Wear, watch and draw to understand the hand
Pat McKee, M.Sc., OT(C)
Pat McKee trained as an occupational therapist at Queen's University, Kingston ON, then worked in Edmonton AB for several years. She went on to get a master's degree in Anatomy.
She began her academic career at the University of Toronto in 1987, preceding that with 11 years on faculty at the University of Alberta in the Departments of Occupational Therapy and Anatomy and Cell Biology. Throughout those years she taught anatomy, hand therapy, biomechanics, orthotics (splinting), ergonomics and occupational therapy for musculoskeletal conditions to students and therapists.
She is an internationally recognized expert in hand anatomy and hand therapy. She was the 2013 honored hand therapist at the Philadelphia Hand Meeting; invited international hand therapist at the 2014 Brazilian Congress of Hand Surgery (Maceio Brazil); and was the 2015 keynote speaker at the European Federation of Societies of Hand Therapy meeting in Milan Italy. She has also been an invited instructor at Lunds University, Sweden and Port of Prince, Trinidad.
Pat has been providing orthotic, anatomy and hand therapy education to therapists and students since 1976 and co-authored the textbook “Orthotics in Rehabilitation: Splinting the Hand and Body”, as well as numerous peer-reviewed articles.
She has been honoured with Life Membership Awards from the Canadian Association of Occupational Therapists (2015) as well as from the Canadian Society of Hand Therapists (2017). Additionally, the Canadian Association of Occupational Therapists honoured her in 2011 with the Award for Innovative Practice.
Pat is also a musician and composer. Most notably she wrote and recorded "Look Beyond", Canada's Official Song for International Year of Disabled Persons.
Anne Agur, BSc(OT), MSc, PhD
Professor, Faculty of Medicine, University of Toronto
Anne Agur has been a faculty member in the Division of Anatomy, Department of Surgery at the University of Toronto since 1978.
She teaches Anatomy, Histology, Neuroanatomy and Embryology. Anne is course director of the Physical and Occupational Therapy Gross Anatomy courses and also contributes to the anatomy course in the Structure and Function block and the Neuroanatomy course of the Brain and Behaviour block of first year medicine.
She is the current editor of "Grant’s Atlas of Anatomy" and a co-author of "Essential Clinical Anatomy" and "Clincally Oriented Anatomy". Her research interests include skeletal muscle form and function, clinically applied Neuroanatomy, and Anatomy education.
The Story Behind the Anatomy Glove Learning System
The Development of the Anatomy Glove - written by Pat McKee
Since 1978 and 1987 respectively, Professor Anne Agur and I have provided anatomy and biomechanics education to occupational therapy students at the University of Toronto, as well as hand therapists through continuing education.
Over the years, as our class sizes increased and the amount of classroom and lab time for our anatomy teaching decreased, we became aware that students were struggling to understand the complexities of hand anatomy and function.
Students found that the most difficult part to understand was the finger extensor mechanism - the combined effect of the extrinsic finger extensors with the interosseous and lumbrical muscles. Professor Agur used coloured transparencies to show, layer by layer, the various components of the extensor expansion; and we showed students how to draw the extensor expansion onto paper pre-printed with outlines of the hand bones.
However, since since paper is two dimensional, many students were confused by how the volar interossei and lumbricals, with muscle bellies in the palm of the hand, attached distally into the dorsal aspect of the fingers. How could volar structures be extensors of the interphalangeal joints, they wondered?
In the early 2000s, we took our teaching a step further and introduced a 3-D teaching concept, using an examination/rubber/latex glove. We created a pre-lab activity in which students used our written instructions to draw the metatcarpal and phalangeal bones, followed by the small muscles of the hand, onto examination gloves. During the follow-up lab, we reviewed finger motion with the students, thus using the glove as a teaching tool.
The 3-D glove learning approach proved superior to 2-D learning when it came to understanding muscle function in the hand. When I incorporated this learning approach into continuing education orthotic (splinting) workshops, I found that practicing therapists also really liked the activity.
After using this teaching method for a while, we learned that some students and therapists were keeping their gloves proudly pinned on bulletin boards or taped above their desks, but not otherwise using them as a reference. This was because the examination gloves quickly deteriorated and the coloured lines (even when drawn with permanent markers) would bleed into the rubber/latex glove material. The drawn examination glove was an interesting memento but it didn’t serve as a useful reference or a tool once the learning activity was complete. We solved that problem in 2006 when we substituted plain cotton gloves (in three sizes) for rubber gloves.
Once we had found a way to make the glove more durable, we addressed our next challenges. First, we wondered if we could improve the student’s experience by substituting videos for written instructions. Second, we needed a way to help students draw more accurate representations of the hand’s anatomy, helping them through the difficulty of drawing properly proportioned and properly positioned bones and joints.
We addressed our first challenge in 2008 with the creation of video segments showing hand anatomy on a dissected human specimen and how to draw the muscle layers onto the glove – from the deep muscles to the superficial ones; and we added more hand muscles to the video drawing instruction.
Students watched each video segment, then drew muscles on their own gloves, which they were wearing on their non-drawing hands. Students told us that they better understood the anatomy with the addition of the video instruction but that they also wanted to be able to watch the videos again to review and consolidate their understanding of the structure and function of the hand muscles.
The solution to our second challenge, the difficulty of drawing bones and joints, came from our students. They said that they would prefer having a glove with pre-printed anatomically-correct bones, so we provided gloves with iron-on transfers depicting the bones. (See figure) We had an enthusiastic response from students and therapists but we, the founders, needed to find a more efficient method of making the gloves.
In early 2011, after a very long and time-consuming search, we finally sourced a stretchy glove and found a creative, enthusiastic local printer who embraced the challenge of printing the bones onto the glove. In 2012 we created new, more extensive videos, with the skilful videography provided by our friend Peter Reid.
Our stretchy Anatomy Glove now fits adult hands from small to large and provides learners with an accurate “canvas” on which to draw the extrinsic and intrinsic muscles. The anatomically-correct bones align with the joints of the person wearing the glove.
In addition to our student users, clinicians also individually purchase the system to enhance their hand anatomy knowledge using our easy-to-follow self-learning approach.
The Anatomy Glove Learning System has been shown internationally at conferences and in continuing education courses in numerous countries. As of May 2017, instructors in 14 countries, on six continents, have adopted the Anatomy Glove Learning System for their anatomy, medical, rehabilitation and massage therapy students. Every year, new programs adopt the Anatomy Glove Learning System. Some instructors do the glove drawing as a classroom activity; others have the students do the glove drawing as a pre-class activity.
There is nothing like this system. It is uniquely low tech and enhances 3D understanding of hand functional anatomy unlike than another other educational product.