Background: In pediatric neurorehabilitation, the assessment of muscular strength is an important
clinical parameter for the planning of treatment and the monitoring of treatment response.
The majority of age- and gender-specific standard values in childhood and adolescence
are based on tests of the lower extremities of children who have not lost the ability
to walk.
Aims: The aim of this study is to develop age- and gender-specific standard values for
hand strength and to record anthropometric parameters of the upper distal extremity
in childhood and adolescence.
Issue Under Investigation: The established standard values for voluntary grip strength and finger flexion strength
in childhood complement the previously available standard values, thus facilitating
comprehensive clinical diagnosis in children and adolescents with neuromuscular disorders.
Methods: In this cross-sectional study, tests were performed on 137 healthy children between
the ages of 5 and 10 years (girls n = 68, boys n = 69). The age distribution of the subjects was as follows: 5 years n = 7 (4 girls, 3 boys); 6 years n = 12 (5 girls, 7 boys); 7 years n = 29 (12 girls, 17 boys); 8 years n = 40 (17 girls, 23 boys); 9 years n = 35 (22 girls, 13 boys); and 10 years n = 14 (8 girls, 6 boys). Anthropometric parameters (body height, body weight, Body
mass index, hand width, hand length, forearm length, and forearm circumference, in
each case on both the right and left sides) were recorded. As strength parameters,
maximum voluntary grip strength in the distal phalanges (II-V2) and intermediate phalanges
(II-V4) as well as maximum voluntary finger flexion strength in the distal and intermediate
phalanges of the middle finger ((III2 and III4) on both the right and the left sides
were measured. The measurement of the strength parameters was performed using the
hand and finger dynamometer HFD 200 under isometric, biomechanically precise and standardized
measurement conditions.
Findings: Of the 68, 64 girls tested (94%) and 62 of the 69 boys tested (90%) stated that the
right hand was their hand of habitual use. In both boys and girls of all ages, the
mean values of the measurements obtained for hand length, forearm circumference, and
forearm length were 1 to 2 mm greater for the right side than for the left side. The
mean values obtained for hand width did not show any difference in favor of the right
side, irrespective of gender. The values of the strength parameters, with the exception
of grip strength in the distal phalanges (II-V2), likewise did not reveal any difference
in favor of the right hand.
The greatest increase in strength was found in the mean values for grip strength in
the intermediate phalanges (II-V4) of the right hand among girls. The mean value for
strength in the 5-year-old girls was 85.8 N, compared with 220.1 N in the 10-year-old
girls. This represents an increase of 257%. Among the boys, the increase in grip strength
II-V4 for the corresponding age groups amounted to 145%.
The evaluation of the data was performed separately for each gender and for each age
group (5–10 years). For each gender and for each age group, the mean values and standard
deviation were calculated separately both for the individual anthropometric parameters
and for the strength parameters on the right and left sides.
In both genders, the mean values for all parameters increased in parallel with age.
Conclusion: The measurements obtained for the anthropometric parameters and for maximum voluntary
grip and finger flexion strength enabled age- and gender-specific standard values
to be established. These standard values complement the international standardized
measurements for muscular strength and function and can be used in future as reference
values for neuropediatric rehabilitation and for interventional treatment studies.
