assembly tool usage and upper extremity disorders

Assembly Tool Usage and Assembly Tool Usage and Upper Extremity DisordersUpper Extremity Disorders

Group 12Group 12Katie BragnaloKatie Bragnalo

Maaz MalikMaaz MalikJimmy WarnerJimmy Warner

Hand Tool DexterityHand Tool Dexterity

There are two There are two different different names for the names for the test that is test that is performed performed using this using this tool:tool:

• Minnesota Hand Tool Dexterity TestMinnesota Hand Tool Dexterity Test• Bennett Hand Tool Dexterity TestBennett Hand Tool Dexterity Test

Minnesota (Bennett) Hand Tool Minnesota (Bennett) Hand Tool Dexterity TestDexterity Test

Description: Description: Twelve Twelve nut/bolt/washer nut/bolt/washer assemblies of assemblies of three different three different sizes in a sizes in a wooden frame wooden frame are loosened are loosened with tools, with tools, disassembled, disassembled, transferred to transferred to the other side of the other side of the frame, and the frame, and tighten with tighten with tools. tools.


Objective: The test can be used as a Objective: The test can be used as a general assessment of an individuals skill general assessment of an individuals skill in using ordinary mechanics tools. Results in using ordinary mechanics tools. Results of the test have been used to determine of the test have been used to determine vocational interest and as an indicator of vocational interest and as an indicator of success where jobs/tasks require the use success where jobs/tasks require the use of these and similar tools. of these and similar tools.


Before administering test:Before administering test: Check apparatus to ensure Check apparatus to ensure

all bolts are on the same all bolts are on the same side of apparatus with all side of apparatus with all heads on the inside.heads on the inside.

Ensure nuts cannot be Ensure nuts cannot be removed with fingers, yet removed with fingers, yet are not too tight to be easily are not too tight to be easily removed with wrenchesremoved with wrenches

Ensure that once loosened, Ensure that once loosened, nuts can be removed easily nuts can be removed easily with fingerswith fingers

Close jaws of adjustable Close jaws of adjustable wrench completelywrench completely

Place tools between uprightsPlace tools between uprights Set the frame with the bolts Set the frame with the bolts

at the left of the examineeat the left of the examinee


Procedure: Procedure: Normal setup – standing with the frame securely Normal setup – standing with the frame securely

clamped to work surface 34” in height. clamped to work surface 34” in height. Instruct according to Bennett Hand Tool Dexterity Instruct according to Bennett Hand Tool Dexterity

Test Administration ManualTest Administration Manual NOTE – this is not a test of ability to follow directions NOTE – this is not a test of ability to follow directions

therefore additional instruction and demonstrations therefore additional instruction and demonstrations may be given to ensure the examinee understands may be given to ensure the examinee understands the taskthe task

Score using the Administration ManualScore using the Administration Manual


A series of instructions are then read to the examineeA series of instructions are then read to the examinee These instructions include:These instructions include:

The best way to go about testThe best way to go about test To loosen all nuts in the row with the tools the remove fully with To loosen all nuts in the row with the tools the remove fully with

fingersfingers To remove all nuts and bolts before transferring to second To remove all nuts and bolts before transferring to second

uprightupright Once removing the bottom row do not place bolts on table, place Once removing the bottom row do not place bolts on table, place

them in holes on opposite uprightthem in holes on opposite upright Tighten all nuts with fingers then with toolsTighten all nuts with fingers then with tools Ensure heads of bolts are on the inside of the uprightEnsure heads of bolts are on the inside of the upright To work as rapidly as possibleTo work as rapidly as possible

The examiner starts timing as soon as the examinee The examiner starts timing as soon as the examinee picks up the first wrenchpicks up the first wrench

Minnesota Hand Tool Dexterity Minnesota Hand Tool Dexterity TestTest

Procedure (con’t):Procedure (con’t):1.1. Check bolts to make sure they cannot be removed with Check bolts to make sure they cannot be removed with

fingers – they must be loosened with tool firstfingers – they must be loosened with tool first2.2. Close jaws to adjustable wrench and place in boxClose jaws to adjustable wrench and place in box3.3. Set frame with bolts to left of examineeSet frame with bolts to left of examinee4.4. Objective: remove all bolts from one sire and assemble Objective: remove all bolts from one sire and assemble

on the other sideon the other side5.5. Nuts inside to start then outside to finishNuts inside to start then outside to finish6.6. Loosen all nuts first then spin off nutsLoosen all nuts first then spin off nuts7.7. Remove middle row then lay on the benchRemove middle row then lay on the bench8.8. Start at the top and work to the bottomStart at the top and work to the bottom9.9. Work left to rightWork left to right10.10. Start with small then medium then largeStart with small then medium then large11.11. Tighten to point where fingers cannot remove Tighten to point where fingers cannot remove


Evaluates:Evaluates:1.1. Manipulative skill independent of intellectual Manipulative skill independent of intellectual

factors such as understanding of mechanical factors such as understanding of mechanical principles or the ability to plan a task or follow principles or the ability to plan a task or follow directionsdirections

2.2. Medium dexterityMedium dexterity3.3. Simple tool handling capabilitiesSimple tool handling capabilities4.4. Physical tolerances:Physical tolerances:

Standing with some bendingStanding with some bending Sustained horizontal reachingSustained horizontal reaching Bilateral light to moderate pushing/pullingBilateral light to moderate pushing/pulling Torquing with hand toolsTorquing with hand tools Bilateral fingeringBilateral fingering


Special Instructions:Special Instructions:

1.1. Workstation modifications may include:Workstation modifications may include: Positioning of examinee seated, for severe Positioning of examinee seated, for severe

intolerance of standing.intolerance of standing. Adjustment of the work height to minimize Adjustment of the work height to minimize

bending or neck flexion, if necessary for bending or neck flexion, if necessary for lower back or cervical pain disorders.lower back or cervical pain disorders.

2.2. Document workstation modificationsDocument workstation modifications


Observations:Observations: Ability to tolerate about 10 minutes of standing with some Ability to tolerate about 10 minutes of standing with some

bendingbending Posture and positioning – standing on one leg, Posture and positioning – standing on one leg,

slouching/bending, lateral bending, rocking from side to sideslouching/bending, lateral bending, rocking from side to side Avoidance of use of one hand or armAvoidance of use of one hand or arm For severe hand injuries, resourcefulness in performing the task For severe hand injuries, resourcefulness in performing the task

partially or completely one-handedpartially or completely one-handed Interpretive Issues:Interpretive Issues:

Difficulty tolerating pushing/pulling of tools needed to Difficulty tolerating pushing/pulling of tools needed to loosen/tighten assembliesloosen/tighten assemblies

• Severe cervical, shoulder or lower pain disordersSevere cervical, shoulder or lower pain disorders Inability to maintain a symmetrical, stationary standing position Inability to maintain a symmetrical, stationary standing position

for short duration comfortablyfor short duration comfortably• Severe lower back pain disorders, or disorders involving the knee(s) Severe lower back pain disorders, or disorders involving the knee(s)

or ankle(s)or ankle(s)

Minnesota Hand Tool Dexterity Minnesota Hand Tool Dexterity TestTest

Scoring: The score on this test is the Scoring: The score on this test is the amount of time that it takes the examinee amount of time that it takes the examinee to remove the nuts and bolts from the left to remove the nuts and bolts from the left upright and mount them on the right upright and mount them on the right upright. The timing starts when the upright. The timing starts when the examinee picks up the first wrench and examinee picks up the first wrench and stops when the last bolt is tightened.stops when the last bolt is tightened.


Scoring is a time percentile based on:Scoring is a time percentile based on: GenderGender EmploymentEmployment Physical capabilities/limitationsPhysical capabilities/limitations Race/ethnicityRace/ethnicity AgeAge

Where/when the test is usedWhere/when the test is used

Automotive or aviation mechanics and students Automotive or aviation mechanics and students in these areasin these areas

WeldersWelders Maintenance positionsMaintenance positions Vocational institutesVocational institutes For workers with back or other injuriesFor workers with back or other injuries Aviation mechanics/studentsAviation mechanics/students RehabilitationRehabilitation Machine/tool operatorsMachine/tool operators Assembly line workersAssembly line workers

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

The DASH Outcome Measure is a 30-item, self-The DASH Outcome Measure is a 30-item, self-report questionnaire designed to measure report questionnaire designed to measure physical function and physical symptoms in physical function and physical symptoms in people with any one of several musculoskeletal people with any one of several musculoskeletal disorders of the upper limb. The tool gives disorders of the upper limb. The tool gives clinicians, researchers, and ergonomists the clinicians, researchers, and ergonomists the advantage of having a single, reliable instrument advantage of having a single, reliable instrument that can be used to assess any or all joints in the that can be used to assess any or all joints in the upper extremity. upper extremity.

Prior to using the tool, an intent to use form must Prior to using the tool, an intent to use form must be filled out and sent to the Institute for Work be filled out and sent to the Institute for Work and Health located in Toronto, ON Canada.and Health located in Toronto, ON Canada.

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

The disabilities of the arm, shoulder and The disabilities of the arm, shoulder and hand (DASH) outcome measure was hand (DASH) outcome measure was developed by the American Academy of developed by the American Academy of Orthopedic Surgeons as a region-specific Orthopedic Surgeons as a region-specific instrument for measuring upperextremity instrument for measuring upperextremity disability and symptoms (Hudak et disability and symptoms (Hudak et al.1996).al.1996).


Instructions:Instructions: Every question is to be answered based on the Every question is to be answered based on the

client’s condition in the last week by circling the client’s condition in the last week by circling the appropriate number appropriate number

If a certain activity was not performed in the past If a certain activity was not performed in the past week, client is to estimate to the best of their ability week, client is to estimate to the best of their ability which response would be the most accuratewhich response would be the most accurate

It does not matter which hand or arm is used to It does not matter which hand or arm is used to perform the activity, client must still answer based on perform the activity, client must still answer based on their ability regardless of how the task is performedtheir ability regardless of how the task is performed


Some examples of questions relate to:Some examples of questions relate to: Opening a jarOpening a jar WritingWriting Sexual activitiesSexual activities Gardening/yard work Gardening/yard work The questions are to be answered choosing The questions are to be answered choosing

one of five options provided by the Likert one of five options provided by the Likert scale questionnaire.scale questionnaire.

DASH DISABILITY/SYMPTOM SCORE = [(sum of n responses) - 1] x 25, where n is equal to the number of completed responses.

DASH cont’dDASH cont’d

A dash score may not be calculated if there are A dash score may not be calculated if there are greater than 3 missing items (questions).greater than 3 missing items (questions).

There are two other optional modules contained There are two other optional modules contained within the questionnaire called The Work Module within the questionnaire called The Work Module and the Sports/Performing Arts Module.and the Sports/Performing Arts Module.

The Work Module asks questions about the The Work Module asks questions about the impact of arm, shoulder, or hand problems while impact of arm, shoulder, or hand problems while at work and the Sports/Performing Module does at work and the Sports/Performing Module does the same but asks questions about playing the the same but asks questions about playing the instrument or sport.instrument or sport.

Test Reliability and ValidityTest Reliability and Validity Reliability and Validity: Reliability and Validity: A Swedish version of the test was A Swedish version of the test was

studied by Isam Atroshi, Christina Gummesson, Bodil studied by Isam Atroshi, Christina Gummesson, Bodil Andersson, Elsa Dahlgren and Anita Johansson (2000). Andersson, Elsa Dahlgren and Anita Johansson (2000). The participants completed the DASH and SF-12 generic The participants completed the DASH and SF-12 generic health questionnaires before elective surgery or physical health questionnaires before elective surgery or physical therapy. Internal consistency of the DASH was high therapy. Internal consistency of the DASH was high (Cronbach alpha 0.96). Test-retest reliability, evaluated (Cronbach alpha 0.96). Test-retest reliability, evaluated in a subgroup of 67 patients who completed the DASH in a subgroup of 67 patients who completed the DASH on two occasions, with a median interval of 7 days, was on two occasions, with a median interval of 7 days, was excellent (intraclass correlation coefficient 0.92). excellent (intraclass correlation coefficient 0.92). Construct validity was shown by a positive correlation of Construct validity was shown by a positive correlation of DASH scores with the SF-12 scores. DASH scores with the SF-12 scores.

DASH is a reliable and valid instrument that can provide DASH is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in a standardized measure of patient-centered outcomes in upper-extremity musculoskeletal conditions.upper-extremity musculoskeletal conditions.

Test Reliability and ValidityTest Reliability and Validity

The DASH has been shown to be reliable and valid in a The DASH has been shown to be reliable and valid in a patient population with elbow disorders (Turchin et al. patient population with elbow disorders (Turchin et al. 1998) and another with various upper-extremity 1998) and another with various upper-extremity disorders (McConnel et al. 1999).disorders (McConnel et al. 1999).

However,However, obtaining population norms for the DASH will enhance the interpretability of the scores.

The original DASH was administered to 368 patients with different upper-extremity conditions, and the results showed a mean DASH score of 38 (SD 22) and a median score of 35 (McConnel et al. 1999).

assembly tool usage and upper extremity disorders

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