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CANADIAN JOURNAL OF OCCUPATIONAL THERAPY VOLUME 63 NO 4

CATHERINE BACKMAN LINDA E. DANIELS

KEY WORDS Grip strength Pediatrics Pinch strength testing

A description of grip and pinch strength in children aged 6 to 1 1


years using the Martin Vigorimeter

ABSTRACT

The vigorimeter is potentially a useful instrument for measuring grip and pinch strength in children. However, no normative or comparative data are supplied by the manufacturer, and only two previous studies using it to test children's hand strength could be found in the literature. The purpose of this study was to collect preliminary hand strength data in children aged 6 to 11 years. Spherical grip, tip pinch and tripod pinch strength were measured in 134 children. Graphs displaying the results suggest that, on average, strength increases with age, boys are stronger than girls, and the right hand is often (but not always) stronger than the left. While far from producing norms, this study did demonstrate that the vigorimeter has utility as an instrument for measuring grip and pinch strength in children, and provided some preliminary baseline data to assist clinicians in judging the results of hand strength tests. Le vigorimtre peut tre un instrument utile pour mesurer la force de prhension grossire et la force de prhension fine chez les enfants. Cependant, le fabricant ne fournit pas de donnes normatives ou comparatives et on ne trouve dans la littrature que deux tudes dans lesquelles l'instrument a t utilis pour valuer la force de prhension des enfants. Le but de cette tude tait de recueillir des donnes prliminaires sur la force de prhension des enfants gs de 6 11 ans. La force de la prise palmaire sphrique, des prises digitales et des prises tridigitales a t mesure chez 134 enfants. Les rsultats prsents dans les graphiques suggrent qu'en gnral la force augmente avec l'ge, les garons sont plus forts que les filles et la main droite est souvent (mais ce n'est pas toujours le cas) plus forte que la gauche. Loin de produire des normes, cette tude a toutefois dmontr que le vigorimtre est un instrument utile pour mesurer la force de prhension grossire et la force de prhension fine chez les enfants. l'tude fournit galement quelques donnes de base prliminaires qui aideront les cliniciens apprcier les rsultats des tests sur la force de prhension.
RESUME

Catherine Backman, M.S., 0.T.(C) is Senior Instructor, Division of Occupational Therapy, School of Rehabilitation Sciences, The University of British Columbia, T3252211 Wesbrook Mall, Vancouver, BC V6T 2B5. Linda Daniels, M.A., 0.T.(C) is sole charge therapist, Outreach Therapy, Port Alberni, BC. At the time of this study she was an Instructor, Division of Occupational Therapy, School of Rehabilitation Sciences, The University of British Columbia.
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C. Backman & L. Daniels

Grip and pinch strength are frequently measured by occupational therapists when assessing hand function in children to help identify level of development or degree of impairment, to establish treatment needs, and to measure treatment outcomes. For these clinical purposes it is necessary to have instruments, procedures and normative data that are reliable and valid. Most of the published research dealing with grip and pinch strength measurement has focused on adults, but there is increasing interest in establishing reliable and valid normative data for children. Measurement and procedural problems of a similar nature have been identified in both the adult and pediatric grip strength literature, namely differences in the following: (a) the instruments used, (13) the instructions used, (c) the position of the subjects and the instruments, (d) the numbers of trials, and (e) the calculation methods used to construct the various forms of normative data. As a result, at least three requirements for the measurement of grip and pinch strength to be reliable, valid and clinically useful have emerged in author recommendations: (a) accurately calibrated test instruments which are commercially available, (b) standardized test procedures, and (c) normative data for comparison and interpretation of the results. In addition, it has been noted that most commercially available instruments were developed for adults, and therefore are too large and too heavy for children's small hands (Robertson & Deitz, 1988). A search of the literature identified 13 studies which examined grip and pinch strength in children. These papers were reviewed with respect to the three criteria outlined above.

gauge (Newman, Pearn, Barnes, Young, Kehoe, & Newman, 1984), the Martin Vigorimeter with the smallest size bulb (Robertson & Deitz, 1988; Link, Lukens & Bush, 1995), a modified sphygmomanometer (Dunn, 1993), and a Collins elliptical dynamometer (Montpetit, Montoye & Laeding, 1967). Six of the studies measured pinch strength. The Preston pinch gauge was used in two of them (Ager et al., 1984; Imrhan, 1989), the Pinsco or B & L Engineering gauge was used in two (Fullwood, 1986; Mathiowetz et al., 1986), and a standard but unspecified pinch gauge was used in two (Burmeister & Flatt, 1975; Weiss & Flatt, 1971).

STANDARDIZED TEST PROCEDURES


Uniform procedures and test positions were reportedly used within each study but not across studies, with one exception: Link, Lukens and Bush (1995) essentially replicated Robertson and Deitz's 1988 study of spherical grasp in preschool children. Positioning variations included the position of the subjects (seated, standing, position of the arm and hand, position of the instument within the hand), the type of pinch or grip measured, the number of trials, and the order of testing. These variables have been demonstrated to influence grip and pinch measurement in adults (Mathiowetz, Rennells & Donahoe, 1985). For example, the position of the elbow has been shown to result in significantly different grip strength scores (Kuzala & Vargo, 1992) and flexing the non-active fingers during pinch results in significantly higher pinch strength than when the fingers are extended (Hook & Stanley, 1986). The use of standardized verbal instructions and demonstration is believed to affect performance on evaluation tests, and is considered an important factor contributing to adequate test reliability (Davis, 1974). The use of standardized instructions was clearly identified in half of the studies (Bowman 8c Katz, 1984; Dunn, 1993; Link et al., 1995; Mathiowetz et al., 1986; Monpetit et al. 1967; Robertson & Deitz, 1988), but not specified in the remaining papers. Future studies on hand strength testing would be more meaningful, more easily reproduced, and more useful for clinical interpretation of test scores if standardized procedures were used and specified. The American
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INSTRUMENTATION
The Jamar dynamometer was used in four of the nine studies which measured grip strength in children. However, the handle position was not consistent across the studies. The third or middle position was used by Bowman and Katz (1984), the second position by Mathiowetz, Wiemer and Federman (1986), while Fullwood (1986) and Ager, Olivett and Johnson (1984) adjusted the handle position relative to the size of the child's hand. A Stoelting dynamometer, adjusted for hand size, was used in two studies (Montoye & Lamphiear, 1977; Imrhan & Loo, 1989). Other instruments were a strain
CANADIAN JOURNAL OF OCCUPATIONAL THERAPY VOLUME 63 NO 4

C. Backman & L. Daniels

Society of Hand Therapists produced recommendations for hand function tests to promote this practice (Fess & Moran, 1981).

NO R MAT I V E DATA
Some form of normative data was included in all of the studies. However, there was no consistency across studies regarding the unit of measurement used, method of calculating individual scores (e.g., single trial, mean of three trials), types of normative scores (e.g., use of mean, standard deviation, percentiles), or age intervals used to display norms. The similarities and differences for hand strength are summarized in Table 1. The lack of consistency regarding instruments, test procedures and normative data continues to limit the reliability, validity and clinical usefulness of grip and pinch strength measures for children. In spite of the numerous methodological differences, Daniels and Backman (1993) identified a number of trends in the development of hand strength which did emerge from these studies: (a) strength increases with age, (b) boys are stronger than girls, (c) increases in strength are parallel for boys and girls until adolescence when boys' strength increases rapidly while girls' strength increases gradually, (d) the right hand is stronger for right handers while findings for left handers are inconsistent, and (e) height and weight are significantly correlated with grip and pinch strength. The question of instrument suitability is a critical variable which could influence the entire issue of the development of strength norms for children. Robertson and Deitz (1988) suggested that most commercially available dynamometers are too large and too heavy for children's small hands. Instrument size and weight could be even more important factors to consider when attempting to measure strength in children with hand impairments. These same authors point out that traditional dynamometers require the use of a cylindrical grasp pattern, while occupational therapists are more likely to be interested in measuring the more function-related spherical grasp, which incorporates thumb opposition. As a result, Robertson and Deitz (1988) chose to use the Martin Vigorimeter (also known as the Dynamometer Pinch Gauge Combination) to
236 OCTOBRE 1996

measure the spherical grip strength in children aged three to five years old. Their study cited an unpublished study (Level, 1984, cited by Robertson & Deitz, 1988) that used the vigorimeter to measure spherical grip strength in children aged six through nine years, as the apparent impetus for their study. Subsequently, Link et al. (1995) also used the vigorimeter to test preschool children. Neither Robertson and Deitz nor Link et al. used the vigorimeter to measure pinch strength in children. To date, there are no published vigorimeter pinch strength norms for children or adults. The purpose of the present study therefore, was to establish preliminary spherical grip, tip pinch and tripod pinch strength performance data for children 6 through 11 years of age, using the Martin Vigorimeter, and to describe the effects of age and gender on hand strength as measured by this instrument.

METHOD
SAMPLE

The sample consisted of 134 children, 68 girls and 66 boys, 6 to 11 years of age. Age was determined by self-report (i.e., How old are you?). The only exclusion criteria was recent hand pain or injury, but none of the volunteers indicated this to be the case. Forty-seven subjects were recruited in shopping malls and community centres in the Greater Vancouver area of British Columbia. The remaining subjects volunteered at a rural elementary school on Vancouver Island, British Columbia. Nine children stated they were left-handed. Permission to approach children was granted by the accompanying parent or caregiver in the case of community test sessions and by the principal in the case of the school. A simplified consent form was used and children signed their own forms. The study was approved by the University of British Columbia Behavioral Sciences Screening Committee for Research and Other Studies Involving Human Subjects.
INSTRUMENT

The Martin Vigorimeterl is a pneumatic dynamometer with three sizes of rubber bulbs (circumferences of 19 cm, 16.5 cm and 13.5 cm) to
'Although the vigorimeter used in this study was purchased through the J.A. Preston catalogue, the enclosed instructions describing the instrument and its calibration are labeled Elmed Incorporated, 60 West Fay Avenue, Addison, Illinois 60101.

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Table 1
Summary of 13 Studies of Hand Strength Norms for Children
first author & year

indiv
score single trial

metric

sample size

age range

Norms described by: age gender yes yes

R vs L hand
yes

score type table of means & SD for each of grip & 3 pinches

Ager 1984
Bowman

lbs

474

5-12 yrs

(1-yr intervals) 153 6-9 yrs


yes no yes

mean of kg &

table of means & SD for grip

1984
Burmeister

2 trials
not stated

lbs
kg

(1-yr intervals) 1741 K-8th grade no


no yes equations to predict strength of 5 different pinches based on hand size

1975

Dunn

mean of

mmHg

273

3-7 yrs

yes

no

yes

table of means & SD for grip

1993 Fullwood 1986 Imrhan 1989


Link

3 trials
single trial kg &

(6-mo intervals) 214 5-12 yrs


yes yes yes table of means &SD for each of grip & 6 different pinches no table of means & SEM, box plots, for grip and 6 pinches

lbs
kg

(1-yr intervals) 62 5-12 yrs


no yes

2 trials

mean of

kPa

225

3-6 yrs

yes

no

yes

table of means & SD for grip

1995 Mathiowetz 1986 Montoye 1977 Montpetit 1967


Newman

3 trials
mean of

(6-mo intervals) lbs 471 6-19 yrs


yes yes yes table of means & SD for grip

3 trials
best of kg

(2-yr intervals) 1019 10-19 yrs


yes yes no table of means, SD & percentiles for grip no graphed mean scores for grip

2 trials 2 trials
kg*

(1-yr intervals) 908 8-17 yrs


yes yes

(1-yr intervals)
mean of

1417

5-18 yrs

yes

yes

no

graphed percentiles for grip graphed mean grip relative to height and weight

1984

4 trials (2 R, 2 L)

(1-yr intervals)

Robertson

mean of

kPa

380

3-5.5 yrs

yes

no

yes

table of means 8< SD for grip

1988
Weiss

3 trials
sum of 5 different not specified

(6-mo intervals) 198 5-13 yrs


no no dominant vs table of correlations of hand length and strength pinches

1971

Note: * this author recorded strength in lbs and later converted the scores to kg

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C. Backman & L Daniels

Figure 1
Group means for grip strength by age, gender and hand.

65

60

55

50

45

40

A Boys, RH A Boys, LH O Girls, RH Girls, LH


35
/

accommodate different hand sizes or functions. The pressure exerted_ on the rubber bulb is recorded on a calibrated meter, with a needle that remains in position indicating maximum pressure exerted until released by the observer. According to the instrument specifications enclosed with the instrument, all vigorimeters manufactured prior to 1976 were calibrated in kilopont (kpt), a parameter for workload, but following international standardization of parameters by the World Health Organization, the calibration was changed to bar and kilopascals (kPa) in 1976. Pascal is "the SI unit of pressure, which corresponds to a force of one newton [N] per square meter; symbol, Pa" (MillerKeane Encyclopedia & Dictionary of Medicine, Nursing & Allied Health, 1992, p. 1116). Since all three measurement units are almost identical, except for the placement of a decimal point, this has led to confusion in recording the unit of measurement and the labeling of results [1 kpt/cm2 = 98.1 kPa (Thorngren & Werner, 1979); 1 bar = 1.019 kpt/cm2 (Elmed Inc.)]. Recording results in kPa perinits the use of whole numbers, thus the kPa scale was used in this study. Solgaard, Kristiansen and Jensen (1984) used a universal testing machine to evaluate the accuracy of the vigorimeter under a range of forces from 50 to 500 N (in increments of 50 N) which resulted in an almost perfectly linear curve, suggesting consistency regardless of the amount of force applied to the rubber bulb. They also reported low variation coefficients of 6-7/o in a clinical study of 100 adults (45 men and 55 women), and found the vigorimeter to be more precise than spring-loaded dynamometers. Jones et al. (1991), in a study of non-disabled adults and adults with rheumatoid arthritis, reported very good test-retest
reliability, r > 0.91, and inter-rater reliability,

r > 0.97. Percent agreement of 98% or better


(depending on the rater pair) was established by the first author and two research assistants prior to col-

lecting the data for the present study.

dr

PROCEDURES

I 9

I __IL_ 10 11

Age (years)

For each test of grip and pinch strength subjects were positioned following the recommendations of the American Society of Hand Therapists (ASHT): seated with the shoulder adducted and neutrally

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rotated, elbow flexed to 90, and the forearm and wrist in neutral position (Fess & Moran, 1981). Graduated benches were used to ensure that each child's feet were supported on the ground. Spherical grip strength was measured with the thumb opposed to the fingers around the medium bulb. Pinch was measured with the small bulb. Tip pinch was defined as the opposition of thumb tip to index finger tip, and tripod pinch strength (three-point palmer pinch, three-jaw-chuck pinch) was defined as the opposition of thumb pad to the pads of the index and middle fingers. The order of testing was standardized, and started with the right hand and alternated between hands, resulting in rest periods between trials of approximately 15 seconds. Grip strength was measured first, followed by tip pinch strength then tripod pinch strength. Standard instuctions were given, as follows: (a) for grip strength: "I am going to measure your grip strength. You will have three tries to squeeze this bulb as strongly as you can. Keep your arm in this position. Are you ready? Go." (b) for tip pinch strength: "I want you to pinch the bulb like this (demonstrated) using the tips of your thumb and index finger. You will have three tries to pinch as strong as you can. Keep your arm in this position. Are you ready? Go." (c) for tripod pinch strength: "I want you to pinch this bulb like this (demonstrated) with the pads of your thumb, index and middle fingers. You will have three tries to pinch as strong as you can. Keep your arm in this position. Are you ready? Go." Subsequent verbal instructions for all three measures included saying "Relax" after recording the vigorimeter score and moving on to the next trial with the statement "Are you ready for the next trial? Go." The mean of three trials (Fess & Moran, 1981) of each hand was used as the child's score for grip, tip pinch and tripod pinch.
RESULTS Descriptive data for boys and girls in one year intervals are shown in Tables 2, 3 and 4. The mean scores by age, gender and hand are graphically displayed in Figures 1 and 2. Because there are only 10

Figure 2
Group means for tip pinch strength and tripod pinch strength by age, gender and hand.

45

40

35

30

25

20

Boys, RH Boys, LH 0 Girls, RH Girls, LH


15

10 11

Age (years)

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C. Backman & L. Daniels

Table 2 Descriptive Statistics for Grip Strength (kPa) in Boys and Girls Aged 6 to 11 Years.
Age & Gender

minimum

maximum

mean

std. dey.

median

6 Years
boys
girls

21 27

21 24

59 44

59 48

39 36

36 34

10 6

10 7

40 35

34 32

7 Years
boys
girls

32 29

29 28

51 44

51 42

37 36

38 34

6 5

6 5

36 34

37 36

8 Years
boys girls

40 37

33 36

63 67

56 59

48 45

44 45

7 8

6 6

45 43

43 43

9 Years
boys girls

43 41

41 36

68 75

55 74

54 55

48 54

6 12

5 13

54 53

46 53

10 Years
boys girls

43 35

40 36

84 65

81 65

60 48

58 46

15 9

13 9

59 48

59 43

11 Years
boys
girls

59 36

54 41

86 94

93 85

66 56

63 59

8 18

12 14

62 52

59 57

Note: R = right hand; L = left hand.

to 14 children in each group, the sample was considered too small to yield meaningful results with further statistical analysis. However, the graphed data illustrate lesser differences between children at six and seven years of age that appear to become more substantial by age 11. Among the children tested, boys were generally stronger than girls and the right hand was often, but not always, stronger than the left hand.

DISCUSSION Although hand strength typically increased with age, the grip strength of 10-year-old girls dropped almost to the level of 8 year-old-girls. Similarly, the tripod pinch strength for 9 and 10-year-old girls
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also dropped below that of 8-year-old girls. Given that each age group consisted of only 10-14 children, the most likely explanation for the dips in the graphs is one related to small, non-random sampling. None of the other studies reported in the literature identified a similar trend. This result illustrates the importance of understanding the source of normative data before making judgments about individual children's test results in the clinical setting. The data from this study are insufficient to be used as norms, even though they may provide preliminary baseline information to aid in the interpretation of children's hand strength scores on the
vigorimeter.

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Table 3
Descriptive Statistics for Tip Pinch Strength (kPa) in Boys and Girls Aged 6 to 11 Years.
Age (yrs)

minimum

maximum

mean

std. dev.

median

& Gender 6 Years


boys girls

12 10

11 11

32 23

28 24

19 16

18 17

7 4

6 4

17 17

16 17

7 Years
boys
girls

16 17

12 17

23 24

24 23

20 20

19 20

2 2

3 2

20 20

20 21

8 Years
boys girls

11 16

11 15

30 26

27 23

19 22

19 20

5 3

4 3

19 21

18 20

9 Years
boys
girls

16 11

14 11

30 28

22 25

21 20

19 19

4 6

2 5

19 23

20 21

10 Years
boys
girls

18 12

15 13

34 32

33 27

26 24

24 22

6 7

6 5

26 25

24 22

11 Years
boys
girls

24 21

21 22

44 39

42 38

33 31

32 29

6 5

6 7

33 32

31 31

Note: R = right hand; L = lefi hand.

The manufacturer's insert with the Martin Vigorimeter suggests the following normal values for grip strength in healthy children: adolescents 40 to 120 kPa; 7 years old 40 to 80 kPa; 5 years old 30 to 70 kPa; 3 years old approximately 12 kPa. In the present study, neither 7-year-old boys nor girls produced group means within the range stated by the manufacturer, although 40 to 80 kPa does describe the 8 to 11- year- olds. Also, the current 6 and 7-year-olds' scores, with means ranging from 34 to 39 kPa, are lower than those reported by Robertson and Deitz (1988) for 5-year-olds (mean 42 kPa, standard deviation 9). The 3-year-olds in

the Robertson and Deitz study also outperformed the manufacturer suggested value of 12 kPa, with a mean of 23 kPa for the 68 children aged 3 to 3.5 years old, and 28 kPa for the 77 children aged 3.51 to 4 years old. However, the 3 to 5-year olds tested by Link et al. (1995), with group means of 13 to 36 kPa, are more in line with the trends emerging in the present study. Age comparisons may not be accurate since the preschool children were tested using the smallest bulb, and school aged children were tested using the medium bulb. Parenthetically, it is important to note that the medium bulb is too large for pre-schoolers' small hands. Clearly, if the vigorimeter is to be used for estimating the presence or absence of impairment with regard to hand

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Table 4
Descriptive Statistics tor Tripod Pinch Strength (kPa) in Boys and Girls Aged 6 to 11 Years.
Age lyrs)
minimum maximum

mean

std. dev.

median

& Gender 6 Years


boys
girls

2418

20 19

43 33

37 33

33 28

29 25

6 5

5 5

32 29

30 25

7 Years
boys girls

24 25

21 23

42 37

36 46

30 31

30 32

5
4

5
7

29
31

29
33

8 Years
boys girls

26 23

26 25

42 44

39 47

33 36

32 34

5 6

4 6

33 36

32 33

9 Years
boys girls

29 20

31 21

41 40

43 42

36 34

37 32

4 6

4 6

37 35

38 32

10 Years
boys

girls

31 24

28 27

50 45

46 37

39 33

36 32

6 7

6 4

39 32

36 31

11 Years
boys

girls

33 32
hand;

32 27 L = left
hand.

51 48

46 45

43 41

39 36

6 7

5 6

44 42

39 35

Note:

R = right

strength, normative data beyond those values enclosed with the instrument and in the three available studies are required. This does not, however, preclude the vigorimeter's use as an instrument for collecting baseline performance and registering change over time, since it has been shown to produce consistent and reliable data (Jones, et al., 1991; Solgaard, et al., 1984). Robertson and Deitz (1988) and Link et al. (1995) found no significant difference in the grip strength of boys and girls in the age groups they studied (3 to 5.5 years), although most other studies of hand strength have indicated that boys are stronger than girls (Daniels & Backman, 1993). The results of the present study suggest that gender differences may begin to emerge when children
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approach elementary-school age, just beyond the age group evaluated in the Robertson and Deitz, and Link et al. studies. However, in some of the age groups (in particular, the tip pinch strength results graphed in Figure 2) the gender difference is of very small magnitude in the 6 to 11-year-olds tested, suggesting that further evidence is required before it is known what, if any, effect gender has on hand strength in children.
LIMITATIONS

Although height and weight (Daniels & Baclunan, 1993) and hand size (Link et al., 1995) have been significantly correlated with hand strength, these variables were not included in the present study. It is possible that children's physical size rather than
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their age may be a more appropriate way to categorize normative data for strength measures. Use of a convenience sample, and a small one at that, limits the generalizability of the findings. The magnitude of this limitation is illustrated in part by comparing the results of the grip strength studies by Robertson and Deitz (1988) with Link et al. (1995). The former also used a convenience sample while the latter used a random sample stratefied by age, ethnicity and family income. When age group means were plotted on a graph, the pattern of the curves was very similar, but the children from Robertson and Deitz's study (white, middle-class, Seattle residents) were consistently stronger than children in Link et al's stratefied random sample from Kalamazoo preschools, by about 10 kPa. Until other 6 to 11-year-old children are tested, it is not known if the the convenience sample tested in the present study is representative of other school-aged children or not. No attempt was made to explore the relationship between hand strength and the broader domain of occupational performance. Although hand strength testing may be useful to identify presence or absence of impairment at the level of physical components, its impact on the child's performance of school, self-care or leisure activities requires additional assessment.

tional therapist's assessment of physical components, provided standardized procedures are used and data, such as norms, are available to aid in interpretation of results.
REFERENCES Ager, A.C., Olivett, B.L. & Johnson, C.L. (1984). Grasp and pinch strength in children 5 to 12 years old. American Journal of Occupational Therapy, 38, 107-113. Bowman, 0.J. & Katz, B. (1984). Hand strength and prone extension in right-dominant 6 to 9 year olds. American Journal of Occupational Therapy, 38, 367-376. Burmeister, L.F. & Flatt, A.E. (1975). The prediction of hand strength in elementary school children. Hand, 7, 123-127. Daniels, L. & Backman, C. (1993). Annotated bibliography: Grip and pinch strength norms for children. Physical and Occupational Therapy in Pediatrics, 13, 81-90. Davis, EB. (1974). Standards. for educational and psychological tests. Washington, DC: American Psychological Association. Dunn, W (1993). Grip strength of children aged 3 to 7 years using a modified sphygmomanometer: Comparison of typical children and children with rheumatic disorders. American Journal of Occupational Therapy, 47, 421-428. Fess, E.E. & Moran, C.A. (1981). Clinical assessment recommendations. American Society of Hand Therapists. Fullwood, D. (1986). Australian norms for hand and finger strength of boys and girls aged 5-12 years. Australian Occupational Therapy Journal, 33, 26-36. Hook, WE. & Stanley, J.K. (1986). Assessment of thumb to index pulp to pulp pinch grip strengths. Journal of Hand Surgery, 11B, 91-92. Imrhan, S.N. & Loo, C.H. (1989). Trends in finger pinch strength in children, adults, and the elderly. Human Factors, 3/, 689-701. Jones, E., Hanly, J.G., Mooney, R., Rand, L., Spurway, P, Eastwood, B.J., & Jones, J.V. (1991). Strength and function in the normal and rheumatoid hand. Journal of Rheumatology, 18, 1313-1318. Kuzala, E.A. & Vargo, M.C. (1992). The relationship between elbow position and grip strength. American Journal of Occupational Therapy, 46, 509-512. Link, L., Lukens, S., & Bush, M.A. (1995). Spherical grip strength in children 3 to 6 years of age. American Journal of Occupational Therapy, 49, 318-326. Mathiowetz, V., Rennells, C. & Donahoe, L. (1985). Effect of elbow position on grip and key pinch strength. Journal of Hand Surgery 10A, 694-697. Mathiowetz, V. Wiemer, D.M. & Federman, S.M. (1986). Grip and pinch strength: Norms for 6- to 19-year olds. American Journal of Occupational Therapy, 40, 705-711. Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing & Allied Health. (1992). (5th ed.). Philadelphia: WB. Saunders.

SUMMARY
Clinical assessment recommendations put forth by the ASHT for testing adults were applied to the positioning of children and use of the vigorimeter without difficulty. The scores of 134 children aged 6 to 11 years provides some baseline data for the grip, tip pinch and tripod pinch strength of typical children using the vigorimeter, however further research with larger, random sampling is required to provide useful norms. The results obtained with this sample support trends identified in the literature, such as strength increasing with age and a tendency for the right hand to be stronger than the left. Further, there is some suggestion that gender differences in hand strength just begin to emerge in the age group tested, with boys starting to have average strength scores higher than girls. Hand strength testing can be a useful part of the occupa-

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C. Backman & L. Dc-iniels

Montoye, H.J. Lamphiear, D.E. (1977). Grip and arm strength in males and females, age 10 to 69. Research Quarterly, 48, 109-120. Montpetit, R.R., Montoye, H.J. Laeding, L. (1967). Grip strength of school children, Saginaw, Michigan: 1899 and 1964. Research Quarterly, 38, 231-240. Newman, D.G., Pearn, J., Barnes, A., Young, C.M., Kehoe, M. 8c Newman, J. (1984). Norms for hand grip strength. Archives of Disease in Childhood, 59, 453-459. Robertson, A. 8c Deitz, J. (1988). A description of grip strength in preschool children. American Journal of Occupational Therapy, 42, 647-652.

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REVUE CANADIENNE D'ERGOTHRAPIE VOLUME 63 * NO 4