Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1006

Original Article

CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRICVARIABLES AND QUANTIFYING HAND GRIP STRENGTH IN CHILDRENOF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIANPOPULATIONEruva Indira 1, Rajeswari. M *2

1 Postgraduate in Physiotherapy, Sri Ramachandra University, Porur Chennai, Tamilnadu, India.*2 Assistant professor, Sri Ramachandra University, Porur Chennai,Tamilnadu, India.

Background: Hand grip strength is an important quantitative measure in evaluation of hand which is alsoconsidered as a predictor of general health status. Influence of various anthropometric variables on Hand GripStrength has been studied in adult population. Martin Vigorimeter is a simple instrument which is consideredto be appropriate for measuring hand grip strength in the age group 3-5.5 years for which norms have beenestablished in Caucasian population. This study aims to analyse the correlation of hand grip strength withanthropometric variables and to quantify grip strength in children of age 3-5.5 years using Martin Vigorimeterin Indian population.Methods and Methodology: 211 children from five schools were included in this cross sectional study aftergetting consent from the principal of the schools. The anthropometric variables height, weight, BMI, handanthropometric variables were measured. Hand grip strength was measured using Martin Vigorimeter, threetrials were measured and best of the three was taken as the standard grip strength on both right and left sides.Results: Pearson’s correlation was used to analyse the relation between hand grip strength and anthropometricvariables which showed a positive correlation between BMI and hand grip strength and independent t-test wasused to compare hand grip strength of Indian and Caucasian population which showed a significant decreasein hand grip strength in Indian population with a p value <0.05.Conclusion: The study concludes that anthropometric variables should be considered while quantifying handgrip strength. A significant decrease in hand grip strength in Indian population when compared to Caucasianpopulation demands a need to evaluate the cultural sensitivity of such instruments prior to clinical usage andto interpret clinically.KEY WORDS: Hand Grip, Strength, Vigorimeter, Anthropometric Variables.

ABSTRACT

INTRODUCTION

Address for correspondence: Rajeswari.M, Asst Professor, Faculty of Physiotherapy,Sri Ramachandra University, Porur, Chennai 600116, Tamilnadu, India. Phone: +919841417473.E-Mail: rajeswarim2001@gmail.com

International Journal of Physiotherapy and Research,Int J Physiother Res 2015, Vol 3(2):1006-11. ISSN 2321-1822

DOI: http://dx.doi.org/10.16965/ijpr.2015.124

Quick Response code

Access this Article online

International Journal of Physiotherapy and ResearchISSN 2321- 1822

www.ijmhr.org/ijpr.html

DOI: 10.16965/ijpr.2015.124

Received: 13-03-2015Peer Review: 13-03-2015Revised: None

Accepted : 26-03-2015Published (O): 11-04-2015Published (P): 11-04-2015

The human hand is an inexplicable tool whichserves us extremely well in multitude of ways.Human hand is capable of complex and precisefunctions which can be divided into grasping

abilities and manual dexterity. The power gripis grasping of an object against the palm withthe isometric motion where as manual dexter-ity is the ability to make coordinated hand andfinger movements to grasp and manipulateobjects [1]. Grip strength is the result of

Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1007

Eruva Indira, Rajeswari.M. CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIPSTRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION.

forceful flexion of the finger joints with a maxi-mal voluntary force that the subject is able toexert under normal biokinetic conditions [2].Hand grip strength is an important componentto perform precise and refined fine motoractivities. Thesefine motor skills startsdeveloping as the child grows but precise needof these skills increases when the child startsperforming activities such as drawing, feedingetc. As the child grows there will be increaseddemand for performing fine motor activities,which forms an integral part of the child’s motordevelopment.Hand grip strength is influenced by multiplefactors such as age, gender and body size [3].Studies done in adult population onanthropometric variables and hand grip strengthshowed a positive relation between them suchas BMI, hand anthropometric variables [4,5,6].The relation of the anthropometric variables andhand grip strength below 6 years of age is notexplored which demands the need to know theirinfluence on hand grip strength.Quantification of hand grip strength is importantin determining the efficiency of varioustreatment strategies in rehabilitation of hand andto monitor prognosis. The commonly usedinstruments for measuring hand grip strengthare Jamar dynamometer, Lode dynamometer,Pneumatic squeeze dynamometer, Harpendendynamometer, Isometric strength testing unit,Rotterdam Intrinsic Hand Myometer (RIHM), Griptrack dynamometer [7,8] for which norms areestablished in adults. Certain limitations wereobserved while measuring the grip strength withthe above mentioned dynamometers such asinappropriate size, weight of the instrument etc.,when used in younger population. An idealinstrument which is suitable for measuring thehand grip strength in children of age 3-6 yearshas not been recognized.Martin Vigorimeter is a type of dynamometerused to measure the grip strength which couldbe an appropriate instrument for measuringhand grip strength in children due to its easyconstruct and handling which enables thechildren to understand and perform easily.Literature gives norms for the MartinVigorimeter from the age group of 3 which havebeen quantified in Caucasian populations, [9]

which may not be appropriate to apply clinicallyin Indian population due to cultural and ethnicvariations.This study aims to find out the relationship ofanthropometric variables with hand grip strengthand quantify hand grip strength using MartinVigorimeter in children of 3- 5.5 years in Indianpopulation. The results of the study will help thephysical therapist to evaluate and quantify handgrip strength in children with abnormalpathological or structural impairments of theupper extremities by which one can be guidedin the rehabilitation and monitor the prognosis.

METERIALS AND METHODS

This cross sectional study involves children fromage 3-5.5 years as subjects to find the correlationbetween anthropometric variables with handgrip strength and to quantify hand grip strengthin the same population.This study has beenapproved by the Ethics committee for Student’sproposals (CSP/13/OCT/31/162)Sri RamachandraUniversity, Tamil Nadu, India.The subjects were recruited from schools inChennai. Five schools were approached toconduct the study and permission was obtainedfrom the principal of the school. 211 children ofboth genders in the age group from 3-5.5 yearswere included in this study and children withNeurological impairments, Musculoskeletalimpairments of upper limb and Congenitaldeformities were excluded from the study.

INSTRUMENTATION:

MARTIN VIGORIMETER: The Martin Vigorimeteris a device developed in the late 1970s, used toassess the spherical grip strength of children. Itconsists of a set of three rubber bulbs of differentsizes (diameters of 4 cm, 5 cm, and 6 cms) anda dial that records the strength of sphericalgrasp. The smallest bulb was used as it wasfound to be effective for the younger children.The air pressure within the bulb is recorded inkilo pounds per square centimeter on amanometer via a rubber connection (1 kp/cm2= 98.1 kPa). The dial on the manometer has anarrow that rotates and stops at the highest pointof pressure exerted and then maintains thereadings to allow for accurate recording.

Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1008

Eruva Indira, Rajeswari.M. CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIPSTRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION.

ANTHROPOMETRIC MEASUREMENTS: Theheight is measured by the stadiometer or theheight rode, weight is measured by the weighingmachine. [Weight (kg)/ Height (m2)] was usedto calculate Body Mass index. Hand breadth ismeasured from the radial side of metacarpal(index finger) to ulnar side of metacarpal (smallfinger). Hand span is measured from the tip ofthe thumb to the tip of the small finger with thehand opened as wide as possible. Hand lengthis measured from the tip of the middle finger tothe distal wrist crease.PROCEDURE: The children of 3-5.5 years agewho met with inclusion criteria were taken asthe sample for the study. The dominance of handis found by using Edinburgh HandednessInventory. The anthropometric measurementswere measured and hand grip strength ismeasured by Martin Vigorimeter. The child ismade to sit on a child size chair that allowedtheir feet to be flat on the floor. The upperextremity to be tested is positioned so thatshoulder is adducted and neutrally rotated;elbow is flexed at 90 degrees, forearm in neutraland wrist in 30 degrees of extension, maintainedby the elbow and wrist on the table. TheVigorimeter bulb is placed in the palm of thechild and the fingers are wrapped around thebulb thumb opposed to the middle or the ringfinger and asked to press the bulb as much aspossible. Three trails were taken for each handwith rest period between each trail by performingalternately on left and right hands to preventfatigue and the measurements were taken, bestof the three was taken as the grip strength value.

The children were grouped into 5 groups withage as reference as follows Group I (3- 3.5 years),Group II (3.6 -4 years), Group III (4- 4.5 years),Group IV (4.6 -5 years), Group V (5- 5.5 years)

Martin Vigorimeter

Grip strength of right hand using martinvigorimeter:

STATISTICAL ANALYSIS AND RESULTS:

Pearson’s correlation was used to analyse andestablish the correlation between hand gripstrength and anthropometric variables,Independent t-test was used to find thesignificant difference between Caucasian andIndian populations.The mean grip strength of male population isgreater than the grip strength of femalepopulation which says that boys are havinggreater grip strength even in the younger agegroups which is shown in the Table 1.Table 2 shows the mean, standard deviation, rvalue and p value of BMI and grip strength in allthe five groups. The right and left hand gripstrength have a significant positive correlationwith BMI in all the age groups except left handgrip strength in group I which is shown in Graphs1&2, but the hand anthropometric variables didnot show a positive correlation in all the agegroups.The grip strength of the Indian population is lesswhen compared to the Caucasian populationwith the significant difference between themwith the p value (<0.05) which is shown in theTables 3&4.

Table 1: Comparison of grip strength in males andfemales.

GRIP STRENGTH

Sex N MEANSTD.

DEVIATIONt value p value

GIRLS 101 27.37 5.93BOYS 110 29.36 6.49GIRLS 101 25.47 6.11BOYS 110 27.67 6.56

RIGHT -2.32 0.021

LEFT -2.52 0.012

Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1009

Eruva Indira, Rajeswari.M. CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIPSTRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION.

Table 2: Correlation of BMI with right and left handgrip strength.

N MEAN SD r value p value15.37 1.37

Right 22.05 3.37 0.353 0.026Left 20.2 3.56 0.154 0.343

15.61 10.91Right 25.71 3.75 0.678 0Left 24.13 4.45 0.611 0

16.42 2.45Right 28.95 5.11 0.789 0Left 27.1 5.53 0.761 0

17.2 2.68Right 29.76 5.4 0.88 0Left 28.05 5.16 0.707 0

20.01 2.3Right 36.05 3.88 0.568 0Left 34.05 4.21 0.509 0.001

Group IBMI

40Grip strength

Group IIBMI

48Grip strength

Group IIIBMI

42Grip strength

Group IVBMI

41Grip strength

Group VBMI

40Grip strength

Graph 1: Correlation of BMI with right hand gripstrength.

Graph 2: Correlation of BMI with left hand grip strength.

Table 3: Correlation between right handgrip strengthof caucasian and indian population.

M 23 22.05SD 6 3.37M 28 25.71SD 5 3.75M 32 28.95SD 7 5.11M 35 29.76SD 7 5.4M 42 36.05SD 9 3.88

INDIAN POPULATION

p VALUE

GROUP I 0.083

GROUP II 0

CAUCASIAN POPULATION

GROUP III 0

GROUP IV 0

GROUP V 0

Table 4: Comparison between left handgrip strength ofcaucasian and indian population.

CAUCASIAN POPULATION

INDIAN POPULATION

p VALUE

M 23 20.2SD 5 3.56M 27 24.13SD 5 4.45M 31 27.1SD 7 5.53M 34 28.05SD 6 5.16M 40 34.05SD 10 4.21

GROUP IV 0

GROUP V 0

GROUP I 0

GROUP II 0

GROUP III 0

DISCUSSION

Quantification of hand grip strength plays a vitalrole in framing goals in hand rehabilitation andto monitor prognosis. The increased hand gripstrength in male children when compared tofemale children of the same age group suggeststhat even in the younger age group genderdifference in hand grip strength is evident whichis in contrast with the result done by Lisa Linket al 1995 which did not show any genderdifference.Correlation between BMI and hand grip strengthshowed a positive correlation in all the agegroups with a significant p value of <0.05 exceptfor left hand grip strength in Group I. Thispositive correlation shows that hand gripstrength increases as the BMI increases. Thisinterpretation correlates with the study done byS Koley et al., 2007 which concludes that thereis a strong association between height, weightand BMI with right and left hand grip strength.

Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1010

Eruva Indira, Rajeswari.M. CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIPSTRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION.

Hand anthropometry did not show positivecorrelation with hand grip strength with all thegroups. Right hand breadth showed positivecorrelation in Groups II -V but left hand breadthcorrelated to left hand grip strength only in GroupII. Right hand length showed positive correlationwith right hand grip strength in Groups I -IV butleft hand length correlated only in Group II andGroup III. Right and left hand span showedpositive correlation with grip strength in allGroups except Group IV.The entire correlationsof specific hand anthropometry with hand gripstrength showed a varied presentation incontrast with the study done by Mohamed SheriffSirajudeen et al(2012) in adults with the similarparameters which showed a positive correlationwith specific hand anthropometric variables(hand breadth, hand length, hand span, forearmwidth).The reason for this varied presentationin this age group could be due the difference inthe rate of growth of the child with respect tothe hand anthropometry in the age group studied.The analysis of mean grip strength in all the 5Groups shows significant statistical difference(p <0.05) with that of the Caucasian population.The difference in the mean grip strength fromGroup I -V between Caucasian and Indianpopulation are 0.95, 2.29, 3.05, 5.24, 5.95 onright hand and 2.80, 2.87, 3.90, 5.95, 5.95 onleft hand. The difference in the mean gripstrength in the two populations increases as theage increases which could be due to greaterexperience of children in the Caucasianpopulation to different toys which demands lotof throwing, squeezing and grasping activitiesat an early age. The results of this study goes inconcordance with study done by Rajani PMullerpatan et al.,(2013) in the age group of 18-30 years which concludes that the decreasedgrip strength in Indian population might be dueto short stature, lower BMI when compared withsimilar age groups in other continents. Thoughthe construct of Martin Vigorimeter was simpleand suitable for children, some children foundit difficult to comprehend the instructions,probably due to lack of exposure to such itemswhich also could have an influence on the gripstrength.A study done by P. Deurenberg et al.,(2002) toanalyse the relationship between BMI and

BF%(body fat percentage)in Asians andCaucasian population concludes that Asianpopulation have a higher body fat percentageat a lower BMI when compared to Caucasianpopulation and body fat percentage was higherfor similar BMI values in Asian population. Theincreased fat percentage and decreased BMIcompared to Caucasian population could be thereason for decrease in grip strength as the BMIand grip strength has a positive correlation.The mean grip strength of right and left side is28.41 and 26.62. The dominant hand grip isstronger than non dominant which coincideswith the results of the study done by MohamedSherif Sirajudeen et al., in adult population. Astudy done by I. C. McManus et al., 1988 to findthe development of handedness concluded thatthough degree of handedness increases over therange of 3-7 years handedness is more or lessfixed by the age of three. This is supported bythe scores on Edinburgh handedness inventorywhich showed strong handedness from the ageof three and increased hand grip strength on thedominant hand than non dominant in all agegroups in this study states that dominance isstrongly established by 3 years of age.Correlation between birth weight and gripstrength did not show any association in thisstudy which is in contrast with a study done byJG Barr et al 2010. This study states that greatergrip strength in childhood is associated with thelarger overall size and muscle mass at birth. Lackof correlation in this study could be due tolimited number of subjects with known historyof birth weight.Though Martin Vigorimeter is a standardizedmeasure to assess hand grip strength in the agegroup of 3- 5.5 years, environmental, culturaland Ethnic variation limit the usage of thisinstrument with established norms forCaucasian population. Evaluation of culturalsensitivity of such measures should be done priorto clinically using and framing goals based onthe results.

CONCLUSIONThe results of the study concludes that there isan influence of Body Mass Index on Gripstrength in the age group of 3 -5.5 years whichconveys that BMI should be considered while

Int J Physiother Res 2015;3(2):1006-11. ISSN 2321-1822 1011

Eruva Indira, Rajeswari.M. CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIPSTRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION.

quantifying grip strength in clinical practice.The decrease in grip strength in Indianpopulation when compared to their counterpartsin Caucasian population makes it necessary toevaluate the cultural sensitivity for a specificregion or ethnic group especially when theinstrument is being used to quantify, diagnoseand plan the treatment of a child.

Conflicts of interest: None

REFERENCES

[1]. Kamieniarz Malgorzata, Wanda Stryla, P. Haglaver,G. Kamieiarz. Standardised computer tests forassessment of chi ldren manual dexterity.Computational Methods in Science and Technology1999;5:25-38.

[2]. Richard W. Bohannon. Reference Values for ExtremityMuscle Strength Obtained by Hand-HeldDynamometry From Adults Aged 20 to 79 Years. ArchPhys Med Rehabil. 1997;78.

[3]. Koley, Shyamal, Arvinder Pal Singh. Effect of HandDominance in Grip Strength in CollegiatePopulation of Amritsar, Punjab, India.Anthropologist. 2010;12(1):13-16.

[4]. Mohamed Sherif Sirajudeen, Umama Nisar Shah,Padmakumar Somasekharan Pil lai, Naaji lMohasin, Manjula Shantaram. Correlation betweenGrip Strength and Physical Factors in Men.International Journal of Health and RehabilitationSciences 2012;1(2).

[5]. Koley, Shyamal, Gandhi, Meenal, Singh, ArvinderPal. An Association of Hand Grip Strength withHeight, Weight and BMI in Boys and Girls aged 6-25 years of Amritsar, Punjab, India. The InternetJournal of Biological Anthropology 2006;2(1):4.

[6]. Dr.Shrikant S. Sant, Dr.Heena Bhatt, Dr. DeepaliHande, Dr.Subhash M. Khatri, Dr. Mayur Khairnar.Association of BMI and Hand grip strength in schoolchildren in rural area of Maharashtra in India.International J. of Healthcare & BiomedicalResearch 2013;1(2):53-59.

[7]. Balogun Joseph A, Sarafadeen A. Adenlola, AbideenA. Akinloye. Grip Strength Normative Data For theHarpenden Dynamometer. JOSPT 1991;14(4):155-160.

[8]. Desrosiers, Johanne, Gina Bravo, Réjean Hébert,and Élisabeth Dutil. Normative Data for GripStrength of Elderly Men and Women. The AmericanJournal of Occupational Therapy 1994;49(7):637-644.

[9]. Andrea Robertson, Jean Deitz. A Description of GripStrength in Preschool Children. The AmericanJournal 0f Occupational Therapy 1987;42(10).

[10]. Mullerpatan Rajani P, Gayatri Karnik, Rebecca John.Grip and pinch strength: Normative data for healthyIndian adults. Hand Therapy 2013;1-6, Sage publications.

[11]. Deurenberg Paul, Mabel Deurenberg Yap, SyafriGuricci. Asians are different from Caucasians andfrom each other in their body mass index/body fatper cent relationship. Obesity Reviews.2002;3(3):141–146.

[12].McManus I. C., G. Sik, D. R. Cole, A. F. Mellon, J. Wong,J. Kloss. The development of handedness inchildren. British Journal of DevelopmentalPsychology. 1988;6(3):257–273.

How to cite this article:Eruva Indira, Rajeswari. M. CORRELATION OF HAND GRIP STRENGTH WITHANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIP STRENGTHIN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIANPOPULATION. Int J Physiother Res 2015;3(2):1006-1011. DOI: 10.16965/ijpr.2015.124