1999 Conference Proceedings

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M J Topping
Staffordshire University


In 1995, work began on the formation of a proposal to develop a hand assessment system. It was decided to develop a stand alone assessment system which would be beneficial in the treatment of patients who experience all types of hand pathology. Funding was obtained from the European Commission D.G. XIII Telematics Application Programme for the Elderly and Disabled and the Hand Assessment and Treatment System (HATS) began in January 1997.

Within the European Community significant numbers of patients with hand and wrist injuries are treated daily. Common cases treated include fractures, crush injuries, hands cut by glass and stabbings and rheumatics following surgery to the hand. Methods currently being widely used in Europe for the assessment of hand injury patients are, in the main, basic, labour intensive and time consuming to implement and consequently it can take up to 90 minutes to conduct a full hand assessment with over 150 measurements being recorded.

Currently instruments (fig.1) such as mechanical goniometers are used to assess the degree of movement available in a patient's hand and fingers; plastic rulers are used to monitor finger span; everyday tape measures, vigrometers and volumeters are used to monitor oedema (swelling); dynamometers test hand strength and pinch gauges are used to test pinch strength. In the main these tools were not specifically developed for recording accurate measurements of the hand and even the most experienced therapist can have problems obtaining accurate and repeatable measurements.

During the assessment of one hand, therapists need to write down all data onto a log sheet, which is subsequently used to compile comparative data for analysis, this process is very time consuming for the therapist. As this process requires more than two hands to perform it correctly (two hands to collect the measurement data, and one hand to record it onto a log sheet), some therapy manuals suggest the use of a scribe to log the data during assessments. Quite clearly, current hand assessment protocols requires large proportions of hand therapist/patient contact time.

The Development of HATS

The Hand Assessment and Treatment System (HATS) project aims to eliminate many of the anomalies described earlier through the development of superior automatic data acquisition hand assessment tools, a data storage and transfer unit and Windows interface software. The tools will be capable of measuring power grip, pinch grip, range of movement, oedema and hand span.

User Requirements Analysis

A detailed user requirements analysis was produced in collaboration with hand therapists, medical consultants, doctors, rehabilitation engineers, industrial designers, computer programmers, medical technicians, data security experts and data integration experts. Information about what data would need to be recorded and what tools would be needed was collected.

The Assessment Tools

The opinions of therapists and doctors from throughout the European Community were considered before a choice of which assessment tools the HATS should support. It was decided that the following five tools would be required:

  1. Goniometer (for measuring range of movement)
  2. Span Gauge (for recording finger to thumb span distance)
  3. Pinch Gauge (for pinch and key grip)
  4. Dynamometer (for grip strength)
  5. Oedema Gauge (for measuring the amount of swelling)

HATS is modular in design and built up of the following three main component parts:

1. Data acquistion assessment tools

The design of the HATS tools are based around existing solutions which are already in widespread use by hand therapists throughout the European Community and therefore interoperability will be practical to implement, the distinction being that the HATS tools have data acquisition capabilities. The HATS assessment tools (fig. 2) have been designed to be user friendly, and easy to use. Each has a small data acquisition button comfortably built into its design. A simple press of a button, located on the computer based hand assessment tools is sufficient to accurately record measurement data and to transfer it to a data storage unit.

2. Data Acquisition Unit

The data acquisition unit is capable of receiving and storing measurement data from the hand assessment tools for subsequent transfer to a PC mother computer for analysis. Although utilising the very latest technology the unit is designed to be user friendly, incorporating a touch screen, high quality graphic representations, sound and speech synthesis.

3. Windows User Interface Software

The main functions of the HATS software are the acquisition of patient data, management of patient data, analysis and visualisation of patient data and the generation of reports. The interface software is sophisticated and comprehensive. Therapists are able to enter patient details such as demographic data, social history, Deformities, perceived pain etc. as well as recording the hand assessment measurements. Semi-automated report writing facilities are available to hand therapists, these documents are provided quickly and without effort for Consultants in hand clinics and insurance claim work assessments for example.

Advantages of HATS

HATS provides a more accurate and time effective computer-assisted hand assessment procedure, significantly reducing the time currently taken to acquire and log hand assessment measurements. This time saving will allow therapists increased scope and time to practice their skilled professional judgement and specialist knowledge in the treatment of their patients.

Early trials indicates that HATS will result in a significant reduction in the time it currently takes to carry out a hand assessment and measurements taken during hand assessment with HATS are more accurate.

Evaluation of HATS

In August 1998 HATS will be evaluated at the Occupational Therapy Departments of Orthopaedische Klinik Volmarstein, Germany, and Staffordshire District Hospital, Stafford, UK with several hundred hand injury patients at these hospitals over a eight month period. A comparison study will be carried out at each hospital, the aim of this being to compare the HATS protocol against existing methods and procedures.


Amazingly, in terms of the development and use of high technology solutions, the area of hand therapy seems to have largely been overlooked. HATS through its modern approach can revolutionise the field in terms of providing better quality service provision for the therapist and patient. This in turn will facilitate significant cost reductions for the service providers through the streamlining of assessment procedures and the speeding up of patient throughput.

Currently a full hand assessment can take over an hour to complete, HATS will reduce this time significantly thus savings made in time and costs within hand therapy units would be enormous, making the replacement of the current outdated methods by the HATS a financial necessity.


[1] Murray, K., Simpson, C.(1998) 'A Therapists View of the HATS Project' British Journal of Hand Therapy. Vol.3, No.2 p.13

[2] Topping M J (1997) 'Healthcare Telematics - Hand Movement Assessment'. ethos Newsletter ISSN 1363-9072, Issue 6, September 1997.

[3] Heck H, Buhler Ch, Suppelna G, Schramm J, Fathmann M, Bolmsjo G, Hedenborn P, Finney R, Topping M, Bishop T, Simpson C, Murray K, Wickramasinghe Y, Alcock S, Gunning T, Perlick O, Reins F. (1997) 'Development of a System for Hand Assessment- A Overview of the HATS Project'. AAATE'97,The 4th European Congress for the Advancement of Assistive Technology, 29 September - 2 October 1997, Greece.

[4] Simpson C., Topping M., et al, (1998) 'The Development of a High Technology Hand Assessment System'. European Federation of Societies for Hand Therapy. Newsletter. January 1998.

[5] H Heck, Ch Buhler, M Topping (1998) 'A System for Computer-Based Hand Assessment'. Proceedings of 6th European Congress on Research in Rehabilitation, Berlin. 31/05-4/06/98, pp 40-43

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