Grasp pattern variations seen in the scleroderma hand.

OBJECTIVES Therapists generally describe a person's grasp in terms of normal prehension patterns that have been discussed in the literature. However, the grasp pattern used by a person with a hand impairment may not fit into these patterns. The purpose of this study was to describe, with qualitative classification systems, static grasp patterns used by hands impaired by scleroderma and to determine the relationship between hand impairment and variations in grasp. METHODS Seventeen subjects with scleroderma were observed grasping a key, a coin, a glass, and a saucepan. Their grasp patterns were recorded on the basis of which fingers were used to grasp the object, the surface areas of the fingers in contact with the object, and the position of the joints of the fingers. In addition, range of motion, grip and pinch strength, skin thickening, digital ulcers, calcium deposits, and tendon friction rubs were assessed. RESULTS More variations in grasp were seen with the coin, glass, and saucepan than with the key. The presence of digital sores indicated more difficulty holding a coin, whereas the presence of calcium deposits indicated more difficulty holding a coin, glass, and saucepan. The number of fingers with contractures correlated with the ability to hold all four objects. CONCLUSIONS Persons with scleroderma show qualitative differences in grasp as compared to normal prehension patterns. These differences are influenced by impairments in the scleroderma hand. Qualitative descriptions of grasp patterns may provide therapists with additional means to document change after surgical or therapeutic intervention.