Seventy-one plastic surgeons and therapists, of varying levels of seniority and experience, were asked to examine a resin cast of an adult male hand and use estimation to measure the angles of the metacarpophalangeal and interphalangeal joints of each digit. Visual estimation by all subjects was inaccurate by a mean of approximately 25% (median percentage error 22, range 1-100). Consultants were the most accurate, whilst physiotherapists were the least. Regular goniometer users were no more accurate. However, hand surgery experience correlated with accuracy, as did a stated interest in hand surgery. Although visual accuracy improves with experience, it is still an inaccurate technique. We, therefore, recommend that goniometers should be used for measuring angles in hand surgery patients.

Self-injurious behavior is frequently noted in institutionalized persons. Several treatment techniques have been attempted including medication, timeout, shock, aromatic ammonia, and adaptive clothing. Several authors have suggested extinction as an alternative technique. One problem with this technique is that self-injury may occur during the extinction period. The present study suggests that staff attention may maintain self-abusive behavior and withdrawal of this attention resulted in a rapid reduction of this behavior in a retarded individual.

No abstract