ࡱ> mol5@ )*bjbj22 4`XX)" t#t#t#t#4# ?2P$P$P$P$h$h$h$h$s?u?u?u?u?u?u?$&ARxC?(&h$h$(&(&?P$h$?H(H(H((&vP$h$s?H((&s?H(0H(x(;<P$D$ Jt#&;g= ?0?;D\'D(<  D<h$L$6H($,%h$h$h$??  >(  Project title: The Ten Blood-bottle Test of upper limb function. Investigators: Aneetha Skinner, Roger Holden, Lynne Turner-Stokes Back ground A wide range of valid and reliable measures have been developed to assess upper limb function. These include the Frenchay Arm Test, Nine hole peg test, Action Research (AR) Arm test, Box and Block test, Stroke rehabilitation of movement (Upper limb subscale), Jebson Taylor Hand Function Test. However, many of these are lengthy to apply or require special equipment which may not be available in every setting. The Ten Blood-bottle Test (TBT) is designed to be a simple test of upper limb function that can be applied in any clinical setting, which does not require special equipment. The test The 10 Bottles upper limb function test requires only the following items which should be readily available in most hospital settings: 10 10 ml blood sample bottles 1 Disposable paper or polystyrene cup (10 cm tall, diameter at top 7.5 cm) 1 Mug (10 cm tall, diameter at top not less than 7 cm) 1 Meal Tray 1 Stop watch or watch with a seconds hand The bottles are put into the cup and then emptied onto the tray. The time the subject takes to put the bottles back into the cup (one by one) is recorded. The original version of this test used the plastic/polystyrene cup as the receptacle. However, the cup tends to fall over as the bottles are put in it, especially at speed. Preliminary testing demonstrates that subjects use one of several strategies to overcome this and successful placement of all ten bottles in the cup therefore tests cognitive abilities such as planning and problem solving as well as upper limb function. Use of the (more stable) coffee mug has therefore been added as a first stage test which is dependent solely on upper limb function. Upper limb function is to some extent dependent on age and dominance of the limb and as yet there is no normative data for this test, either using the cup or the mug as a receptacle. Naturally the configuration of the equipment will vary slightly from setting to setting, so before we seek to pilot the test in clinical populations with impaired UL function, it is necessary first to obtain data from the normal population, across the age ranges The aims The purpose of the present study is to define the normative values of the ten Blood Bottles test, in the unaffected population A secondary aim is to engage as many of the UK specialist registrars in rehabilitation medicine as possible in a collaborative project, and to familiarise them with the test. Once data has been collected and collated for the normal population, a multi-centre reliability study will be set up to test the repeatability of the test and its validity in discriminating between normal and abnormal function Method of investigation The subjects In the first instance, data will be gathered in a group of normal adults who have no symptoms of upper limb dysfunction. Participating SpRs will be asked to recruit a sample which includes at least one male and one female in each of the following age groups: 16-25, 26-35, 36-45, 46-55, 56-65, 66-75, 76-85, 86+. These individuals may be recruited from their family and friends, and may include hospital staff so long as this is done on an entirely voluntary basis, out of working hours. The SpRs will also be invited to participate in the second study, which will examine repeatability and validity in individuals with mild to moderate upper limb dysfunction. However, this second study will require MREC permission and will be described in a separate proposal. The procedure and materials used Equipment 10 x 10 ml blood bottles as available in the Trust where the SpR works 1 x Disposable cup (paper or polystyrene) 1 x China coffee mug 1 x Hospital meal tray again as standard issue within their local Trust 1 x Stopwatch, or watch with second hand Each SpR is asked to record a digital photograph of the equipment they use, so that variations can be recorded, and also to record the dimensions of the meal tray and of the cup and mug that they use. Information and invitation to participate Written information giving a brief outline of the study will be given to the participants. The information leaflet will contain a reply slip for staff to indicate if they would/would not be willing to participate, and a convenient time will be found. The test usually takes no more than 10 minutes. Outline of Procedure The purpose and outline of the study is explained to the subject They are asked to indicate their age band, gender, and dominant hand. Part A A coin is tossed to determine the order of completion of the test ( dominant or non-dominant hand first) The ten blood bottles are place in the mug and emptied haphazardly onto the tray. The mug is then place in the centre of the tray. The individual is instructed I would like you to put all the bottles into the cup/mug with the lid up, as quickly as possible, You may only use one hand at a time (I will tell you which hand in a moment. You can only pick up one bottle at a time. You may not hold the cup/mug with your other hand. The observer starts the timer at the time the say go Times are recorded when the fifth bottle has been placed, and the tenth - at the point where all ten bottles have been successfully placed in the upright mug. The bottles are then emptied out again, the mug place centrally, and the test repeated using the opposite hand. Further tests are repeated, using alternating hands until the subject has complete three with each hand. If one or more of the bottles fall on the floor that test may be re-started Part B: The same procedure is then completed using the paper or polystyrene cup, starting with the same hand as they started Part A. In addition to the recorded times, the observer records any strategies used to stabilise or right the cup (this may be discussed with the subject to understand the extent to which these were deliberate or automatic) For example, some subjects place all the bottles into the fallen cup and place it upright only at the end. Others space the first 3-4 bottles around the cup to stabilise it before placing the remaining bottles If the subject asks about any strategies other than those given in the instructions, they are told they may decide, but any strategies used are recorded on the datasheet Participants are then thanked for their contribution Data handling Data will be entered into an Excel spread sheet and analysed using simple descriptive statistics Ethical considerations The proposed study has been approved by the British Society of Rehabilitation Medicine Research and Clinical Standards Committee. Ethics permission is not needed for the pilot study on normal individuals. Where the recruiting SpRs and/or their consultant agree to participate in the phase II study, one of them will be named as the local investigator in each centre for the MREC application. Method of dissemination of findings Poster presentation at BSRM meeting. If successful, we will also publish this study in a peer reviewed journal. 10 Bottle Upper Limb Function Test Data Collection tool Name: 1. Date Completed: _ _ / _ _ / _ _ _ _ Time. 2. Gender: Male  Female  3. Age: 16 25  26 35  36 45  46 55  56 65  66 75  76 85  86+  4. Dominant hand Left handed  Right handed  Mug: Which hand first: Dominant / Non-dominant (Toss a coin) Dominant handNon dominant handAttempt5 bottles10 bottlesAttempt5 bottles10 bottlesFirstFirstSecondSecondThirdThird Cup: Which hand first: Dominant / Non-dominant ( same order as Mug) Dominant handNon dominant handAttempt5 bottles10 bottlesAttempt5 bottles10 bottlesFirstFirstSecondSecondThirdThird 6. Strategies used 7. Any other comments Investigator:Signed Equipment used: It is assumed that the same equipment will be used for all tests undertaken by each spR, so this information need not be duplicated for each subject, unless the equipment specifications change Please record a digital photograph of the equipment used for this test and supply the following dimensions: Meal tray: cm. X cm. Mug: Height: cm Diameter:.cm Cup: Height: cm Diameter:.cm Material: paper / plastic / polystyrene ( circle one) Timer used: (tick one) ( Stop-watch ( Wristwatch with second hand Name of Investigator:.(please print) Centre ..(please print) $%(?@A`a' / . 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