NOTICBThis narcriatmaybo

protcctcd bycopyilgfulawFitle 17 US Oo&l

' l l l f. O(.(ltrPAllONAl. l l l I ' :RAPY lOIJRNAI. Of Rl^sl:AR(:lI s I

test and retest occasions. Possible uqriables that malt baueaffected tbese results are discwsed To eualuate concurrenlualidiA, he Nine Hole Peg Test wcts compared to tbe PurducPegboard The obsmted colrelations (right r = -.61, leltr = -.5il indicated that the tests are timilar but not equiu-alent tests of finger clexterity. For the normatiue datct stud.1',628 nonnal subjects from 20 to 94 years were tested Datetwere stratified by sex and by 12 age groups to allout tbctherupist to easily compare patients' scoles to a nornutiL,epopulation Data sbtruted tbat females scored sligbtly hettartban males, finger dexterity decreased witb age, ancl rigbt.hand and left-band dominant subjects demonstrated mini-mal differences in performance.

The Nine Hole Peg Test is commonly uscd by occupational therapists usa qrrick measuremcnt of t ingcr dexterity. A rclativcly incxpensil 'c con-struction cost and bricf :rdministration timc may account for its widc-spread use. Only one publishcd report on the Ninc Hole Pcg ' l 'cst \\ ' :rstbund (Kellor, Frost, Silbcrbcrg, Ivcrscn, & Cummings, l97l ). That studvuscd a samplc of 250 malcs :rnd fcmales, stratified by scx ancl thrcc l:rrgcage groups. Normative data based on regression analysis were proviclcdfor 20- to 80-year-old adults in 5-year intervals. The norms we re prcse ntcdin tabular form, facilitating comparison of patient scorcs rvith nornrulindividuals of the sanre lgc and sex. A description of the pcgs and pcli-board was provided, but thc containcr for the pegs was not dcscribcd irtsufficient detail to be replicated. The general procedure for testing, rvusdescribed, but therc wcrc no standardized instructions reportcd. In iultli-tion, no reliability or validiry data were reported in the articlc. I)uc tothese limitations, the validiry of the Nine Hole Pcg Test and its av;ri luhlcnorms wcrc scriously conrpromiscd.

An alternative m€asure me nt of finger dexteriry is the Purdue Pcgb<xrrd.which has been standardized for factory workers in a widc varictv ofindustrial iobs. Reliabiliry and validity data have been reported, and nor.mative data have been established for various employee groups (Tiftin,1968) and school children (Gardner & Broman, 1979) Unfortunrtclr '.normative data are lacking for a general adult population. For clinici:rns.perhaps the most obvious limitations of the Purdue Pegboard is that thcnormative data for factory workers poorly represent the older adults sccnin most physical disabil it ics clinics. In addition, the test in its cntirctl issomewhat lengthy to administer.

Adult Norms For The Nine Hole pegTest Of Finger Dexterity

Virgil MathiowetzKaren Weber

Nancy KashmanGloria Volland

'l'he prtrposcs o.l tlttis stud-\' u,ere tO cstablish standarrlizetl

procedttres for the Nine Hole Peg Test of finger dexteriq,, toet'aluate its reliahilitlt tmcl ualiditlt, and to establish neu,t'linicttl ttttrttrs lxtserl ott tbesc sktrldurdizcd proceclttres. l\trthe reliabilit.y mtd uctlicliU, strtdl, 26 female occupationallherilP.l' stttd('tlts tt,t'rc lasled. Ven, bigh inteffater reliabilit.l,(rigbt r = .9', lcl't r = 99) u,crsfrntncl.'fest.retest retiabilitl,urcts rcporlcd to be rnrxlenrte to bigb (rigbt r = 69, left r =-I.J)trtrrl u srlgtri.l'ictrnt ltrrtt'tir'c ef[L't't tt'tts found behrccn tht,

\rirgil )tathiorverz, \lS, OTR, is Assistanr professor, Occupational Therapy pro_gram, [tniversin' of \\'isconsin-]lilwaukee, p.O. Box 413, Milwaukee, lVI 53201.Karen \\reber, orR, is sraff occupational therapist, sacred Heart RehabilitationHospital, ill i lwaukee.

Nano' liashnran, O]'lt, is surff occupational therapist, l\{ilwaukee County MenolI {eal th Complex. } l i lqaukec.

Gloria Volland, OTR, is Director of Occupational Therapy, River l{iils Wesr HealthCare Centrr , Pcrvarrkct . . Wl.

I c r \ \ r r r r l r t t i l (o r \k r l l : a , t r r i l l ) . i l r i l i l . r1 I l r r r ! l ] r ( .u lu r t r )n a nx , ( ) r ! r r r rc l in f , t ro t a hand ( r_ r lo r r ion

l0 )lA'l lIlO\\'l-. 1 Z, \\'I:lJt:R. KASIl,\1AN. VOI.IANI)

Table I(.haractcrisrics of Subjccts: Age, Sex, and Hand Dominance

lUales FemalesAge Range N Mean Age Righf Leff N Mean Age Righf Left,

' i l r l - o(-( . t PAl toNAt- ' f l tERAPY.touRNAl. or Rh.sFlAR(.1| i I

Table 2lest .Retcst Rel iabi l iw of Nine Hole Pcg Tcst

for 27 Females, Ages 2O-39,

Using th( Pearson Correlation Coeficient

Test2(i-2i) i - 7()

.l( !-li

.r t-.19-r(l-{,i.r 5--i9) ( F ) - l

f-i960--6i65-69

1 5 +

l'otirl

2 9 2 t 7 2 6 J2 7 . 4 2 t 6

2 - J 2 r 2 4 ll 5 J r l u I2(r . i L5 22 4Iti .r'. l 2it 0. ?5 5 t . 9 25 02 f i 7 . t 2 t 0)4 (r?. I 22 22 t- (t6.f 27 026 72 .0 21 l

26 22.4 26 027 26.6 25 226 32.1 23 32 5 3 6 . 4 t 7 83r 42 .1 l0 I2 5 1 7 . t 2 5 025 5r.9 22 325 56.5 25 025 62.4 24 I28 67.3 25 329 71 .8 28 |

Correlat ion

25 789 25 0 26 78 .8 25 1JrO 288 22 318 295 2)

69 i "-i 213'

' t r < . o 5 .' ' /, <.(x) I.

four tcsts of hand strength. The latter were administered aftcr thc t\\'odcxtcriq'tests to avoid hrving fatigue affect thc dcxteriry test scorcs.

RESUTTS

Reliability and validity Study

A very high interrater reliabiliq, ( right r = .97 ,left r = .99) was obtaincdusing the Pearson correlation coemcient. Test-retest reliability was hig,h(r = .69) for the right hand and moderate (r = .4J) for the left hand(Table 2). Using the same test-retesr reliabiliry data (Table 2), I ts'o-tailed, paired data t test was used to evaluate the practice effect berrvccnthe rwo occasions for each hand. A significant diffcrencc was notcd tirrthc right hand Qr<.001) and fbr t lrc lctt hand (p<.05). A Pcarson cor'relation coemcient was used to assess the concurrent validiry of the NineHole,Peg Test with thc Purdue Pegboard as the parameter. A sig,nificirntinvcrse rclationship was obtained for the right hand (r = - .61) and tltcleft hand (r = -.i3).An inverse relationship was expected, becausc tltclon,er the score on thc Ninc Hole Peg Test, the bctter the pcrformatlcc.whcreas on the Purdue Pcgboard, thc higher thc score, the bcttcr thcpcrfirrmancc.

Normative Study

The avcrage performancc of males on the Nine Hole Peg Tcst is rcportcdin Table 3 and the averag,c performance of females in Tablc 4' tor botltmales and females, the 2V24 age group demonstrated the highest pcr'formance (lowest score), and the 75 + age group demonstrated the lon'cst

Righ l

Lc t t

1 6 . r 1 8|8 .7 1 .6

t 5 . 2 l . 6t 7 . t 2 . 2

J 5'0 { )

'Right-lrand or lcft-hand d()minancc.

from 20 to 59 .vcars of age were free from disease or injury that couldaffect rheir dexteriry. The following less stringent criteria were followedfor subjects o\1er age 60: ( I ) no acute pain present in their arms andhands; (2) ar leasr 6 months post-hospiralizarion (i.e., heart attack or anysurgen'); (.1) nraintaincd a normal l i festylc (i.e., subject had not hadrestricted activin. le yel be cause of a health problem). Consequently, peo.plc rvith dcgcncr:rrivc joint discasc rvho wcrc not currcntly cxpcricncingpain and who wcrc maintaining their normal acrivity level were includedin this study. The rationale for using these less stringent criteria is thatpcoplc of this ;tgc group frequenrly huve sonre chronic health problems(.lack .\ Ries, lgti I ).

A bricf inten,iew preceded all the testing procedures to determine ifsul)iccts ntet rhc l[><lvc critcria. ' l 'hc

subject's name, age, sex, hand dom-in:rnce, :rnd occirp:rti,n q,crc recordcd. Hand dominance was determinedbv rsking, "Arc \ 'ou right.handed or lcft-handcd?,' If rhe subject reportedtho' uscd bclth hands equallr', thc hand used to write was determined tobc the "dominanr" Itand. This study was part of a larger study of handstrcngtlr lnd dcxrcritt,(Mathiowctz, Kashman, Volland, Veber, Dowe, &Rogers, in press; Mlrthiorvetz, Volland, Kashman, & Weber, in press). TheNine Hole Peg 'l-est was the first test administered in a series of tests. Itwas follon'ed bv u tcst of manual dcxteriw, rhe Box afti Block Test, and

. JZ ) lA l 'H iO\ \ /E l '7 . . \ \ ,E I tER, KASt I r \1AN. \ , ( ) t . tANt )

Table j.\r'crugc l)crfi;rmancc of Normal Males

on rhc Ninc l lo lc peg' l 'est ( r in)c in secont ls)

Age Hnnd Mean SD SE Low Hish

l 'HE OCC(, IPAI ' IONAI- ' fHEMP\ ' . IOLIRNAI,

OF ITESEARCII 5 I JJ

Table 4Average Pcrfbrmance of Normal Fcnralcs

on thc Ninc l lo lc Pcg Test ( t imc in scconds)

Age Hand Mean SD SE Low I{iglr) i L ) J

' ) i_ )()

.1(I-J j

.t i-.19

.r()- | |

.t.)- r(.)

)(F){

))-)\,

60-(r-r

6;69

7(!--J

7 5 +

Al l I I r lcSubiecrs

l ( r . l

I (r.fl

t 6 -

I - . -

l r . '

I t i . -

r -.9

t 9 . rt - -

r u 9IU .uf,O. r

r 9 .220. -

l 9 . ll t . r )20. .1l l . 020,--) f ( )

22. ( l-2.1. tr) ) r \

i ( ) . I

1 9 . 020.(t

R

R

l .l)

R

I .

R

I .

I t

l .

R

I ,

R

R

;t .RI ,R

t{l .

r . 9) . 2L(r

1 . 6

z \

! . 2

2 . 1

I tt . !1 . 0I t! .9Lu) \t 6

2.62 5) 0

l 5.1. l.1 91 0-r.u

1 9

. _15

. i t

..1 I

.iit

. t J

. { 8

.70

. r .1

..t9, i J

5 5

.1616)()70' )q

i l5 5o /

t ) )

17809(rl 822

l . J

I Jt 1l )

t 1

t 5l : l

l l

I t )

l 5t 5t ;t 6I it 7l )

l 81 5l{Jl 1

l 6l 7l 9l . lr l

zz

2 l2 l! +

26

2IlJ J

2 . i! 72 Z

2 52 72 52 7)().10.10] Jt 5J73 537

RI

RL

R

l .RI.Rt .Rt .Rt.

Rl .RLRI-RI .RL

Z, I! . +

2 .22 . 11 . 9

.1.( )1 . 6) r l

l . l2 . t i1 . 0l . ( )2 .5

J.02 .6) l

2.02 .2

2 1' r.1

2.7l o

. i . l

l.tlt . {

4 l

. { l

.+0

_10

. i 0

. {0

. 5 1

.19

..{rl

.50

.60

. 5 2

..19

.11

.44

. ) I

) l

.5t l

.ll5

. 1 6

. 1 9

t 7r it .1l 5l - 1

l 5L 4I ir . iI f

l . al ( rl 4l 6

l 6l 5t 1r 6t 7I )

I t l

l ?

I t l

l 2

l {

2 2i t )

) l

! >

.l( )

] J

.l0

i l) l

J t

l {

. l l

2 . t

!6

.16

J J

2 5

l 5

Z6

l()

2 -

J l. t iJ lt i

2t>24

) <--)o

10-.1{

35-.19

i( l - r r

.i5-i9

) ( F ) {

5 s-59

6tl-(r{

65*'69

7(>71

/ ) +

All l:cmalc

Sublccts

I ) . t J

t ] . 2I 5.itt7.2I (r.J

t ; . rJl 6 . it 7..1| (r.ll

I tl.(rt ' . 11 8 . l

I 8 . 0

20. I

t 7 .8

r9.1I tt.{20.6t o <1 r i

20.222.t12 l . tz{ ( )

l 1 . 9t 9.6

performance (highcst scorc) Thus, ir was rrot surprising that there wasa high correlation bcrwccn thc_Nine Hole peg Tesi and ige (mates: righthand r = .62, left hand r = .65; females: right hand r = .d,left hirOr = .63).

vhen the scores of all malc subiects and all female subiects were com-pared using thc dara from Tabres 3 and 4, ir was crear ihat the averagcfemale scored slightly betrer rhan rhe average male. This can be grapi'i-callv seen in Figurc I, which al.so demonstraies a relatively normai-curvein the disrriburion of scorcs on rhe Ninc Hole peg Test.

vhen rhe scores of right-hand dominant ana tln.niho dominant sub-

jects were compared, therc was little functional diffcrcnce betrvccrr thcirmean scores. As would bc cxpccted, for malc and fcmalc right-hand donr-inant subjects, their right-hand mean scores were I to 2 seconds bcrrcrthan their left-hand m€an scores. For male left-hand donrinant subiccts,their left-hand m€an scores were less than I second better than tlrcirright-hand mean scores. ln contrast, female left-hand dominant subjcctsscored better with their right hands than with their lcft hands, I)uc t(}these mixed results with lcft.hand dominant subiects, the relativclv srrrulldi-fferences between their mcan scores, and the fact that lcft-hancl dorrrinant subiects comprised oaly 7o1, of the sample, the normativc clat;r in

t { I IA ' l l l lO\ \ 'L l ' lZ, \ \ r l :Bt_R, KASt iMAN, \ .OLlnNI)

O O O 6 0 uo 6 o e . ; l g R R l

Acuanbar3

I : igrr rc J l ; rcr l r rcncr polvtons f r l r f i .nta lc ;Lrrc l r l : r lc

N

@

6

o

a

No

o oo Eo co ON ( J

6 ;

o ( l )

. 96 Oc U )

N O

o .(DN F

N 6 '

N

N Oo t r

-2@ F

o0)

; a ); ( !

t I E

t i lE oC(.t. j t ,A Ir()NAl_ l Ht:R\p\ ' . lotrRNAt. () l : RESI_ARClt 5: l J5

Tables 3 and 4tafe the combination of borh r ishr- rnd left"hand dominantsubiccts.

DISCUSSION

Reliability and Validity Srudy

The very high interrater reliabiliry demonsrrarcd rhar nvo independentraters scored the test in nearly the exact same wal'. The moderate to hightest-retest rel iabi l i ry scores rvere lowcr t l i ; rn desirablc for a tcst of f ingerdexterity. The Purdue Pegboard, a similar resr, has reported higher reli.abi l i ry (r = .60 to .79)for onc rr ial resring. Onc possible cxplanation isthrrt thc sxmplc tcsted in this studr, tvls : l vcn' hontogcneous group ofnornlal subjects ( nrinimal variancc in scrlrcs ). Sincc thc :r |cr i lgc tcst scorcswerc relat ivcly low, a small change in scores coul( l haYe affected thercl ixl) i l i t ) .

' l ' (rst-rctcst rcl iubi l i tY nt ight l)c irrrproVcrl br rcr luir ing tu() or

t l .rrec tr ials to obtain a larger samplc of rhc subiccr 's pcrformance. Manvtests of dexterity, such as the Plrrdue Pegltoarcl .lld rltc Nlinrrcsota Rateo l 'Mun ipu la t io r ) ' [ ' cs t , s r . r l ] l l cs t n tu l t ip l t . t r i l l s to i l t rp rovc rc l i r r l t i l i t y . Inarl t l i t i<ln, t l rc sqr.r ' l rc containcr clcsigrrccl f i rr thc pcus nrat.havr uffcctcclscolcs. Sonlc subjt 'cts lr :r t l r l i l f icrr ln pickirrg up l)cl ls rhi lr \ \ 'crc i l l thecorncrs , rvh ich n t igh t no t l )c i l l t ro l t l cnr rv i th : r ro r r r rc l co t r ta incr . Anothcrconsiclcrat i<lrt is t lut t l rc Nirrc l lolc l)c!. l l t 'st l r trs bccrr lccorlrnrcrlr lcd;rslu cl inicul tcst f i rL l thvsic:r l lv lrancl icultpccl sult jccts;rnrl not l i rr rrornlr lsubiects. Since hlndicappccl subjects tcncl to bc :r nrctre hetcrogcneousgroup (widcr variancc in scorcs). rcst.rcrcst rcl iabi l i rv nt ighr be highcrwith that samplc, Thc.fcl tscn Hand Furrct ion

' lest. \ \ 'hich also h;rs lo.s'

scorcs and was designed f i tr l rhYsical l l handicaltped subiccrs. I las tcsr-rctcst rcl iabi l i t ) 'data on subiccrs wirh stablc hancl cl is<lrders onh'. Thei r r r l ' r l i cu t io r r i s t l ru t r t ' l i l b i l i t \ : ( l l t l ; t on r ro r rn ; r l su l ) i c ( . t s i s l t ' ss in t l to r tun tsincc thc tcst wi ls fccontmcndcd t irr hlncl icuppcrl subjccts Onlr ' .

r \ l though u l)ract icc tr i :r l s ' trs arlclccl ro thc st:rrrr l :rr t l izcd proccdurcs ol 'thc Ninc Holc Pcg' l 'cst, I sigrr i f icalt t pnrct icc cl l i 'ct rcnlr iucd.

' l his nrcans

that xn improvement in a subjcct 's rctcst scorc c<;Lrlr i sinrplv l tc due tothc pr : rc t i cc ob ta incd in the in i t i ; r l t cs t i l r !1 . S inc t ' soru t ' rhc r lp is rs r l so usethc tcst i ls a nlct l tod of trcatnrcnt, thc rctcst scorcs ,rvould bccorl lc ct,crrnrorc inf luenced bv thc prxct icc cffcct. I t is s1'rccul;rtcd thtt a t lrrcc-tr i . .r lsamplc, Ls suggestcd aboYe to inrpror,c rcsr-rcrcsr rclilbilin'. miglt dccreasethc practicc cffcct. F'urthcf rcsclrch is nccdccl to udclrcss thcsc issucs.

' l 'hc modcratc to high invcrsc rclatronshi l t bcrrvccn rhc Nine Hole Peg

'[ 'cst and thc l)urdr.rc Pcgbolrcl i trdicutccl thut the tcsr ntc:rsurcd sint i lar

r igh t N inc Ho lc l )cg ' l cs r

scorcs

J6 \1 , { l l l lO \ \ ' l : lZ , \ \ ' f r l J l :R . KASI l rv lAN. \ 'O I - lnNI )

bur not equivalcnr ;rspccrs of t ' ingcr dcxreriq' . ' I l . r is would imply that bothtests might bc uscful in cvl luating f ingcr dexteriN and that neither couldcompleteh' substi tutc t irr thc other,

Normative Study

'I 'hc norr lat ivc datx in this study support conclusions of previous studies.

That is, fcmales havc sl ightlv bettcr dcxrcrir) ' rhan nralcs (Mathiowctz,\/ol lund, Kushnlru, & \\ /cbcr. in press; Rushmore, 1942), r ight hand scoresffc bcttcr than lctt-hand scorcs, and for adults dextcriry graduallv dccrca-scsn ' i th ugc (Kc l lo r c t : r1 . , l9T l lMath iowctz , Vo l land, Kashman, & Wcber ,in press).

Future rcsctrch rcgarding thc Ninc Holc Peg Test should adclrcss thct ir l lou' i ng ( lr .rcst ions:

l . Woukl r\ \ ,o or rhrcc rr irr ls of thc tcst improve tcst-rctcst rcl iabi l in,ancl clccrc;rsc thr nr:rcticc efti'ct'1

l . \ \ 'oulr l tcsr.rt ' tcst lr ' l i : rbi l i t l i rrr l trovc \\ , i th : l sl lnlplc t t f plr1,sicul l1,I tuncl icappctl sub jcctsi '

.1 . \ \ ' o r r l r l : r s l r l r l k r r r ro r r r r t l to l r t : r i r r t l i r t rp rovc tcs t - r ( . t cs t l c l i t r l t i l i t y i ,

.1. l)oc.s t lr t ' Ninc l lol t ' l ' r 'g ' l ' t 'st

t l ist irrguislr l tctwccrr norrrr:r l subjccts;rrrr l subjccts rvith yrrxrr f i rrgcr t lcxtcri tvl

5 l l ' t l rc st;rnd;r ldiz-cd l t loccdurcs ol r i lc tcst nccd to bc changcd toinrprovc thc rcl i ;rbi l i r t ' of t l rc tcst, docs t lrc normativc d;rta col lcctcd inthis stt tcly rcnr:r in lrcctrratc ! '

An addit ional question of interest to occuparional therapists would con.cern the relat i<lnship berq,ccn tcsts of dextcriry (c.9., Nine Holc Pcg 1'est,l iox uucl l l lock

' l 'cst. ctc.) to tcsts of hrrnd function (c.g., Jcbscn) or to

pcrt irrnlrncc of hrnctir lnal xct ivi tv. Alrh<lugh rclat ionships might bc prc-strrt t t ' t l , thcsc It ;rvt ncvcr' l r t ' t rr rvclI docurncrrtcd.

Duc to thc ulxrr l Lrrrrcsolvccl questions rcgarding thc Ninc Holc PcgTcst. i t slruuld bc uscd u,i t l r cuution. I t should not be uscd to test normalsubjccts ( i .c., o'ah-rat ing nornr;r l individuals for job placement ). There arebctrcr dcxteri t l tcsts uvui lablc (c.g., I)urduc I ' ]cgboard, Minncsota Ratc ofiVlanipulat ion 1'cst, ctc.) that lravc becn designed for this purp<tsc. Thetcst also should not bc uscd to rcsearch the cffectiveness of treatment toimprove poor finger dexterirt'. The tesr might be caurioush' uscd as aquick scrcening rool for f ingcr dcxteriw. I f a dcf ici t were found, addit ionaltest ing would bc indicltcd to confirm t lrc dcf ici t lnd to cr ' :r luatc theeffect ivencss of trcxtnrcnt r)r 'cr t inrc. ! l

' I I t [ ( X . ( . 1 l ' A ' l l ( ) N , \ 1 . ' l l l I : R A P ) ' . l o t ' R N A I ( ) l ' R I S I : A R ( l l 5 | ' J :

Acknowledgments

i l l i rny thanks to Frlnkl in srcin. I)hl). o' fR, t i rr rcscltrch ancl stat ist ic:t l ctt t t

Sultat ion, and to Nli tn' l )o$c. Sltudrl t l l t lgcrs, l . t l r i Donit l t trc, artt l (- l tcnl

l lcnncl ls f i rr assistancc i t l t l l t t l t ct l l lCction and analvSis, Also th:trrks to t l t t

many placcs',rncl pc<4rle * lro hclpcd ntakc this study possiblc: \ \ r tukt 'sl t : t

C6unty Fair ( ' fern' F' i l rcntrrn ). t iunrnr^ge-O-Rlrm. (Vir l tcr lgsncr') . \ tr ' t l l '

r ic lgc incl Sosthridgc SIl4rlr ipg ( lcptcrs, l . ' icsta i l lcxicanl. \ \ ' rLshirt l i tort l ' r trk

Scnir lr Ccntcr ( l lctn, lVt lsck ). Mc(iovcrn P:trk Scnior Ccntcr (( i lor i l l l r t l l )

t .ukc Plrrk l .uthcrl tn Ohurch Scnior (,crrtcr (( 'arol l latrcr) ' l ' is lrott Scrt iot

Ccntcr anct Sacrcd Hcart Rchabil i tat ion Center (Elainc Stracl iot l t) ' l ' l t is

stud.y was partially fundccl br' :ur Amsrican occupational 'l'hcr:t1lt l:ttttrt'

c l l t i<ln rcSCiarClr grunt. l lcsctrrch rcs' l ts \ \ ,crC rcptlr tct l l l t thc Al) l(r ici l l l

gccupati 'nal ' l 'hl .r tpv Ass'ci; t t i .n Arr ' tut l ( l .nlcrcncc. Klnsits (. i t t \ lo

t984.

Itl:FDItliN(lliS

Agnc\ \ , , l ' . .1 . , & i \ l ; t ss . l ; . ( l9 l ' t l ) . l l l t l l t l t r r t rc t io l r rc l l t te t l to : l l ' l ( ' i l r l ( l : ( \'

Archiues rtJ'Pl11t1;iLal! tl!ctlicine und Rehahilittttirn' (t'J' 269-2- |

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