The VLT Test is an innovative test developed to qualify the arm and hand function (AHF) in persons with tetraplegia.
Over the last years hand function has become a clear topic in rehabilitation research. During this time a totally new instrument has been developed for both therapists and researchers who aim to investigate and explicate tetraplegic hand function in a reproducible way. This short introduction describes the development and the functionality of this test.
In 1994 the Hoensbroeck rehabilitation centre in the Netherlands started to protocolize the tetraplegic hand function in a qualitative way. The aim was to assess all tetraplegic manifestations treated both conservatively as well as surgically. For many years hand surgery has taken place in co-operation with the Atrium Hospital in Heerlen. The protocol underwent many changes and resulted in the VLT: the Van Lieshout hand function test for Tetraplegia.
Tetraplegic hand function can in no way be compared to the normal hand function. Our occupational therapists assessed many hand function tests in order to find a test to support decision making and therapy goal setting. No tests were found to be appropriate. Even the quantitative Grasp & Release Test (developed especially for persons with tetraplegia at level C5/C6) could not fill this gap . The VLT examines the functionality of the tetraplegic arm and hand, not by testing functions but by testing tasks based on daily activities.
The VLT test was developed to fulfil the following demands:
- Means to objectively determine the changes in tetraplegic hand function.
- Feasible to all tetraplegic persons with some kind of hand function: i.e. C5 to Th1, complete and incomplete, pre- and postoperative.
- The results of the test must contribute to therapeutic decision making and goal setting.
- With the test result the therapist must be able to pronounce upon whether the ultimate tetraplegic hand therapy goals have been achieved or not.
The VLT has proven to be a sensitive, valid and reliable test for evaluating AHF in persons with tetraplegia [2, 3].
The VLT comes in two versions of quality testing: a short research version with 10 tasks taking approximately 30 minutes and a more extensive clinical version of 19 tasks. With the research version only the best hand is assessed and scored; with the clinical version both hands, the complicating factors of the task performance and the way the test person experiences the performance of the tasks are scored.
The VLT is a test to assess the ultimate goals in tetraplegic hand function therapy. For each of the 19 tasks performance levels were developed. A score of 5 equals the best possible task performance; score of 1 equals the minimum requirement. The levels of performance are scaled ordinally.
The 19 tasks represent the following 5 “tetraplegic themes”:
- Positioning and stabilising the arm
- Arm-powered movement of the body
- Opening and closure of the thumb
- Opening and closure of the fingers
- Hand skills
The test may contribute to the quality of therapy and treatment of tetraplegic people. Both the research version and the clinical version of the VLT test are offered on CD Rom in three languages (English, Dutch and German). Also, a course is offered in which the use of the VLT is explained in detail. For more information, please contact us at the address given below.
- van Tuijl JH, Janssen-Potten YJM, Seelen HAM: Evaluation of upper extremity motor function in tetraplegics: a review. Spinal Cord 40:51-64, 2002
- Spooren AIF, Janssen-Potten YJM, Post MWM, Kerckhofs E, Nene A, Seelen HAM: Measuring progress in arm hand skilled performance in persons with a cervical spinal cord injury: Responsiveness of the Van Lieshout Test. Spinal Cord 44(12):772-779, 2006
- Post MWM, Van Lieshout G, Seelen HAM, Snoek GJ, IJzerman M, Pons C: Measurement properties of the short version of the Van Lieshout Test. Spinal Cord 44(12):763-771, 2006
- Spooren AIF, Janssen-Potten YJM, Snoek G, Seelen HAM. Clinical outcome of Arm Hand Skilled Performance in persons with Cervical Spinal Cord Injuries. J Neurotrauma 2006;23(5):767
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- Spooren AIF, Janssen-Potten YJM, Kerckhofs E, Seelen HAM. Outcome of motor training programmes on arm and hand functioning in patients with cervical spinal cord injury according to different levels of the ICF: A systematic review. J Rehabil Med 2009;41(7):497-505
- Spooren AIF. Arm-hand skilled performance in persons with cervical spinal cord injury: Evaluation and training. PhD thesis. Brussels, Free University Brussels, 2010. (ISBN 978-90-9025545-3)
- Spooren AIF, Janssen-Potten YJM, Kerckhofs E, Bongers HMH, Seelen HAM. ToCUEST: a task-oriented client-centred training module to improve upper extremity skilled performance in cervical spinal cord injured patients. Spinal Cord. 2011 Oct;49(10):1042-1048
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- Spooren AIF, Arnould C, Smeets RJEM, Bongers HMH, Seelen HAM. Improvement of the Van Lieshout hand function Test for Tetraplegia using a Rasch analysis. Spinal Cord. 2013 Oct; 51(10): 739-744
- Spooren AIF, Arnould C, Smeets RJEM, Bongers HMH, Seelen HAM. Reference values for the Van Lieshout hand function test for Tetraplegia. Spinal Cord. 2013 Oct; 51(10): 745-749