Improving attitudes towards children with disabilities in a school context

unstable or slippery objects used in everyday tasks. The development of dynamic hand control during object manipulation is an important aspect of fine motor coordination for children but, this skill is difficult to quantify with current clinical tools. Much of the work examining fingertip force coordination during static tasks and recent work on dynamic tasks has been gathered using expensive items of equipment such as force transducers that are not readily available in the clinic. Instead, clinicians rely on standardized tests and dynamometers to examine dexterity and hand strength. The Strength-Dexterity test (SD-test) is a tool originally designed to measure dynamic hand control in adults that could also allow quantification of fingertip force coordination in the pediatric clinic. The advantage of the SD-test for the adult or pediatric population is that it could be used in conjunction with other measures of dexterity and strength to obtain a comprehensive view of sensorimotor control of the hand without the expense or time needed to analyse kinetic or kinematic data. Therefore, the SD-test is likely to have a great deal of utility. Despite the ease in clinical use, because the SD-test is a high-level dexterity task it requires sufficient sensibility and pinch strength to control the direction of fingertip forces of opposing digits. It also requires that the child have sufficient cognition and anticipatory control to understand the goal of the task and to position the digits suitably at opposing grasp points in advance of force generation. Thus, performance on the SD-test will be affected if sensibility is diminished, pinch force reduced, cognition limited, or anticipatory control impaired. The choice made by Vollmer et al. to retain items with less difficulty was an important one. With lower levels of difficulty the SD-test could provide a sensitive measure of dexterity for children whose performance could be impeded at higher levels of difficulty owing to impairment or skill level. There are limitations to the SD-test that require consideration. First, it may be difficult for some children without sufficient finger differentiation or in-hand manipulation skill to employ just the thumb, index, and middle finger, while keeping the ring and little finger flexed during task performance. Second, select clinical populations may not be able to employ a three-fingered pinch owing to insufficient thumb opposition. Therefore, it may be necessary to examine task performance using alternative prehension patterns such as a lateral pinch, commonly displayed by children with tetraplegia after cervical spinal cord injury. Finally, joint ligamentous laxity may reduce the stability of the metacarpophalangeal and interphalangeal joints of the fingers and thumb during the task. For children with ligamentous laxity one or more joints may collapse before the spring buckles even though dexterity, as shown on the Box and Block Test or Nine Hole Peg Test, may be sufficient. As the SD-test evolves the limitations may be addressed. In summary, the study by Vollmer et al. provided strong statistical evidence that the SD-test is valid and has the potential to be a useful measure of dynamic hand control in typical and atypical pediatric populations. As the authors indicate, they will be conducting further testing to support the use of this tool in clinical populations. For example, this tool could be used to quantify the differences in dynamic hand control between the affected and less affected hands of children with hemiplegic cerebral palsy. Furthermore, this unique tool may be a useful method to examine the efficacy of intervention strategies employed to improve fingertip force coordination in children with various hand impairments and prehensile dysfunction.