ThinkHand: what iconic image captures hand function best?

There is a PROM for hand function; what do you make of it? #ThinkHand #MSBlog #MSResearch

“Thank you for engaging with our #ThinkHand Campaign; response to the survey has been excellent. We are hoping to get more than additional 400 responses by mid August for our ECTRIMS poster.”

“In addition, to the survey there are another two things we need help with from this post.”

“Firstly, I would like you comments on the ABILHAND patient-related outcome measure. Does this capture hand function for you? What items are missing? I personally can think of several items that are missing and I don’t have MS.”

“Secondly, we need an iconic image of a hand to make #ThinkHand stick. For example, what image would you want see on a #ThinkHand campaigners T-shirt? It needs to instantly recognisable; the image has to make the general public and the MS community say ‘Yes, I know how important hand function is to people with MS; let’s do something about it’. The following are examples of images that may, or may not cut the mustard.”

“Thank you!”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


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  • Picking up a tablet (drug) from a table, some can be very small like vit D.
    Holding/gripping a carton of milk or bottle.
    Gripping a cooking pan of water.
    Putting on a pair of tights.

    Both images are ok, the top one looks like a hands ready to grip position. The second image shows different size/shape hands. I would be interested to see other images of hands.

  • 40 Butting up a shirt / blouse
    I have not been able to butten up my blouse, I had to look in the mirror to do so.

    I also could not feel what was in my pocket, for example I could not feel the difference between a screw and a plug (I was trying to hang up pictures).

    But the problem came and went, so fortunately it did not stay.

  • Do you have to use this tool as it is already validated? I think there are items that could possibly be left out. It could be shorter and more organised by looking at the actions, pincer grip, twist, grip strength etc. Or it could go on forever.

    Certainly agree with picking up tablets (and pushing them out of those wretched foil sheets). Opening tubs of margarine and pulling the plastic tab/cover on milk is surprisingly difficult – teeth better. Taking those little caps off tyre valves and fixing on the tyre air pressure machine. Starting up the strimmer. I could go on.

    Afraid I don't like either image. First one is just odd and I won't say what images came to mind and the second one does not catch the imagination and is too literal.

  • Some elements of personal grooming can be tricky such as dressing hair, washing back/shoulders, bum wiping, cutting finger/toe nails.

    Maybe an wavering imperial 'thumbs up'

  • On one end of the scale, there is the remarkable dexterity of the violinist Maxim Vengerov. The precision and steadiness required by a surgeon. On the other, the things we take for granted. The ability to make a cup of tea without scalding oneself or do handwriting without going stiff. How do you condense everything that dexterity means into a simple image? An image which makes people recognise what there is to lose? I don't know.

  • I think this is a very worthwhile endeavour and another example of the MS doctors at Barts being leaders in the field.
    My additions to the list would be: using a knife and fork to eat; pulling up trousers or pants; using a pair of scissors; signing one's name (I can do this but I struggle to write a sentence longer than "Jesus wept."); most of the things mentioned by people above. Some of the things on the list you have given us to comment on are unnecessary. I have an electric toothbrush because I can no longer brush my teeth with a manual one (although the list doesn't actually specify). You don't need to be able to tear a bag of chips open if you can still use scissors.
    I think it is very difficult to put hand actions into categories – too many of them need their own category (where would 'pulling trousers up' fit?). However I really believe it is possible to produce a better list to assess hand function. I think you (or one of us – I'd have a go if you want) can come up with a better list than the example above. I think it should be ordered in some more sensible way. Perhaps put actions that are similar together? Or putting things into three groups: strength, precision, both and then ordering by how difficult the actions are?
    I don't like either image. What about a picture of a hand writing some appropriate word or slogan? Maybe writing 'MS hand function' with the writing getting progressively worse? But perhaps someone else could think of a better slogan.
    Hope this is helpful.

  • What about handling and inserting a urinary catheter, using a urine dipstick, inserting a contact lens, using a wheelchair (wheels and electronic controls), put on my TENS electrodes, using a TENS machine, etc. This scale was not designed for MSers with disabilities; can I suggest you start from scratch and design a new PROM?

  • Driving, cycling (gear changes and brakes), computer mouse, mobile phone, TV remote, using tampons, make-up application (lipstick and mascara), masturbation, ear buds, earings, toilet paper, contact lenses, etc.

  • I think that this is a good list, can I make a few suggestions?

    How about:
    Unlock a smartphone
    Rather than typewrite how about use a keyboard and then increasing functions
    Use a keyboard to Google something
    … Order groceries
    … Write an email

    If I were being pedantic I notice that pealing spuds with a knife does not align with cracking hazelnuts (without a tool) or perhaps I am not man enough to crack hazelnuts with my hands.

  • Manual dexterity is a huge range of tasks and an attempt to list every one of them is difficult and endlessly boring. Without too much effort it could be categorized.
    Fine control such as writing or doing up buttons.
    Grip such as holding cutlery or turning a tap tap or putting a top onto a bottle.
    Strength such as using secateurs.
    Hand control such as slicing a loaf of bread.
    Repetitive action such as tapping or hitting a nail with a hammer.
    Steadiness such as holding a pint glass full of beer with one hand

    There is another issue, a lot of manual dexterity also calls for vision and you need to careful not to confuse one problem with the other

    As for am image – a hand holding a pen and writing a cheque, the quality of the writing getting worse and worse until it becomes illegible

    • "a hand holding a pen and writing a cheque, the quality of the writing getting worse and worse until it becomes illegible"

      Very good idea. But I'd suggest a love letter, rather than a cheque.

  • For an image, I keep thinking of a cat's cradle ( holding something that represents independence but I'm not sure what that should be. The image would show that independence depends on the hands and the cord would remind the viewer that the hands are restricted. I'll leave this to someone more creative…

    PS I just tried doing a cat's cradle, I couldn't even tie the ends together to start 🙁

  • I do have some sympathy with Patrick's point (even though it contradicts what I said above). I would like to add that some PWMS struggle to do things with their hands because they have tremors in their hands, rather than simple loss of strength or dexterity. The questionnaire needs to capture this information.

  • To include in the list of hand actions: handling medication, including popping pills out of those pesky strips without dropping them and undoing bottles with childproof locks.

  • Scratching an itch.
    (Picking your own nose.)
    The ability to control soft/slow/fast movements, stroke something/one, slap away a bug.
    The annoyance of intention tremor.

    Re hand function, there is dexterity, strength, and sensitivity, at least for me. All 3 have been affected, to varying degrees, and as usual, fatigue plays its part, too.

    Re image, a hand grasping something, or failing to grasp/something slipping. A hand, or hands, that indicate activity. (Isn't there a graphic out there somewhere, of a hand writing, and the word being written becoming more illegible?)

  • Tie Shoelaces
    Tie a ribbon
    Wrap present (nicely)
    Writing for long period (thank goodness for computers)
    Holding wooden spoon and stirring for a long period, like making risotto

  • I googled 'hand surrealism' and saw a drawing of a hand in which the fingers were lit candles. The candles (fingers) were melting, molten wax running down the hand towards the wrist. To me it stood out as a visual of how it felt when I temporarily lost the use of my hand and how now my hand function can fluctuate, that feeling of movement and control melting away. I got quit emotional looking at it!

  • What about a distortion of Escher's picture where one of the drawing hands is perfect but the other one is a much rougher sketch, suggesting that one of the hands is losing its ability to draw? Losing function, in other words?

  • Playing chess, cards, draughts, snooker, pin-ball, video-games, etc. Jig-saw puzzles, building lego structures with the grandchildren, using a remote control, taking pictures, painting, etc. All these things are important to me; not to for get being able to inject myself each day with Copaxone.

  • Definitely picking up small things like pills (or peanuts), putting on a bra, applying make-up, spraying perfume, using a smartphone(unlocking, swiping, typing).

    Types of hand problems – strength, spasticity, tremor, touch, proprioception, articulation. I find that I am no longer able to flex my wrist properly if I am holding something.

    I like Sewingchick's idea of using the Escher hands

  • I like this #ThinkHand campaign. It is so spot on and explains what a lot of people are suffering from and have to cope with.

    What is the KEY question preceding the above ABILHAND list? What is Easy, Difficult, Impossible???

  • Here are some things I find difficult and therefore might be useful to include on the measures:

    Fastening / unfastening bra
    Tie shoe laces
    Grip clothing to e.g. pull up pants after going to the toilet
    Grip to unscrew bottles and jars
    Sense too hot and too cold (I have numb fingers)
    Hold kitchen equipment -e.g. a pan, a ladle to scoop soup, knife
    Chop vegetables
    Peel vegetable
    Chop food on a plate
    Pick up a tablet (medicinal, not technical)
    Keep a drink steady in a glass
    Keep a drink steady in a cup with a handle
    Hold my house key steady to access the lock and unlock the door
    Hit the intended key on a typewriter, keyboard, phone or tablet
    Wash my hair
    Brush my hair

    The only image that appeals is the first one ……. but it doesn’t say ‘think hand’ to me.

By Prof G



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