Hands performing tasks, interconnected gears, flowing streams

Scleroderma Hand Assessment: A New Protocol for Occupational Therapy

Reese Marlowe monogram
Reese Marlowe in Health & Wellness October 2026 • 3 min read.

"Discover how a new assessment protocol is transforming occupational therapy for scleroderma hand, improving outcomes and daily life for patients."


Systemic sclerosis (SSc) is a rare, chronic autoimmune disease characterized by irregular immune responses affecting the small blood vessels, skin, and internal organs. A significant cause of morbidity and disability in SSc patients is hand impairment, affecting approximately 90% of individuals.

While physiotherapy and rehabilitation are recommended to alleviate disability from osteo-articular and skin involvement, there's limited research focused specifically on hand involvement in SSc. Recognizing this gap, a new study introduces an assessment protocol to refine occupational therapy strategies, aiming to enhance the evaluation and treatment of scleroderma hand issues.

This study seeks to analyze scleroderma hand involvement using instrumental tests and rating scales. By identifying key anomalies, the protocol aims to guide occupational therapy strategies and establish specific, measurable outcomes, ultimately improving patient care and functionality.

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Impact of Scleroderma on Daily Activities

Systemic sclerosis (SSc) is characterized by tissue stiffness and contraction, which can limit the ability to carry out day-to-day activities. A 2019 study set out to investigate the effects of specialized physical-occupational therapy focused on the hands and face, including its impact on quality of life. A separate study aimed to analyze articular involvement of the scleroderma hand using instrumental tests and rating scales to inform occupational therapy strategies and outcome measurement.

Comprehensive Assessment Protocol

Hands performing tasks, interconnected gears, flowing streams

The study included 45 SSc patients, each undergoing a comprehensive assessment protocol. Key components of this protocol were:

The Strickland measurement, evaluating total active motion (TAM), revealed symmetrical hand involvement in nearly all patients (93%). However, only 30% demonstrated excellent TAM levels (scoring above 85%). Diffuse SSc patients showed statistically significant reduced total active movement in their dominant hands.

  • Total Active Motion (TAM): Measured using the Strickland method.
  • Grip Strength: Assessed with a Jamar dynamometer and pinchmeter.
  • Prehension Evaluation: Sixteen different types of prehension were evaluated using various objects encountered in daily activities.
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Assessments and Rehabilitation Research

A 2024 Springer chapter reviews assessments used to measure disability and participation in people with systemic sclerosis and discusses rehabilitation techniques intended to improve joint motion, hand function, strength, general conditioning, and participation in daily life. A 2026 review describes a study by Bassel et al. (2012), which examined Canadian SSc patients with hand involvement and their referral to and use of physical or occupational therapy services, using responses to the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. A separate 2024 paper describes an analysis of functional performance among patients with generalized scleroderma treated at the Department of Dermatology of the PIM.

Assessment Must Account for Individual Hand Limitations

The available sources do not report a specific failure of a scleroderma hand assessment protocol. One study conducted on 45 patients with systemic sclerosis proposed using instrumental tests and rating scales to identify hand anomalies and guide occupational therapy strategies and outcome measurement. SRUK notes that occupational therapists may assess sensory impairment, functional limitations, strength, grip, and range of movement. It also emphasizes that the condition of the skin needs to be taken into account during hand assessment.

Interventions and Disability Measurement

A study of people with diffuse cutaneous systemic sclerosis compared two 18-week occupational therapy interventions: an intensive group receiving eight weekly in-person sessions plus app-delivered home exercises, and an App Alone group. The supplied study description does not state which intervention produced better outcomes, so their relative effectiveness cannot be determined from this information. Separately, the SHAQ measures physical disability with a composite score from 0 to 3, with higher scores indicating greater disability. Another study described a protocol using instrumental tests and rating scales to identify scleroderma hand anomalies and support occupational therapy planning.

Evaluation of grip strength using the Jamar dynamometer and pinchmeter showed reduced strength in 75% of patients, predominantly in the dominant hand. Statistically significant weakness was observed when grip strength was below 15 kg. Assessment of 16 different prehension types revealed impairments mainly in palmar grip (44%), tip-to-tip grip (37%), and vice grip (30%).

Optimizing Hand Function in Scleroderma Patients

The study underscores the importance of addressing dominant hand involvement and reduced range of motion in the 2nd and 5th fingers. Occupational therapy should focus on tailored interventions, including educational programs to optimize hand use, distribute workload between dominant and non-dominant hands, and recommend assistive devices. Early intervention and comprehensive strategies are vital for improving hand function and quality of life in SSc patients.

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Pairing Tailored Therapy With Trackable Exercise

A 2019 study describes systemic sclerosis as involving tissue stiffness and contraction that can limit day-to-day activities, and examines specialized physical-occupational therapy focused on the hands and face and its impact on quality of life. A 2021 study examines short- and longer-term effects of two occupational therapy interventions on hand disability in people with diffuse cutaneous SSc. Its description notes that an app designed to increase exercise engagement allows objective tracking and standardized exercise prescription. Together, these sources describe the rationale for focused therapy and the use of app-based tools, but the supplied snippets do not report comparative outcome results.

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What methods are used to assess hand function?

The assessment protocol introduces several methods to evaluate the hand function of individuals with Systemic sclerosis (SSc). It utilizes the Strickland measurement to assess Total Active Motion (TAM), the Jamar dynamometer and pinchmeter for grip strength, and evaluates 16 different types of prehension. The use of these tools helps identify specific impairments and guides occupational therapy strategies.

2

Why is assessment of hand function important for patients with Systemic sclerosis (SSc)?

Hand impairment significantly affects the lives of individuals with Systemic sclerosis (SSc), as approximately 90% of patients experience hand issues. This makes the evaluation and treatment of scleroderma hand extremely important. By accurately assessing hand function using tools like the Strickland measurement for Total Active Motion (TAM), the Jamar dynamometer, and evaluating prehension, occupational therapists can tailor interventions to improve patient outcomes, and enhance their daily lives.

3

What does the Strickland measurement assess and why is it important?

The Strickland measurement assesses Total Active Motion (TAM) in the hands. This method provides a quantitative measure of hand movement, allowing occupational therapists to identify limitations in range of motion. In the study, nearly all patients exhibited symmetrical hand involvement based on TAM. The study revealed that Diffuse SSc patients showed statistically significant reduced total active movement in their dominant hands, highlighting the importance of this measurement in detecting and understanding the impact of Systemic sclerosis (SSc) on hand function.

4

How is grip strength evaluated, and why is this significant?

Grip strength is evaluated using both the Jamar dynamometer and pinchmeter. This assessment is crucial because reduced grip strength is a common problem for those with Systemic sclerosis (SSc). The study found that 75% of the patients had reduced grip strength, predominantly in their dominant hand. This evaluation helps guide occupational therapy interventions, like exercises and assistive devices, aimed at improving hand function and the ability to perform daily tasks.

5

How is prehension evaluated, and what does it reveal?

Prehension, or the ability to grasp and manipulate objects, is evaluated using 16 different types of prehension. The assessment examines the different ways individuals grasp objects, such as palmar grip, tip-to-tip grip, and vice grip. The study showed impairments in these grips, with the palmar grip being affected the most. Identifying these impairments allows occupational therapists to develop targeted interventions, including educational programs and adaptive equipment, to improve hand function and the performance of daily activities in individuals with Systemic sclerosis (SSc).

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