for hand grip strength. Arch Dis Child, 59(5), 453-459.

– Niebuhr, B., & Marion, R. (1990). Voluntary control of submaximal grip strength. Am J Phys Med Rehabil, 69.

– Niebuhr, B. R., Marion, R., & Hasson, S. M. (1993). Electromyographic analysis of effort in grip strength assessment. Electromyogr Clin Neurophysiol, 33(3), 149-156.

– O'Driscoll, S., & Horii, E. (1992). The relationship between wrist position, grasp size, and grip strength. Journal of Hand Surgery, 17A.

– Omer, G. E., Jr. (1992). Median nerve compression at the wrist. Hand Clin, 8(2), 317-324.

– Onne, L. (1962). Recovery of sensibility and sudomotor activity in the hand after nerve suture. Acta Chir Scand Suppl, Suppl 300, 1-69.



March 7-10, 2015

Page 20 of 20


Detail (continued12)– O'Rain, S. (1973). New and simple test for nerve function in the hand. British Journal of Medicine, 3.

– Palumbo, C. F., Szabo, R. M., & Olmsted, S. L. (2000). The effects of hypothyroidism and thyroid replacement on the development of carpal tunnel syndrome. J Hand Surg Am, 25(4), 734-739.

– Peeters, G. G., Aufdemkampe, G., & Oostendorp, R. A. (1998). Sensibility testing in patients with a lumbosacralradicular syndrome. J Manipulative Physiol Ther, 21(2), 81-88.

– Peters, M., & Murphy, K. (1992). Cluster analysis reveals at least three, and possibly five distinct handedness groups. Neuropsychologia, 30(4), 373-380.

– Petersen, P., Petrick, M., Connor, H., & Conklin, D. (1989). Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther, 43(7), 444-447.

– Phelps, P. E., & Walker, E. (1977). Comparison of the finger wrinkling test results to established sensory tests in peripheral nerve injury. Am J Occup Ther, 31(9), 565-572.

– Phillips, P. (1986). Grip strength, mental performance and nutritional status as indicators of mortality risk among female geriatric patients. Age Ageing, 15(1), 53-56.

– Powell, D. M., Zimmer, C. A., Antoine, M. M., Baruch, L. D., Bellian, K. T., Morgan, R. F., & Edlich, R. F. (1991). Computer analysis of the performance of the BTE Work Simulator. J Burn Care Rehabil, 12(3), 250-256.

– Rantanen, T., Guralnik, J. M., Foley, D., Masaki, K., Leveille, S., Curb, J. D., & White, L. (1999). Midlife hand grip strength as a predictor of old age disability. JAMA, 281(6), 558-560.

– Reddon, J. R., Gill, D. M., Gauk, S. E., & Maerz, M. D. (1988). Purdue Pegboard: test-retest estimates. Percept Mot Skills, 66(2), 503-506.

– Reddon, J. R., Stefanyk, W. O., Gill, D. M., & Renney, C. (1985). Hand dynamometer: effects of trials and sessions. Percept Mot Skills, 61(3 Pt 2), 1195-1198.

– Ren, K. (1999). An improved method for assessing mechanical allodynia in the rat. Physiol Behav, 67(5), 711-716. doi: S0031-9384(99)00136-5 [pii]

– Richards, L. G. (1997). Posture effects on grip strength. Arch Phys Med Rehabil, 78(10), 1154-1156. doi: S0003-9993(97)90143-X [pii]


Detail (continued13)– Richards, L. G., Olson, B., & Palmiter-Thomas, P. (1996). How forearm position affects grip strength. Am J Occup

Ther, 50.

– Rider, B., & Linden, C. (1988). Comparison of standardized and non-standardized administration of the Jebsen Hand Function Test. 1.

– Rosen, B. (1996). Recovery of sensory and motor function after nerve repair. A rationale for evaluation. J Hand Ther, 9(4), 315-327.

– Rosen, B., Dahlin, L. B., & Lundborg, G. (2000). Assessment of functional outcome after nerve repair in a longitudinal cohort. Scand J Plast Reconstr Surg Hand Surg, 34(1), 71-78.

– Rothstein, J. M. (1985). Measurement and clinical practice: Theory and application Measurement in physical therapy: clinics in physical therapy. New York:Churchill Livingstone.

– Rothstein, J. M., Miller, P. J., & Roettger, R. F. (1983). Goniometric reliability in a clinical setting. Elbow and knee measurements. Phys Ther, 63(10), 1611-1615.

– Sabari, J. S., Maltzev, I., Lubarsky, D., Liszkay, E., & Homel, P. (1998). Goniometric assessment of shoulder range of motion: comparison of testing in supine and sitting positions. Arch Phys Med Rehabil, 79(6), 647-651.

– Schmidt, G. (1973). Biomechanical analysis of knee flexion and extension. Journal ofBiomechanics, 6.

– Schmidt, R. T., & Toews, J. V. (1970). Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil, 51(6), 321-327.

– Seddon, H. (1973). Surgical disorders of the peripheral nerves (2 ed.). New York: Churchill Livingstone.

– Seki, T., & Ohtsuki, T. (1990). Influence of simultaneous bilateral exertion on muscle strength during voluntary submaximal isometric contraction. Ergonomics, 33(9), 1131-1142.

– Sharma, S., Schumacher, H. R., Jr., & McLellan, A. T. (1994). Evaluation of the Jebsen hand function test for use in patients with rheumatoid arthritis [corrected]. Arthritis Care Res, 7(1), 16-19.

– Shechtman, O., & Taylor, C. (2000). The use of the rapid exchange grip test in detecting sincerity of effort, Part II: validity of the test. J Hand Ther, 13(3), 203-210.


Detail (continued14)– Spaulding, S. J., McPherson, J. J., Strachota, E., Kuphal, M., & Ramponi, M. (1988). Jebsen Hand Function Test:

performance of the uninvolved hand in hemiplegia and of right-handed, right and left hemiplegic persons. Arch Phys Med Rehabil, 69(6), 419-422.

– Spijkerman, D. C., Snijders, C. J., Stijnen, T., & Lankhorst, G. J. (1991). Standardization of grip strength measurements. Effects on repeatability andpeak force. Scand J Rehabil Med, 23(4), 203-206.

– Steenhuis, R. E., Bryden, M. P., Schwartz, M., & Lawson, S. (1990). Reliability of hand preference items and factors. J Clin Exp Neuropsychol, 12(6), 921-930.

– Stern, E. B. (1992). Stability of the Jebsen-Taylor Hand Function Test across three test sessions. Am J Occup Ther, 46(7), 647-649.

– Stillman, B., & McMeeken, J. (1995). A video-based version of the pendulum test: technique and normal response. Arch Phys Med Rehabil, 76(2), 166-176.

– Stokes, H. M., Landrieu, K. W., Domangue, B., & Kunen, S. (1995). Identification of low-effort patients through dynamometry. J Hand Surg Am, 20(6), 1047-1056.

– Su, C. Y., Cheng, K. F., Chien, T. H., & Lin, Y. T. (1994). Performance of normal Chinese adults on grip strength test: a preliminary study. Gaoxiong Yi Xue Ke Xue Za Zhi, 10(3), 145-151.

– Su, C. Y., Lin, J. H., Chien, T. H., Cheng, K. F., & Sung, Y. T. (1993). Grip strength: relationship to shoulder position in normal subjects. Gaoxiong Yi Xue Ke Xue Za Zhi, 9(7), 385-391.

– Sunderland, A., Tinson, D., Bradley, L., & Hewer, R. L. (1989). Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry, 52(11), 1267-1272.

– Szabo, R. M., Gelberman, R. H., & Dimick, M. P. (1984). Sensibility testing in patients with carpal tunnel syndrome. J Bone Joint Surg Am, 66(1), 60-64.

– Tairych, G. V., Kuzbari, R., Rigel, S., Todoroff, B. P., Schneider, B., & Deutinger, M. (1998). Normal cutaneoussensibility of the breast. Plast Reconstr Surg, 102(3), 701-704.

– Tan, U. (1993). Normal distribution of hand preference and its bimodality. Int J Neurosci, 68(1-2), 61-65.


Detail (continued15)– Tassler, P. L., & Dellon, A. L. (1995). Correlation of measurements of pressure perception using the pressure-

specified sensory device with electrodiagnostic testing. J Occup Environ Med, 37(7), 862-866.

– Taylor, C., & Shechtman, O. (2000). The use of the rapid exchange grip test in detecting sincerity of effort, Part I: administration of the test. J Hand Ther, 13(3), 195-202.

– Taylor, N., Sand, P. L., & Jebsen, R. H. (1973). Evaluation of hand function in children. Arch Phys Med Rehabil, 54(3), 129-135.

– Temple, C. L., & Hurst, L. N. (1999). Reduction mammaplasty improves breast sTensibility. Plast Reconstr Surg, 104(1), 72-76.

– Tiffin, J., & Asher, E. J. (1948). The Purdue pegboard; norms and studies of reliability and validity. J Appl Psychol, 32(3), 234-247.

– Tredgett, M., Pimble, L. J., & Davis, T. R. (1999). The detection of feigned hand weakness using the five position grip strength test. J Hand Surg Br, 24(4), 426-428.

– Trott, S. A., Rohrich, R. J., Beran, S. J., Kenkel, J. M., Adams, W. P., Jr., & Robinson, J. B., Jr. (1999). Sensory changes after traditional and ultrasound-assisted liposuction using computer-assisted analysis. Plast Reconstr Surg, 103(7), 2016-2025; discussion 2026-2018.

– van Brakel, W. H., Kets, C. M., van Leerdam, M. E., Khawas, I. B., & Gurung, K. S. (1997). Functional sensibility of the hand in leprosy patients. Lepr Rev, 68(1), 25-37.

– Van Turnhout, A. A., Hage, J. J., De Groot, P. J., & De Lange-De Klerk, E. S. (1997). Lack of difference in sensibility between the dominant and non-dominant hands as tested with Semmes-Weinstein monofilaments. J Hand Surg Br, 22(6), 768-771.

– van Vliet, D., Novak, C. B., & Mackinnon, S. E. (1993). Duration of contact time alters cutaneous pressure threshold measurements. Ann Plast Surg, 31(4), 335-339.

– Voerman, V. F., van Egmond, J., & Crul, B. J. (1999). Normal values for sensory thresholds in the cervical dermatomes: a critical note on the use of Semmes-Weinstein monofilaments. Am J Phys Med Rehabil, 78(1), 24-29.

– Voerman, V. F., van Egmond, J., & Crul, B. J. (2000). Elevated detection thresholds for mechanical stimuli in chronic pain patients: support for a central mechanism. Arch Phys Med Rehabil, 81(4), 430-435.


Detail (continued16)– Wagner, C. (1977). Determination of the rotary flexibility of the elbow joint. Eur J Appl Physiol Occup Physiol, 37(1),

47-59.

– Walamies, M., & Turjanmaa, V. (1993). Assessment of the reproducibility of strength and endurance handgrip parameters using a digital analyser. Eur J Appl Physiol Occup Physiol, 67(1), 83-86.

– Waylett-Rendall, J. (1989). Sequence of sensory recovery: a retrospective study. JHand Ther, 2.

TSAT & Narratives– Mollica, R. F. (2006). Healing invisible wounds: recovery in a violent world. Nashville, TN: Vanderbilt University Press.

– Mollica, R. F., Cardozo, B. L., Osofsky, H. J., Raphael, B., Ager, A., & Salama, P. (2004). Mental health in complex emergencies. Lancet, 364(9450), 2058-2067.

– Mollica, R. F. (2004). Surviving torture. N Engl J Med, 351(1), 5-7.

– Mollica, R. F. (2001). The trauma story: a phenomenological approach to the traumatic life experiences of refugee survivors. [Comment]. Psychiatry, 64(1), 60-63.

– Engel, G. L. (1997). From biomedical to biopsychosocial. 1. Being scientific in the human domain. [Editorial HistoricalArticle]. Psychother Psychosom, 66(2), 57-62.

– Engel, G. L. (1997). From biomedical to biopsychosocial. Being scientific in the human domain. Psychosomatics, 38(6), 521-528.

– Engel, G. L. (1983). The biopsychosocial model and family medicine. J Fam Pract, 16(2), 409, 412-403.

– Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136

Documents

Remote Desktop Redirected Printer Dochandfoundation.org/wp-content/uploads/2015/02/cs... · Surgery & Rehabilitation of the Hand: With Emphasis on Trauma Fess: Concurrent Session