Hand function in Charcot Marie Tooth: test retest reliability of some measurements

Reliability, validity, and responsiveness of pinch strength assessment: a systematic review

PURPOSE

To summarize and critically appraise the quality of studies investigating psychometric properties of pinch strength assessment.

METHODS

Medical literature up to February 2024 was searched for studies reporting on at least one measurement property of pinch strength assessment. The quality of the evidence and the risk of bias were rated using COSMIN 2018 guidelines.

RESULTS

Thirty-three studies (1962 participants) were included. The majority (16/19) of reliability studies were of adequate to very good quality. Seven of 12 studies of validity were rated as adequate or very good. The quality of the eight responsiveness studies was adequate. Reliability was good to excellent (ICC > 0.75) for neurological conditions, and excellent (ICC > 0.90) for musculoskeletal disorders and healthy participants. Pinch strength showed strong to very strong correlations with grip strength (r = 0.72-0.92), moderate to strong correlations with assessments of dexterity (r = 0.78-0.80), and weak to moderate correlation with patient-reported outcome measures (r = 0.03-0.50). Varied results were found for pinch strength responsiveness in a small number of studies.

CONCLUSIONS

Pinch strength assessment is reliable. Validity and responsiveness are less reported, but there is a strong correlation between pinch and grip strength, and a moderate correlation with dexterity.

Pharmacological Doses of Thiamine Benefit Patients with the Charcot-Marie-Tooth Neuropathy by Changing Thiamine Diphosphate Levels and Affecting Regulation of Thiamine-Dependent Enzymes

Charcot-Marie-Tooth (CMT) neuropathy is a polygenic disorder of peripheral nerves with no effective cure. Thiamine (vitamin B1) is a neurotropic compound that improves neuropathies. Our pilot study characterizes therapeutic potential of daily oral administration of thiamine (100 mg) in CMT neuropathy and its molecular mechanisms. The patient hand grip strength was determined before and after thiamine administration along with the blood levels of the thiamine coenzyme form (thiamine diphosphate, ThDP), activities of endogenous holo-transketolase (without ThDP in the assay medium) and total transketolase (with ThDP in the assay medium), and transketolase activation by ThDP [1 - (holo-transketolase/total transketolase),%], corresponding to the fraction of ThDP-free apo-transketolase. Single cases of administration of sulbutiamine (200 mg) or benfotiamine (150 mg) reveal their effects on the assayed parameters within those of thiamine. Administration of thiamine or its pharmacological forms increased the hand grip strength in the CMT patients. Comparison of the thiamin status in patients with different forms of CMT disease to that of control subjects without diagnosed pathologies revealed no significant differences in the average levels of ThDP, holo-transketolase, or relative content of holo and apo forms of transketolase. However, the regulation of transketolase by thiamine/ThDP differed in the control and CMT groups: in the assay, ThDP activated transketolase from the control individuals, but not from CMT patients. Thiamine administration paradoxically decreased endogenous holo-transketolase in CMT patients; this effect was not observed in the control group. Correlation analysis revealed sex-specific differences in the relationship between the parameters of thiamine status in both the control subjects and patients with the CMT disease. Thus, our findings link physiological benefits of thiamine administration in CMT patients to changes in their thiamine status, in particular, the blood levels of ThDP and transketolase regulation.

Upper Limbs Muscle Co-Contraction Changes Correlate With The Physical Motor Impairments in CMT

Background

Subjects with Charcot-Marie-Tooth (CMT) disease show hands impairment which is a relevant problem affecting the quality of life. This symptom is related to muscle weakness and reduced motor coordination of the upper limb. However, most studies focus on lower limb impairment, therefore the investigation of upper limb disability is necessary to identify biomarkers able to monitor disease-specific features and to tailor rehabilitation.

Objective

This study aimed at characterizing upper limb muscle co-contraction using the co-contraction index (CCI) in CMT population.

Methods

Upper limb kinematic and electromyography (EMG) data were collected from fourteen CMT subjects (6-CMT1A and 8-CMT1X) during motor tasks typical of daily living activities. Rudolph's CCI was used to quantify muscle co-contraction of four muscle pairs acting on shoulder, elbow and wrist. All CMT subjects underwent clinical examination. Thirteen healthy subjects served as the normative reference (HC).

Results

CMT1X and CMT1A showed a significant reduction in CCI for distal and proximal muscle pairs compared to HC. Furthermore, CMT1A showed greater values of CCI compared to CMT1X mainly for the axial and axial-to-proximal muscle pairs. Movement speed and smoothness were not altered compared to HC. In addition, EMG metrics showed moderate-to-strong significant correlations with clinical outcomes.

Conclusions

CCI was able to quantify disease-specific deficits with respect to the normative reference, highlighting motor control alterations even before motor output impairment. CCI was also sensitive in detecting CMT subtypes-based differences and adopted compensatory strategies. Our findings suggest that CCI can be an outcome measure for CMT disease monitoring and interventional studies.

Quality of life and upper limb disability in Charcot-Marie-Tooth disease: A pilot study

Charcot-Marie-Tooth (CMT) patients present mainly lower limbs disability, with slowly progressive distal muscle weakness and atrophy, but hands impairment is a relevant problem affecting the quality of life (QoL). The evaluation of the upper limb is of primary importance. Often these patients present subclinical disorders or report difficulties in manipulating objects, with little evidence in the most used outcome measures. We aim to investigate the impact of hand impairment in the perceived QoL of CMT persons and secondly whether the Disability of Arm, Shoulder and Hand (DASH) scale can be useful in assessing upper limb abilities in CMT. We recruited 23 patients with confirmed genetic diagnosis of CMT. We performed a clinical evaluation with Sollerman Hand Function Test (SHFT), Thumb Opposition Test (TOT) and CMT examination score (CMTES). We completed the clinical assessment with DASH scale and the Short form 36 (SF36) questionnaire for a subjective evaluation of upper limb disability and quality of life. All patients also underwent an instrumental evaluation with a hand-held dynamometer measuring hand grip and tripod pinch and a sensor-engineered glove test (SEGT) to evaluate finger opposition movements in a quantitative spatial-temporal way. As expected, we found significant differences between CMT and control group performances in both clinical and instrumental assessment. Concerning QoL, we found that total score of SF36 and the SF36 Physical Composite Score (PCS) correlate with all clinical and instrumental Outcome Measures (OMs), particularly with Tripod pinch strength and TOT, which are considered major determinants of manual dexterity in CMT. DASH scale correlates with most clinical and instrumental OMs. Not surprisingly, we also found a correlation with DASH work, because CMT affects young patients engaged in work activities. However, we found a low correlation with the TOT and the dynamometer suggesting that DASH may not be the best scale for remote monitoring of upper limb disorders in CMT patients. Nevertheless, the results of our study confirm the usefulness of SF36 in recognizing the impact of upper limb disability in these subjects suggesting its use even in the remote monitoring of physical functioning.

Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke

Background

After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants.

Methods

Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test–retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller’s 3D position allowed to compute mean velocity (V_mean), peak velocity (V_peak) and smoothness (SPARC).

Results

Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test–retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (V_mean = 0.22 ± 0.086 ms⁻¹; V_peak = 0.96 ± 0.341 ms⁻¹; SPARC = − 3.31 ± 0.862) than patients with stroke (V_mean = 0.12 ± 0.052 ms⁻¹; V_peak = 0.60 ± 0.202 ms⁻¹; SPARC = − 5.04[− 7.050 to − 3.682]).

Conclusion

The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants.

Trial registration http://www.clinicaltrials.gov; Unique identifier: NCT04694833, Date of registration: 11/24/2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-022-00981-0.

Development and test-retest reliability assessment of a low-cost, 3D printed tool for assessing different aspects of hand dexterity

BACKGROUND

Hand dexterity assessments related to fine motor movements are routinely administered in clinical settings to ascertain an individual's hand function. However, to perform a detailed assessment multiple devices are needed which can be time-consuming and costly to administer.

PURPOSE

We designed and assessed the test-retest reliability of a 3D printed dexterity device in a cohort of healthy young adults and community-dwelling older adults. This study examines the reliability of the device, association between perceived fine motor gripping and manipulation dexterity components, and dominant hand outperformance during both tasks.

STUDY DESIGN

Test-retest study of a clinical measurement tool.

METHODS

A convenience sample of thirty-six healthy community-dwelling older and young adults was included in our study. The device was used to collect data at two testing sessions to establish test-retest reliability. Fine motor manipulation dexterity was assessed by lifting notched pegs over a vertical barrier and inserting them into randomly oriented holes sequentially. Fine motor gripping dexterity was assessed by taking these notched pegs out of the holes, lifting them over the barrier and dropping them into a large container.

RESULTS

Intraclass correlation coefficient (ICC)_2,1 showed good to excellent test-retest reliability on the dominant and nondominant hands when using the device. Only modest association was found within-hand for the gripping versus manipulation dexterity tests. The between-hand motor gripping dexterity test demonstrated a strong association; however, between-hand the motor manipulation dexterity test was only moderately associated.

CONCLUSION

The device was reliable, discriminated between the motor gripping and motor manipulating dexterity tasks, and was sensitive to handedness during the motor manipulating dexterity task. It shows promise as a hand dexterity assessment device which may provide efficiency and cost advantages. It is freely available via http://www.rehabtools.org/dexterity.html.

Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: secondary analyses from a randomized controlled trial

OBJECTIVE

To assess the short-term effects of multimodal occupational therapy on pain and hand function in patients referred for surgical consultation due to carpometacarpal joint (CMC1) osteoarthritis (OA).

METHODS

In this randomized controlled trial, CMC1 OA patients referred for surgical consultation at three rheumatology departments were randomized to 3 months multimodal occupational therapy (including patient education, hand exercises, orthoses, and assistive devices) or usual treatment (OA information). Pain was measured on a numeric rating scale from 0-10 (0, no pain). Function included grip and pinch strength (Newtons), range-of-motion [palmar and CMC1 abduction (°); flexion deficit in digits 2-5 (mm)], and self-reported Measure of Activity Performance of the Hand (MAP-Hand; range: 1-4; 1, no activity limitation) and QuickDASH (range: 0-100; 0, no disability). Between-group difference was assessed with follow-up values as dependent variables and group as an independent variable, adjusted for baseline values and time to follow-up.

RESULTS

Among 180 patients (mean age 63 (SD 8) years; 81% women), 170 completed the short-term follow-up assessment (3-4 months after baseline). Compared to usual treatment, occupational therapy yielded significantly improved pain at rest (-1.4 [-0.7, -2.0], P < 0.001), pain following grip strength (-1.1 [-0.5, -1.7], P = 0.001), grip strength (23.4 [7.5, 39.3], P = 0.004), MAP-Hand (-0.18 [-0.09, -0.28], P = 0.001), and QuickDASH (-8.1 [-4.6, -11.5], P < 0.001).

CONCLUSION

The multimodal occupational therapy intervention had significant short-term effects on pain, grip strength, and hand function in patients with CMC1 OA.

Multidimensional evaluation is necessary to assess hand function in patients with Charcot-Marie-Tooth disease type 1A

BACKGROUND

Charcot-Marie-Tooth (CMT) disease type 1A (CMT1A) is the most common hereditary neuropathy. Several studies have assessed the relation between axonal loss and grip strength; however, the functional impact on dexterity and health-related quality of life (HRQoL) is unknown. We hypothesized that the severity of axonal loss will be correlated with loss of function and HRQoL.

OBJECTIVE

The purpose of this study was to evaluate the relation between severity of electroneuromyography impairment and its impact on function and HRQoL in adults with CMT1A.

METHODS

Grip and lateral pinch strength were evaluated with specific dynamometers: the Jamar and the Pinch Gauge. Dexterity was explored with the Sollerman, Jebsen, and Nine-hole Peg tests. The CMT impact on well-being was assessed by the validated Medical Outcomes Study Short Form 36 (SF-36), Beck Depression Inventory, and Fatigue Severity Scale, and disease severity by the CMT neuropathy score and Inflammatory Neuropathy Cause and Treatment sensory sum score. Finally, axonal loss and demyelination process was assessed by electroneuromyography.

RESULTS

We included 33 participants with CMT1A (23 females, mean [SD] age 47.0 [4.7] years). We found lack of correlation between severe electroneuromyography impairment (frequency of abnormal results >80%), significant distal amyotrophy (70%) and quality of life (mean [SD] scores for physical and mental SF-36 36.4 [10.0] and 48.4 [11.5]), autonomy for activities of daily living, and hand function that remains relatively preserved. We found a correlation between lateral pinch and dexterity according to the Sollerman test (r=0.52, p<0.05) but a lack of correlation among the other parameters.

CONCLUSIONS

Electrophysiological follow-up seems to be of little relevance to follow HRQoL in individuals with CMT1A and manual function related to functional objectives for everyday physical medicine and rehabilitation practice. The manual function is complex and requires an overall, quantitative, qualitative and multidisciplinary assessment. Each tool (Pinch Gauge, Jamar, Sollerman, Jebsen, Nine-hole Peg) measures a specific element of manual function and is necessary when performing a grip function analysis.

A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke

BACKGROUND

Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinematics to clinical assessments of upper extremity function (convergent validity), and to establish the within-session reliability.

METHODS

The NHPT was modified and standardized (S-NHPT) by 1) replacing the original peg container with an additional identical nine hole pegboard, 2) adding a specific order of which peg to pick, and 3) specifying to insert the peg taken from the original pegboard into the corresponding hole of the target pegboard. Eight optical cameras registered upper body kinematics of 30 persons post-stroke and 41 controls during the S-NHPT. Four sequential phases of the task were identified and analyzed for kinematic group differences. Clinical assessments were performed.

RESULTS

The stroke group performed the S-NHPT slower (total movement time; mean diff 9.8 s, SE diff 1.4), less smoothly (number of movement units; mean diff 0.4, SE diff 0.1) and less efficiently (path ratio; mean diff 0.05, SE diff 0.02), and used increased scapular/trunk movements (acromion displacement; mean diff 15.7 mm, SE diff 3.5) than controls (P < 0.000, r ≥ 0.32), indicating discriminant validity. The stroke group also spent a significantly longer time grasping and releasing pegs relative to the transfer phases of the task compared to controls. Within the stroke group, kinematics correlated with time to complete the S-NHPT and the Fugl-Meyer Assessment (rs 0.38-0.70), suggesting convergent validity. Within-session reliability for the S-NHPT was generally high to very high for both groups (ICCs 0.71-0.94).

CONCLUSIONS

The S-NHPT shows adequate discriminant validity, convergent validity and within-session reliability. Standardization of the test facilitates kinematic analysis of movement performance, which in turn enables identification of differences in movement control between persons post-stroke and controls that may otherwise not be captured through the traditional time-based NHPT. Future research should ascertain further psychometric properties, e.g. sensitivity, of the S-NHPT.

Validation of the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1

We aimed to validate the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1 (DM1). Fifty patients with adult-onset, genetically confirmed DM1 were evaluated by Nine Hole Peg Test and re-evaluated at one week. Myotonia was not a limiting factor. The first test was compared with that performed by normal subjects (n = 28). Contextually, patients underwent handgrip and three-finger pinch assessments by handheld dynamometer. The Nine Hole Peg Test showed high intra-rater and inter-rater reliability in DM1 [ICC 0.86/0.83 for dominant and 0.90/0.88 for non-dominant hand, respectively]. Inverse correlation with handgrip and pinch strength values (r = -0.4; p < 0.01) and direct correlation with Muscular Impairment Rating Scale (r = 0.4; p < 0.01) were found for both DH and NDH. The test was able to differentiate severe DM1 patients, stratified by extent of muscle impairment, from mildly affected and normal controls, with a sensitivity of 97% and 95% for dominant hand and non-dominant hand, respectively (p < 0.0001). In conclusion, we showed that the Nine Hole Peg Test is a reliable, valid and sensitive test of dexterity in DM1, and that it can be considered as a candidate outcome measure to monitor natural history of disease and, possibly, therapeutic response in clinical trials.

Nine-hole Peg Test and Ten-meter Walk Test for Evaluating Functional Loss in Chinese Charcot-Marie-Tooth Disease

Background:

The 9-hole peg test (9-HPT) and 10-meter walk test (10-MWT) are commonly used to test finger motor function and walking ability. The aim of this present study was to investigate the efficacy of these tests for evaluating functional loss in Chinese Charcot-Marie-Tooth (CMT) disease.

Methods:

Thirty-four Chinese CMT patients (CMT group) from August 2015 to December 2016 were evaluated with 9-HPT, 10-MWT, CMT disease examination score, overall neuropathy limitation scale (ONLS), functional disability score, and Berg Balance Scale (BBS). Thirty-five age- and gender-matched healthy controls (control group) were also included in the study. Student's nonpaired or paired t-test were performed to compare data between two independent or related groups, respectively. The Pearson test was used to examine the correlations between recorded parameters.

Results:

The mean 9-HPT completion time in the dominant hand of CMT patients was significantly slower than that in the healthy controls (29.60 ± 11.89 s vs. 19.58 ± 3.45 s; t = −4.728, P < 0.001). Women with CMT completed the 9-HPT significantly faster than men with CMT (dominant hand: 24.74 ± 7.93 s vs. 33.01 ± 13.14 s, t = 2.097, P = 0.044). The gait speed of the average self-selected velocity and the average fast-velocity assessed using 10-MWT for CMT patients were significantly slower than those in the control group (1.03 ± 0.18 m/s vs. 1.44 ± 0.17 m/s, t = 9.333, P < 0.001; 1.31 ± 0.30 m/s vs. 1.91 ± 0.25 m/s, t = 8.853, P < 0.001, respectively). There was no difference in gait speed between men and women. Both 9-HPT and 10-MWT were significantly correlated with the ONLS, functional disability score, and BBS (P < 0.05 for all).

Conclusion:

The 9-HPT and 10-MWT might be useful for functional assessment in Chinese patients with CMT.

Comparisons in fluctuation of muscle strength and function in patients with immune-mediated neuropathy treated with intravenous versus subcutaneous immunoglobulin

INTRODUCTION

Variations in muscle strength and function have not been studied in patients with chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy whose treatment regimen has been changed from intravenous to subcutaneous immunoglobulin (IVIg to SCIg).

METHODS

In a prospective, open-label study, patients were changed from monthly IVIg to weekly SCIg. The primary endpoint was variation in isokinetic muscle strength (cIKS). Secondary endpoints were variations in Medical Research Council (MRC) score, grip strength (GS), 9-hole-peg test (9-HPT), and 40-meter-walk test (40-MWT).

RESULTS

The coefficient of variance of cIKS during the IVIg and SCIg treatment periods was unchanged (mean ± SD: 6.97 ± 4.83% vs. 5.50 ± 3.13%, P = 0.21). The variations in the 9-HPT and 40-MWT were significantly lower in the SCIg group (P = 0.01 and P = 0.005, respectively).

DISCUSSION

When therapy was changed from IVIg to SCIg, fluctuation of muscle strength was unchanged, but performance fluctuations were diminished. Muscle Nerve 57: 610-614, 2018.

Evaluation of muscle strength and manual dexterity in patients with Charcot-Marie-Tooth disease

STUDY DESIGN

Matched pair study.

INTRODUCTION

Differences in hand-muscle strength/dexterity between dominant (DH) and non-dominant (NDH) hand in Charcot-Marie-Tooth disease (CMT) are not well understood.

PURPOSE OF THE STUDY

To compare muscle strength/dexterity between DH and NDH and to correlate manual dexterity, strength and sensory function.

PATIENTS AND METHODS

Thirty CMT patients were studied using functional muscle testing (FMT) and strength (dynamometry), dexterity (the Nine Hole Peg Test [NHPT]), and Jebsen-Taylor Hand Function [JTT]), and sensory function (the Nottingham Sensory Assessment [NSA]).

RESULTS

Scores were worse for DH than NDH on FMT (p = 0.043) and NHPT (p = 0.014) but not on JTT (p = 0.098), handgrip strength (p = 0.710) or tripod pinch (p = 0.645). NSA did not correlate significantly with any tests (p's0.05).

CONCLUSIONS

In CMT disease, DH appears more impaired than NDH in terms of function and dexterity. Greater muscle weakness in DH may also emerge as CMT progresses.

LEVEL OF EVIDENCE

3b.

Test-Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke

BACKGROUND

Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related.

OBJECTIVE

To evaluate the test-retest reliability and convergent validity of 3 manual dexterity measures after stroke.

DESIGN

A test-retest design.

SETTING

University Hospital.

PARTICIPANTS

Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke.

MAIN OUTCOME MEASURES

Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho).

RESULTS

The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to -0.68 (NHPT versus mSHFT).

CONCLUSION

The test-retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT.

LEVEL OF EVIDENCE

III.

Reliability and validity of the Manual Ability Measure-36 in persons with Charcot-Marie-Tooth disease

STUDY DESIGN

Descriptive, clinical measurement.

INTRODUCTION

Charcot-Marie-Tooth disease (CMT) is a genetic disorder that results in demyelination or axonal degeneration in peripheral nerves. Characteristic symptoms include decreased muscle strength and sensation, particularly in the hands and feet.

PURPOSE

Examine the reliability and validity of the Manual Ability Measure (MAM-36), a 36-item self-report questionnaire specific to hand function, in persons with CMT.

METHODS

Fourteen participants with CMT completed the MAM-36 at two points one week apart. Participants were also administered performance-based tests for grip and pinch strength, dexterity, and sensation.

RESULTS

The test-retest intraclass correlation coefficient (ICC) for the MAM-36 was 0.96. Pearson correlation coefficients showed fair to good relationships (r = 0.41-0.64) between the MAM-36 scores and most of the performance tests.

CONCLUSION

The MAM-36 is a reliable and valid assessment tool for measuring hand function during everyday tasks in persons with CMT.

LEVEL OF EVIDENCE

IIb.

Test-retest reliability of the Shape/Texture Identification testTM in people with chronic stroke

OBJECTIVE

To evaluate the test-retest reliability of the Shape/Texture Identification test (STI-test^TM) in persons with chronic stroke.

DESIGN

A test-retest design.

SETTING

University hospital outpatient setting.

PARTICIPANTS

Forty-five persons (mean age 65 years) with mild to moderate impairments in the arm and hand > 6 months post stroke.

INTERVENTIONS

Not applicable.

MAIN MEASURE

The STI-test^TM was used to assess active touch of the hand. It consists of two subtests: identification of shapes and identification of textures, each in three different sizes. Both hands were assessed twice, one week apart. The reliability of the data was evaluated with weighted Kappa statistics and the Svensson rank-invariant method (percentage agreement, systematic and random disagreements).

RESULTS

The median total score of the STI-test^TM was 5 points (min-max 0-6 points) for the more affected hand and 6 points (min-max 3-6 points) for the less affected hand at both test occasions. The weighted Kappa coefficient was 0.94 for the more affected hand and 0.55 for the less affected hand. The percentage agreement for the more affected hand was 69% for the subtest shapes and 82% for the subtest textures, and for the less affected hand 62% and 91%, respectively. There were no systematic or random disagreements for any of the subtests.

CONCLUSION

The STI-test^TM is reliable to assess active touch of the hand after stroke.

The cooperative international neuromuscular research group Duchenne natural history study--a longitudinal investigation in the era of glucocorticoid therapy: design of protocol and the methods used

Contemporary natural history data in Duchenne muscular dystrophy (DMD) is needed to assess care recommendations and aid in planning future trials.

METHODS

The Cooperative International Neuromuscular Research Group (CINRG) DMD Natural History Study (DMD-NHS) enrolled 340 individuals, aged 2-28 years, with DMD in a longitudinal, observational study at 20 centers. Assessments obtained every 3 months for 1 year, at 18 months, and annually thereafter included: clinical history; anthropometrics; goniometry; manual muscle testing; quantitative muscle strength; timed function tests; pulmonary function; and patient-reported outcomes/health-related quality-of-life instruments.

RESULTS

Glucocorticoid (GC) use at baseline was 62% present, 14% past, and 24% GC-naive. In those ≥6 years of age, 16% lost ambulation over the first 12 months (mean age 10.8 years).

CONCLUSIONS

Detailed information on the study methodology of the CINRG DMD-NHS lays the groundwork for future analyses of prospective longitudinal natural history data. These data will assist investigators in designing clinical trials of novel therapeutics.

Proof of concept of the ability of the kinect to quantify upper extremity function in dystrophinopathy

INTRODUCTION

Individuals with dystrophinopathy lose upper extremity strength in proximal muscles followed by those more distal. Current upper extremity evaluation tools fail to fully capture changes in upper extremity strength and function across the disease spectrum as they tend to focus solely on distal ability. The Kinect by Microsoft is a gaming interface that can gather positional information about an individual's upper extremity movement which can be used to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. The purpose of this study was to determine the feasibility of using the Kinect platform to assess upper extremity function in individuals with dystrophinopathy across the spectrum of abilities.

METHODS

Investigators developed a proof-of-concept device, ACTIVE (Abilities Captured Through Interactive Video Evaluation), to measure functional reaching volume, movement velocity, and rate of fatigue. Five subjects with dystrophinopathy and 5 normal controls were tested using ACTIVE during one testing session. A single subject with dystrophinopathy was simultaneously tested with ACTIVE and a marker-based motion analysis system to establish preliminary validity of measurements.

RESULTS

ACTIVE proof-of-concept ranked the upper extremity abilities of subjects with dystrophinopathy by Brooke score, and also differentiated them from performance of normal controls for the functional reaching volume and velocity tests. Preliminary test-retest reliability of the ACTIVE for 2 sequential trials was excellent for functional reaching volume (ICC=0.986, p<0.001) and velocity trials (ICC=0.963, p<0.001).

DISCUSSION

The data from our pilot study with ACTIVE proof-of-concept demonstrates that newly available gaming technology has potential to be used to create a low-cost, widely-accessible and functional upper extremity outcome measure for use with children and adults with dystrophinopathy.

The role of the neuromuscular medicine and physiatry specialists in the multidisciplinary management of neuromuscular disease

The neuromuscular medicine and physiatry specialists are key health care providers who work cooperatively with a multidisciplinary team to provide coordinated care for individuals with neuromuscular diseases (NMDs). The director or coordinator of the team must be aware of the potential issues specific to NMDs and be able to access the interventions that are the foundations for proper care in NMD. Ultimate goals include maximizing health and functional capacities, performing medical monitoring and surveillance to inhibit and prevent complications, and promoting access and full integration into the community to optimize quality of life.

Neuromuscular Electrical Stimulation–Assisted Grasp Training and Restoration of Function in the Tetraplegic Hand: A Case Series

OBJECTIVE. This study investigated the immediate effects of repetitive neuromuscular electrical stimulation (NMES)–assisted grasp-and-release activities on the hand of patients with tetraplegia.

METHOD. Three participants with C-5–C-6 tetraplegia underwent grasp training with sequential application of NMES to wrist extensors, finger flexors, and finger extensors to assist participants in grasping and then releasing balls. Before the intervention, participants were assessed with the Jebsen–Taylor Hand Function Test and the Box and Block Test. They were evaluated with the same measures after the first and eighth sessions of intervention. Participants participated in eight 30-min sessions over 14 days.

RESULTS. Within-participant improvements in performance were observed in all outcome measures. Subtests of the Jebsen–Taylor Hand Function Test requiring grasping function showed the greatest improvements. Participants reported reduction of spasticity and more effective grasp.

CONCLUSION. NMES-assisted grasp paired with repetitive task practice resulted in improved performance on functional tests and subjectively improved hand function in the participants.

A narrative review of dexterity assessments

NARRATIVE REVIEW: This article is a narrative review of the psychometric properties (reliability and validity) and other characteristics (cost, time to administer, and year of publication) of commercially available manual and finger dexterity assessments used for adults in the United States. Complete research articles related to dexterity assessments were gathered from online database searches and individually critiqued for scientific rigor based on reliability and validity. Articles relating to 14 dexterity assessments were reviewed. All but three tools had established reliability, seven tools had all five forms of validity established, and two had only face and content validity. The results of this review provide information to those interested in fine motor skill acquisition, impairment, or functional recovery after injury. Therapists may use this information to choose the best assessment instrument to evaluate a patient's recovery of function over time. This review adds to the evidence-based, best-practice literature related to assessment and outcome measurements of patients with limited dexterity function participating in rehabilitation.

Grip strength in children: test-retest reliability using Grippit

AIM

To examine the reliability of peak and sustained grip strength in children using the Grippit. We compared the reliability of one trial, the best and mean of three trials and the reliability within 6-, 10- and 14-year-old groups.

DESIGN

Test-retest study.

METHODS

Grip strength with the Grippit instrument was evaluated at two test occasions in 58 children. Intraclass correlation coefficient 2.1 (ICC), standard error of measurement (SEM) also expressed as a percentage value (SEM%), coefficient of repeatability and coefficient of variation were calculated.

RESULTS

The test-retest reliability was good for both peak and sustained grip strength. The mean and best of three trials were equally reliable. Peak grip strength best of three trials, for example, was more reliable for the 6-year-olds (ICC 0.96, SEM% 6.3) and 14-year-olds (ICC 0.96, SEM% 5.2) compared to the 10-year-olds (ICC 0.78, SEM% 12.5). For peak grip strength in the whole sample, there was a systematic bias with better performance at the second measurement.

CONCLUSION

Grip strength assessment in children with Grippit results in good relative and absolute reliability for peak and sustained grip strength. We recommend that three test trials are used. The mean of and the best of three trials are comparable.

Reliability of clinical outcome measures in Charcot-Marie-Tooth disease

We assessed inter- and intra-rater reliability of outcome measures in Charcot-Marie-Tooth disease (CMT) patients. In 40 CMT patients, we assessed reliability of Overall Neuropathy Limitations Scale (ONLS), 10-m timed walk (T10MW), 9-hole-peg test (9-HPT), maximal voluntary isometric contraction (MVIC) of arm (elbow flexion, hand-grip, and three-point pinch) and leg (knee extension, foot dorsiflexion/plantar flexion). Reliability was substantial for ONLS, excellent for T10MW and 9-HPT. For MVIC, inter and intra-rater reliability was excellent for hand contractions; for leg contractions, intra-rater agreement was moderate to substantial, whereas inter-rater agreement was poor. An ad hoc device was produced to immobilize the foot and MVIC reliability was re-assessed in 26 CMT patients, resulting in excellent inter-rater and intra-rater reliability for foot dorsiflexion, and clear inter-rater improvement for foot plantar flexion. All outcome measures appear adequate for CMT assessment. Use of an immobilization device improves foot MVIC reliability, preventing biased findings in patients with greater strength.