Effect of Hand Exercises on Hand Grip Strength and Manual Ability in Children With Visual Impairment

Not Applicable

Completed

Brief Summary: Development of the visual system immediately starts after birth via visual stimuli and interactions with the environment. The World Health Organization (WHO) has categorized visual impairments with respect to the best-corrected visual acuity as follows: blindness (Snellen visual acuity of 3/30), severe visual impairment (Snellen visual acuity between 6/60 and 3/30), moderate visual impairment (Snellen visual acuity between 6/18 and 6/60), and mild or no visual impairment (Snellen visual acuity of 6/18). The proper function of hands, particularly in delicate activities, depends on the interaction between the various regions of the brain, particularly, the sensory and motor cortex. Sensory stimulation can be used in such children to improve their manual dexterity and therapeutic interventions can be applied to gain hand strength. Developing skillful hands is a necessity in blind children as it often compensates for their missing vision. This study will focus on effectiveness of hand grip strength and manual ability with sensory stimulation in children with moderate to severe visual impairment.

Theraputty hand exercises and sensory stimulation techniques will be used.

Detailed Description: Randomised control trial will be conducted with sample size 20. 20 participants will be included in the study. There will be 10 individuals who will receive hand exercises along with sensory stimulation to improve hand grip strength and manual ability and 10 Individuals who will only receive hand exercises to improve hand grip strength and manual ability. Grip strength and will be analyzed using hand dynamometer. For manual dexterity, box and block test will be used. Grip strength and manual dexterity will be analyzed before and after the intervention.Group A individuals will only receive hand exercises to improve hand grip strength and manual ability. Group B individuals will receive hand exercises along with sensory stimulation to improve hand grip strength and manual ability.

Recruitment & Eligibility

Inclusion Criteria

Children diagnosed with moderate (Snellen visual acuity between 6/18 and 6/60) to severe (Snellen visual acuity between 6/60 and 3/30) congenital visual impairment. (9)
Children diagnosed with bilateral congenital visual impairment. (9)
No prior exposure to therapeutic interventions given to hands. (9)
Children who can understand English or regional Urdu language. (9)
Children aged above 6-12 years (9)
Children of either gender will be included.

Exclusion Criteria

Children with any orthopedic problem related to hand. (9)
Children who went through any surgery of hands or eyes. (9)
Children with any neurological issues related to hand. (9)
Those who were unable to communicate or unable to hear well .(5).
Children diagnosed with complete blindness (Snellen visual acuity of 3/30) .(5).
Non-co-operative patients

Arm && Interventions

Group	Intervention	Description
control group	theraputty hand exercises	The control group will receive thera putty hand exercises.
experimental group	theraputty hand exercises	The experimental group will receive sensory stimulation along with theraputty hand exercises.
experimental group	sensory stimulation	The experimental group will receive sensory stimulation along with theraputty hand exercises.

Primary Outcome Measures

Name	Time	Method
Hand Dynamometer	12 weeks	: most widely reported device used to measure grip strength. It displays grip force in both pounds and kilograms, with a maximum of 200 lb (90 kg). Handheld dynamometer can ensure quantified strength measurement and clinically, it is very effective and efficient tool. It is also considered as a reliable and valid tool to measure the strength of muscles in the upper and lower extremities. intra-rater (ICC 2, k = 0.95 to 0.97) and inter-rater (ICC 2, k = 0.94 to 0.95) reliability.
Box and Block Test (BBT)	12 weeks	A rectangular box divided into 2 compartments by a wooden partition is in front of the individual, and 150 coloured wooden blocks are placed in one compartment. The individual is instructed to move as many blocks as possible, one at a time, from one compartment to the other for the duration of 60 seconds. Approximately 5 minutes are required for set up, explanation of the instructions to the patient and administration of the test. Stopwatch,Wooden box with partition (box: 53.7 x 25.4 x 8.5 cm, partition: 25.4 cm x 15.2 cm x 1 cm), 150 wooden blocks (2.5 cm cubed). Scored by counting the number of blocks carried over by the individual from one compartment to the other. If the individual carries multiple blocks over at a time, this only counts as 1 point.If the individual brings the block over the partition and drops it outside of the box, the block still counts.

Secondary Outcome Measures

Name	Time	Method