Help File FCEase Manual

Reason for performing test:

Grip evaluation provides a consistency observation based on a static measure within the FCE that allows actual maximal grip strength levels at preset positions of the hand and wrist.

Procedure (detail):

• The client should be in a seated position with the wrist supported by the opposite hand and the elbow flexed to 90 degrees. Arm tested should be at side
  
• The wrist should be at 0 degrees of ulnar/radial deviation.
  
• Starting in position one of the dynamometer, have the client squeeze maximally and "hold" then "release." Position 1 is the position closest to the handle.
  
• Each position should be evaluated using positions 1 through to 5 alternating from dominant to non-dominant hands.
  
• Record the pounds or kilograms of force produced at each setting
  
• The pounds measurements are on the outside of the force dial, while kilograms measurements are on the inside of the force dial.
  
• For a more accurate reading, it is recommended that three (3) readings be taken for each position on each hand and the average of the results be used
  
• Observe that the client is not using accessory movements of the wrist, arm, shoulder, or trunk to produce additional effort during the performance of this evaluation.
  
• Plot the forces onto the force grid provided on the Data Input Sheet.

Use of equipment during testing:

The Jamar grip dynamometer is the recommended piece of equipment to use for this evaluation. Jamar has provided the most comprehensive validity and grip information in the industry for use with upper extremity strength. However, newer devices are being brought to market which provide actual force time curves and ulnar radial force monitoring ability.

  Data collection and correlation (what is being measured, observed, and how):

Used to provide measurement of maximal grip strength.

Used to observe a component of consistency during the F.C.E. - failure to provide consistent grip information can be a suggestion of inappropriate effort on other portions of the evaluation.

It should be noted that consistency of body position is important due to the fact that changing body posture or arm positions can affect the maximal effort readings.

  Expected results or normally viewed patterns:

Expected results and plotting of the forces produced at each of the five (5) positions should form a commonly shaped curve with greatest forces noted at position 2 or 3, however, specific job tasks performed over time can create stronger forces at different locations in the plotting. You are looking for consistency of curve structure. Curves should be consistent in shape comparing right to left hand.

  Signs of inconsistent readings

• Low force readings throughout the test
  
• Flat curve lines.
  
• Higher forces at positions 1 and 5 (beginning and ending positions).
  
• Facial grimaces and/or shaking of the upper extremity during test.
  
• Excessive variance between two to three trials at the same position.

  Contraindications:

• Hand lacerations.
  
• Active inflammation of the hand or wrist
  
• Severe Carpal Tunnel Syndrome.

  Typical substitution patterns

Use of accessory movements can alter the results of the testing. Monitor client position and hand/arm position. Do not allow the client to lean forward in chair.

  Supporting documentation

• Mathiowetz
  
• Jamar instruction manual
  
• Rodgers 1982-1985
  
• Force curve graphs used for demonstrating consistency can be included for all FCE reports.

  What information needs to be included in report

• Maximal grip strength in comparison to normative data supplied.
  
• Force curve graphics with explanation as to how this information applies to client’s return to work plan or performance during the FCE.

Hint:

• Use Jamar equipment
  
• Monitor client position.
  
• You may perform position two (2) multiple times during the evaluation should you wish to calculate actual Coefficient of Variation (Standard Deviation divided by the Mean, multiplied by 100). The percent achieved should be less than 15%. This is commonly noted in literature.
  
• Note that male and female differences do exist.