Psychometrics of dominant right hand during the 9-hole PEG test: differences between PEG placement and removal

Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity

BACKGROUND

The Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score.

PURPOSE

To investigate test-retest and intra-rater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT.

STUDY DESIGN

A clinical measurement study.

METHODS

Twenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity.

RESULTS

Test-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return (d = 1.16).

CONCLUSIONS

Kinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.

Intraindividual Variability Measurement of Fine Manual Motor Skills in Children Using an Electronic Pegboard: Cohort Study

Background

Pegboard tests are a powerful technique used by health and education professionals to evaluate manual dexterity and fine motor speed, both in children and adults. Using traditional pegboards in tests, the total time that, for example, a 4-year-old child needs for inserting pegs in a pegboard, with the left or right hand, can be measured. However, these measurements only allow for studying the variability among individuals, whereas no data can be obtained on the intraindividual variability in inserting and removing these pegs with one and the other hand.

Objective

The aim of this research was to study the intraindividual variabilities in fine manual motor skills of 2- to 3-year-old children during playing activities, using a custom designed electronic pegboard.

Methods

We have carried out a pilot study with 39 children, aged between 25 and 41 months. The children were observed while performing a task involving removing 10 pegs from 10 holes on one side and inserting them in 10 holes on the other side of a custom-designed sensor-based electronic pegboard, which has been built to be able to measure the times between peg insertions and removals.

Results

A sensor-based electronic pegboard was successfully developed, enabling the collection of single movement time data. In the piloting, a lower intraindividual variability was found in children with lower placement and removal times, confirming Adolph et al’s hypothesis.

Conclusions

The developed pegboard allows for studying intraindividual variability using automated wirelessly transmitted data provided by its sensors. This novel technique has been useful in studying and validating the hypothesis that children with lower movement times present lower intraindividual variability. New research is necessary to confirm these findings. Research with larger sample sizes and age ranges that include additional testing of children’s motor development level is currently in preparation.

Quantification of the Upper Extremity Motor Functions of Stroke Patients Using a Smart Nine-Hole Peg Tester

This paper introduces a smart nine-hole peg tester (s-9HPT), which comprises a standard nine-hole peg test pegboard, but with light-emitting diodes (LEDs) next to each hole. The s-9HPT still supports the traditional nine-hole peg test operating mode, in which the order of the peg placement and removal can be freely chosen. Considering this, the s-9HPT was used in lab research to analyze the traditional procedure and possible new procedures. As this analysis required subjects with similar levels of dexterity, measurement data from 16 healthy subjects (seven females, nine males, 25–80 years old) were used. We consequently found that illuminating the LEDs in various patterns facilitated guided tests of diverse complexity levels. Next, to demonstrate the clinical application of the s-9HPT, the improvement in the hand dexterity of 12 hospitalized stroke patients (45–80 years old, six females and six males) was monitored during their rehabilitation. Here, we used traditional and guided tests validated by healthy subjects. Consequently, improvements were found to be patient specific. At the beginning of rehabilitation, traditional tests suitably indicate improvements, while guided tests are beneficial following improvements in motor functions. Further, the guided tests motivated certain patients, meaning the rehabilitation was more effective for these individuals.

Biomarker report from the phase II lamotrigine trial in secondary progressive MS - neurofilament as a surrogate of disease progression

Objective

Lamotrigine trial in SPMS was a randomised control trial to assess whether partial blockade of sodium channels has a neuroprotective effect. The current study was an additional study to investigate the value of neurofilament (NfH) and other biomarkers in predicting prognosis and/or response to treatment.

Methods

SPMS patients who attended the NHNN or the Royal Free Hospital, UK, eligible for inclusion were invited to participate in the biomarker study. Primary outcome was whether lamotrigine would significantly reduce detectable serum NfH at 0-12, 12–24 and 0–24 months compared to placebo. Other serum/plasma and CSF biomarkers were also explored.

Results

Treatment effect by comparing absolute changes in NfH between the lamotrigine and placebo group showed no difference, however based on serum lamotrigine adherence there was significant decline in NfH (NfH 12–24 months p = 0.043, Nfh 0–24 months p = 0.023). Serum NfH correlated with disability: walking times, 9-HPT (non-dominant hand), PASAT, z-score, MSIS-29 (psychological) and EDSS and MRI cerebral atrophy and MTR. Other biomarkers explored in this study were not found to be significantly associated, aside from that of plasma osteopontin.

Conclusions

The relations between NfH and clinical scores of disability and MRI measures of atrophy and disease burden support NfH being a potential surrogate endpoint complementing MRI in neuroprotective trials and sample sizes for such trials are presented here. We did not observe a reduction in NfH levels between the Lamotrigine and placebo arms, however, the reduction in serum NfH levels based on lamotrigine adherence points to a possible neuroprotective effect of lamotrigine on axonal degeneration.

Relação entre os desempenhos em diferentes testes frequentemente utilizados na avaliação da função manual

INTRODUÇÃO: Testes de Força de Preensão Palmar Máxima (FP Max) e de destreza manual são utilizados como indicativos da função manual . Porém, a FP Max pode ter sua validade questionada, em virtude de raramente exercermos força máxima em tarefas cotidianas. Para investigar a validade da FP Max, examinamos a relação dessa variável com outras obtidas em testes de destreza manual. Ainda, investigamos a relação entre testes de destreza manual. OBJETIVO: Verificar a relação entre a FP Max e o desempenho no Teste de Função Manual de Jebsen e Taylor (TFMJT) e entre o desempenho nesse teste e o desempenho no teste dos Nove Pinos nos Buracos (9-PnB). MÉTODO: Trinta e seis adultos jovens e sadios (18 homens e 18 mulheres) realizaram o TFMJT, seguido do 9-PnB e do teste de FP Max, com ambas as mãos. Foram realizadas análises de correlação entre o desempenho nesses testes. RESULTADOS: Os resultados revelaram a existência de uma relação negativa moderada entre a FP Max e o TFMJT (r < - 0,74), mostrando que, quanto mais forte o indivíduo, menor é o tempo para realizar o TFMJT. Os resultados revelaram, também, uma fraca correlação entre o teste 9-PnB e o TFMJT, somente na mão não dominante. CONCLUSÕES: A FP Max pode ser utilizada como indicativo da FM, mas seus resultados devem ser utilizados com cautela, pois essa variável não contempla todos os aspectos que envolvem a coordenação e o controle das forças atuantes durante a manipulação de objetos. Os testes 9-PnB e TFMJT indicam características diferentes relacionadas às capacidades manipulativas.