Computerized measures of finger tapping: effects of hand dominance, age, and sex

Finger-specific effects of age on tapping speed and motor fatigability

Introduction

Increased motor fatigability is a symptom of many neuromuscular and neurodegenerative disorders. However, it is difficult to pinpoint pathological motor fatigability, since the phenomena has not yet been fully characterized in the healthy population. In this study, we investigate how motor fatigability differs across age. Given that many disorders involve supraspinal components, we characterize motor fatigability with a paradigm that has previously been associated with supraspinal mechanisms. Finger tapping at maximal speed results in a rapid decrease in movement speed, which is a measure of motor fatigability.

Methods

We collected finger tapping data in a field experiment from the general population with a smartphone app, and we investigated age differences in maximal tapping speed, as well as the decrease in tapping speed for the index, middle, and little fingers.

Results

We found that the maximal tapping speed differed significantly between young (18-30 years, n = 194) and aged (50-70 years, n = 176), whereas the fatigability-induced relative decrease in movement speed did not differ between the age groups (average decrease: 17.0% ± 6.9% (young) vs. 16.5% ± 7.5% (aged) decrease). Furthermore, tapping speed and motor fatigability depended on which finger was used.

Discussion

These findings might relate to dexterity, with more dexterous movements being more resistant to fatigue. In this study, we provide a characterization of motor fatigability in the general population which can be used as a comparison for clinical populations in the future.

Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants' ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21-40 years), middle-aged (41-60 years), and older (61-88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.

The California Cognitive Assessment Battery (CCAB)

Introduction

We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers.

Methods

The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently.

Results

Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification.

Discussion

The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.

Brain and muscle activity during fatiguing maximum-speed knee movement

Although the underlying mechanisms behind upper limb (e.g., finger) motor slowing during movements performed at the maximum voluntary rate have been explored, the same cannot be said for the lower limb. This is especially relevant considering the lower limb's larger joints and different functional patterns. Despite the similar motor control base, previously found differences in movement patterns and segment inertia may lead to distinct central and peripheral manifestations of fatigue in larger joint movement. Therefore, we aimed to explore these manifestations in a fatiguing knee maximum movement rate task by measuring brain and muscle activity, as well as brain-muscle coupling using corticomuscular coherence, during this task. A significant decrease in knee movement rate up to half the task duration was observed. After an early peak, brain activity showed a generalized decrease during the first half of the task, followed by a plateau, whereas knee flexor muscle activity showed a continuous decline. A similar decline was also seen in corticomuscular coherence but for both flexor and extensor muscles. The electrophysiological manifestations associated with knee motor slowing therefore showed some common and some distinct aspects compared with smaller joint tasks. Both central and peripheral manifestations of fatigue were observed; the changes seen in both EEG and electromyographic (EMG) variables suggest that multiple mechanisms were involved in exercise regulation and fatigue development.NEW & NOTEWORTHY The loss of knee movement rate with acute fatigue induced by high-speed movement is associated with both central and peripheral electrophysiological changes, such as a decrease in EEG power, increased agonist-antagonist cocontraction, and impaired brain-muscle coupling. These findings had not previously been reported for the knee joint, which shows functional and physiological differences compared with the existing findings for smaller upper limb joints.

The effects of hand dominance, fatigue, and sex on muscle activation during a repetitive overhead fatiguing task

Previous studies have shown that the dominant arm is generally stronger and more resistant to fatigue. However, whether there are side differences in shoulder muscle activation during a fatiguing upper limb task, and whether this varies according to sex, is unknown. Thirty right-handed adults (15 females) were recruited to complete two sessions of an overhead repetitive fatiguing task (shoulder flexion between 90 and 135° at 1 Hz), performed in two separate sessions with their dominant arm (DA) and non-dominant arm (NDA) until exhaustion. Electromyographic (EMG) data was collected from 11 shoulder muscles of the moving arm, and their activation amplitude (RMS) and activation variability (SD) were assessed. Results show that time to exhaustion was not affected by arm or by sex. There were some main arm effects on EMG activity amplitude, with higher activity on the DA's pectoralis major (p < 0.001), and on the NDA's middle (p = 0.009) and posterior deltoid (p = 0.001) and infraspinatus (p < 0.001). The pectoralis major was affected by arm and fatigue mostly in males. Their DA's pectoralis major activity amplitude was higher, and the amplitude variability was lower, compared to the NDA, with both parameters showing fatigue-dependent decreases at the NDA only (arm x sex x fatigue: RMS: p = 0.007; SD: p = 0.001). As for females, the DA variability of their lower trapezius was smaller, and that of their subscapularis was higher, compared to the NDA (sex x arm, p = 0.028, p = 0.05). There was also more EMG variability on the supraspinatus' dominant side, and on the posterior deltoid and infraspinatus ND side. Results show an overhead shoulder flexion task dependency on pectoralis major control in males, and on lower trapezius and shoulder girdle stabilizers in females, which could be related to both sex- and gender-based factors. This knowledge can help identify side-specific injury risk factors due to overhead work in males and females, and help determine the appropriateness of implementing sex-specific workplace protocols, including alternating arms as fatigue compensatory and recovery strategies.

A common timing mechanism across different millisecond domains: evidence from perceptual and motor tasks

Temporal information processing (TIP) constitutes a complex construct that underlies many cognitive functions and operates in a few hierarchically ordered time domains. This study aimed to verify the relationship between the tens of milliseconds and hundreds of milliseconds domains, referring to perceptual and motor timing, respectively. Sixty four young healthy individuals participated in this study. They underwent two auditory temporal order judgement tasks to assess their performance in the tens of milliseconds domain; on this basis, groups of high-level performers (HLP) and low-level performers (LLP) were identified. Then, a maximum tapping task was used to evaluate performance in the hundreds of milliseconds domain. The most remarkable result was that HLP achieved a faster tapping rate and synchronised quicker with their "internal clock" during the tapping task than did LLP. This result shows that there is a relationship between accuracy in judging temporally asynchronous stimuli and ability to achieve and maintain the pace of a movement adequate to one's internal pacemaker. This could indicate the strong contribution of a common timing mechanism, responsible for temporal organisation and coordination of behaviours across different millisecond domains.

The role of sex and handedness in the performance of the smartphone-based Finger-Tapping Test

The Finger Tapping Test (FTT) is a classical neuropsychological test that assesses motor functioning, and recently it has been employed using smartphones. For classical protocols, it has been observed that sex and handedness influence the performance during the test. By assessing the influence of sex and handedness on the test, it is possible to adjust the performance measurements to ensure the validity of test results and avoid sex- and handedness-related bias. The present study aimed to evaluate the influence of sex and handedness on smartphone-based FTT performance. We developed an Android application for the FTT and recruited 40 males and 40 females to carry out three spatial designs on it (protocols I, II, and III). Participants' performance was measured using the global, temporal, and spatial parameters of the FTT. We observed that for the performance in protocol I, handedness had a significant influence on global and temporal variables, while the interaction between handedness and sex had a greater influence on spatial variables. For protocols II and III, we observed that handedness had a significant influence on global, temporal, and spatial variables compared to the other factors. We concluded that the smartphone-based test is partly influenced by handedness and sex, and in clinical implications, these factors should be considered during the evaluation of the smartphone-based FTT.

A pilot study for testing a low-cost 3D design with an inertial sensor for the quantitative assessment of finger tapping in patients with Parkinson's Disease

Parkinson's disease (PD) is one of the most common neurodegenerative disorders worldwide. Current identification and monitoring of its motor symptoms depends on the clinical expertise. Repetitive finger tapping is one of the most common clinical maneuvers to assess for bradykinesia. Despite the increasing use of technology aids to quantitatively characterize the motor symptoms of PD, there is still a relative lack of clinical evidence to support their widespread use, particularly in low-resource settings. In this pilot study, we used a low-cost design prototype coupled with an inertial sensor is coupled to quantify the frequency of the finger tapping movements in four participants with PD. Repetitive finger tapping was performed using both hands before and after taking levodopa as part of their clinical treatment. The proposed 3D design allowed repetitive movements to be performed without issues. The maximum frequency of finger tapping was in the range of 0.1 to 4.3 Hz. Levodopa was associated with variable changes in the maximum frequency of finger tapping. This pilot study shows the feasibility for low-cost technology to quantitatively characterize repetitive movements in people living with PD.Clinical relevance- In this pilot study, a low-cost inertial sensor coupled to a design prototype was feasible to characterize the frequency of repetitive finger tapping movements in four participants with PD. This method could be used to quantitatively identify and monitor bradykinesia in people living with PD.

Autistic traits are associated with individual differences in finger tapping: an online study

In a novel online study, we explored whether finger tapping differences are evident in people with autistic traits in the general population. We hypothesised that those with higher autistic traits would show more impairment in finger tapping, and that age would moderate tapping output. The study included a non-diagnosed population of 159 participants aged 18-78 who completed an online measure of autistic traits (the AQ-10) and a measure of finger tapping (the FTT). Results showed those with higher AQ-10 scores recorded lower tapping scores in both hands. Moderation analysis showed younger participants with more autistic traits recorded lower tapping scores for the dominant hand. This suggests motor differences seen in autism studies are evident in the general population.

Exploring the comparative adequacy of a unimanual and a bimanual stimulus-response setup for use with three-alternative choice response time tasks

Research often conceptualises complex social factors as being distinct binary categories (e.g., female vs male, feminine vs masculine). While this can be appropriate, the addition of an 'overlapping' category (e.g., non-binary, gender neutral) can contextualise the 'binary', both for participants (allowing more complex conceptualisations of the categories than the 'either/or' conceptualisation in binary tasks), and for the results (by providing a neutral baseline for comparison). However, it is not clear what the best response setup for such a task would be. In this study, we explore this topic through comparing a unimanual (N = 34) and a bimanual response setup (N = 32) for use with a three-alternative choice response time task. Crucially, one of the stimulus categories ('mixed') was composed of stimulus elements from the other two stimulus categories used in that task (Complex Task). A reference button task was included to isolate the motoric component of response registration (Simple Task). The results of the simple task indicated lower motoric costs for the unimanual compared to the bimanual setup. However, when statistically controlling for these motoric costs in the complex task, the bimanual setup had a lower error rate and faster response times than the unimanual setup. Further, in the complex task error rates and response times were higher for the mixed than the matched stimuli, indicating that responding to mixed stimuli is more challenging for encoding and/or decision making processes. This difference was more pronounced in the unimanual than the bimanual setup. Taken together these results indicate that the unimanual setup is more adequate for the reference button task, whereas the intricacy of overlapping categories in the complex task is better contained in the bimanual setup, i.e. when some response alternatives are allocated to one hand and other alternatives to the other hand.

Handwriting kinematics during learning to write with the dominant left hand in converted left-handers

Converting left-handers to their non-dominant right hand was previously widespread, particularly for handwriting. The present study aimed to explore the extent to which adult, converted left-handers can learn writing with their dominant left hand during a 2-year training program. Eleven converted left-handers participated in the training. Handwriting kinematics were assessed at regular intervals (seven sessions) and compared to those of 11 innate left-handed controls matched for age, gender, and overall handedness score for basic (Finger, Wrist, Circle) and complex (Sentence, Copy) handwriting tasks. Regarding basic tasks in the training group, we found rapid increases in left and right-hand frequency and no significant differences between both hands at any time point, indicating successful hand transfer. After 24 months, training participants significantly surpassed controls for writing frequency in basic tasks with their left hand. For complex tasks, we identified significant increases in the training groups' left-hand writing frequency and duration between the first and last session. While training participants' left-hand writing remained significantly slower than their right-hand writing, statistics confirmed final differences between hands only for the duration of the Sentence task. Importantly, left-hand writing in the training group was characterized by lower frequency, lower automaticity, and prolonged duration after 24 months compared to innate left-handers. With training participants' left-hand writing skills significantly increasing for complex tasks and no final statistically significant differences between hands for frequency and automaticity, the program was considered effective. Nevertheless, within 2 years, training participants did not reach innate left-handers handwriting proficiency for complex tasks. Underlying reasons may be various, such as a non-optimal training program, a sensitive period for learning to write, irreversible neural changes during conversion in childhood, age-related decline of motor learning capacity, or retrograde interference between right- and left-hand writing.

Cross-validation and initial investigation of two abbreviated methods of the finger tapping test

The Finger Tapping Test (FTT) is a widely utilized measure to assess lateralized motor speed and dexterity. The current study sought to cross-validate an abbreviated version of the FTT (i.e., M of Trials 3-5) and to evaluate a novel abbreviated method (i.e., M of three trials within five taps of each other; "3 within 5") to examine their respective effectiveness as a predictor of full-score performance based on a traditional administration procedure. The results showed that the abbreviated methods accurately predicted the full-test score, and any statistically significant differences that emerged were small based on effect size analysis and unlikely to be clinically meaningful. These findings were consistent across genders, among older adults, and among individuals displaying significant inter-trial tapping variability and thus requiring lengthier administration time. Classification accuracy statistics for the detection of impairment and performance validity status were high for both abbreviated methods. The results support two valid options for shortening the duration of the FTT. Both methods, used independently or in combination, are compatible with traditional administration procedures.

Effects of age and sex on outcomes of the Q-Motor speeded finger tapping and grasping and lifting tests-findings from the population-based BiDirect Study

Background

Q-Motor is a suite of motor tests originally designed to assess motor symptoms in Huntington's disease. Among others, Q-Motor encompasses a finger tapping task and a grasping and lifting task. To date, there are no systematic investigations regarding effects of variables which may affect the performance in specific Q-Motor tests per se, and normative Q-Motor data based on a large population-based sample are not yet available.

Objective

We investigated effects of age and sex on five selected Q-Motor outcomes representing the two core Q-Motor tasks speeded finger tapping and grasping and lifting in a community sample of middle-aged to elderly adults. Furthermore, we explored effects of the potentially mediating variables educational attainment, alcohol consumption, smoking status, and depressive symptoms. Moreover, we explored inter-examiner variability. Finally, we compared the findings to findings for the Purdue Pegboard test.

Methods

Based on a sample of 726 community-dwelling adults and using multiple (Gaussian) regression analysis, we modeled the motor outcomes using age, sex, years in full-time education, depressive symptoms in the past seven days, alcohol consumption in the past seven days, and smoking status as explanatory variables.

Results

With regard to the Q-Motor tests, we found that more advanced age was associated with reduced tapping speed, male sex was associated with increased tapping speed and less irregularity, female sex was associated with less involuntary movement, more years of education were associated with increased tapping speed and less involuntary movement, never smoking was associated with less involuntary movement compared to current smoking, and more alcohol consumed was associated with more involuntary movement.

Conclusion

The present results show specific effects of age and sex on Q-Motor finger tapping and grasping and lifting performance. In addition, besides effects of education, there also were specific effects of smoking status and alcohol consumption. Importantly, the present study provides normative Q-Motor data based on a large population-based sample. Overall, the results are in favor of the feasibility and validity of Q-Motor finger tapping and grasping and lifting for large observational studies. Due to their low task-complexity and lack of placebo effects, Q-Motor tests may generate additional value in particular with regard to clinical conditions such as Huntington's or Parkinson's disease.

Range of Motion Remains Constant as Movement Rate Decreases During a Repetitive High-Speed Knee Flexion-Extension Task

Maintaining the range of motion in repetitive movement tasks is a crucial point since it directly influences the movement rate. Ensuring the movement amplitude can be reliably maintained when motor function is assessed by measuring the maximum movement rate is therefore a key consideration. However, the performed range of motion during such tasks is often not reported. This study aimed to determine whether individuals are able to maintain an intended range of motion during a knee flexion/extension maximum movement rate task in the absence of tactile and visual feedback. Twelve healthy male individuals performed knee flexion/extension at maximum speed for eight 10-s blocks in a 45° arc between 45° and 90°. The range of motion was monitored using a marker system and the movement rate was measured. The performed range of motion was not significantly different from the 45° arc during the task despite a 13.47% decrease in movement rate from the start to the end of the task. Nevertheless, there was only anecdotal evidence of no difference from 45° in most blocks, while on the second and seventh blocks, there was anecdotal evidence of differences in the Bayesian one-sample test. There was also no significant shift in the maximum flexion/extension angles throughout the task. Healthy male individuals were thus able to perform a consistent average predefined knee range of motion in a maximum movement rate task despite decreases in movement rate. This was achieved without constraint-inducing devices during the task, using only basic equipment and verbal feedback.

Do Hypertensive Men Spy With an Angry Little Eye? Anger Recognition in Men With Essential Hypertension - Cross-sectional and Prospective Findings

BACKGROUND

Higher trait anger has inconsistently been associated with hypertension and hypertension development, but social context in terms of recognition of other persons' anger has been neglected in this context.

PURPOSE

Here, we investigated anger recognition of facial affect and trait anger in essential hypertensive and normotensive men in addition to prospective associations with blood pressure (BP) increases.

METHODS

Baseline assessment comprised a total of 145 participants including 57 essential hypertensive and 65 normotensive men who were otherwise healthy and medication-free. Seventy-two eligible participants additionally completed follow-up assessment 3.1 (±0.08 SEM) years later to analyze BP changes over time. We assessed emotion recognition of facial affect with a paradigm displaying mixed facial affect of two morphed basic emotions including anger, fear, sadness, and happiness. Trait anger was assessed with the Spielberger trait anger scale.

RESULTS

Cross-sectionally, we found that with increasing BP, hypertensive men overrated anger displayed in facial expressions of mixed emotions as compared to normotensive men (ps ≤ .019) while there were no differences in trait anger (p = .16). Prospectively, the interaction between mean anger recognition and trait anger independently predicted BP increases from baseline to follow-up (ps ≤ .043), in that overrating displayed anger predicted future BP increases only if trait anger was high.

CONCLUSIONS

Our findings indicate an anger recognition bias in men with essential hypertension and that overrating displayed anger in combination with higher trait anger seems to predict future BP increases. This might be of clinical relevance for the development and progression of hypertension and cardiovascular disease.

The association between cytokines and psychomotor speed in a spectrum of psychotic disorders: A longitudinal study

Background

In schizophrenia, impaired psychomotor speed is a common symptom predicting worse functional outcome. Inflammation causes changes in white matter integrity, which may lead to reduced psychomotor speed. Therefore, we wanted to investigate if peripheral inflammation assessed with cytokines affected performance on psychomotor speed in patients with a spectrum of psychotic disorders.

Methods

The current study is a prospective cohort study, including participants from a pragmatic, randomised controlled trial comparing three atypical antipsychotics in patients with a spectrum of psychotic disorders. For the purposes of this sub-study, we analysed drug treatment groups collectively. Psychomotor speed was assessed at baseline, and at weeks 6, 12, 26 and 52 of follow-up, using the neuropsychological tests trail making test (TMT) A and B, and symbol coding. Serum concentration of the following cytokines were measured: interleukin (IL)-β, IL-2, IL-4, IL-6, IL-10, IL12 p70, IL-17a, interferon (IFN)-γ and tumor necrosis factor (TNF)-α. Blood samples were collected at baseline and after 1, 3, 6, 12, 26, 39 and 52 weeks. We analysed the effect of cytokines levels on psychomotor speed over time in linear mixed effects models.

Results

In our linear mixed effects models controlling for possible confounders, IFN-γ had a significant negative effect on TMT-A and symbol coding performance. None of the other tests for psychomotor speed were significantly associated with cytokines. Overall psychomotor speed performance increased significantly across the study period while cytokine levels remained stable.

Conclusion

Our study indicates a negative association between IFN-γ and psychomotor speed, which might be of importance when understanding the mechanisms behind psychomotor deviations in psychotic disorders.

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The cytokine interferon (IFN) – γ is related to psychomotor speed in patients with psychotic disorders.

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For majority of cytokines, we found no significant association with psychomotor speed.

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Cytokines remained stable during the study period of 52 weeks.

State and trait of finger tapping performance in multiple sclerosis

Finger tapping tests have been shown feasible to assess motor performance in multiple sclerosis (MS) and were observed to be strongly associated with the estimated clinical severity of the disease. Therefore, tapping tests could be an adequate tool to assess disease status in MS. In this study we examined potential influencing factors on a maximum tapping task with the whole upper-limb for 10 s in 40 MS patients using linear mixed effects modelling. Patients were tested in three sessions with two trials per body-side per session over the course of 4–27 days of inpatient rehabilitation. Tested factors were the expanded disability scale (EDSS) score, laterality of MS, age, sex, hand dominance, time of day, session, trial (first or second), time between sessions, and the reported day form. A second model used these factors to examine the self-reported day form of patients. Linear mixed effects modelling indicated the tapping test to have a good inter-trial (proportional variance < 0.01) and inter-session reliability (non-significant; when controlling for time between sessions), an influence of hand-dominance (proportional variance 0.08), to be strongly associated with the EDSS (eta² = 0.22, interaction with laterality of MS eta² = 0.12) and to be not associated with the reported day form. The model explained 87% (p < 0.01) of variance in tapping performance. Lastly, we were able to observe a positive effect of neurologic inpatient rehabilitation on task performance obvious from a significant effect of the time between sessions (eta² = 0.007; longer time spans between sessions were associated with higher increments in performance). Day form was only impacted by EDSS and the time of the day (p < 0.01, R² = 0.57, eta²_TIME = 0.017, eta²_EDSS = 01.19). We conclude that the tapping test is a reliable and valid assessment tool for MS.

Measurement of finger tapping performance using a smartphone application: a pilot study

[Purpose] Describe the measurement, reliability and validity of finger tapping repetitions recorded using a commercially available smartphone application (app). [Participants and Methods] We tested a convenience sample of 12 young right-handed participants who completed unilateral index finger tapping and peg board completion tasks with each hand. [Results] Measurement of finger tapping performance was practicable and was shown to be acceptably reliable and able to distinguish between performance of the dominant versus nondominant hand. Finger tapping was not correlated with pegboard performance. [Conclusion] A small sample of young adults showed that measures of finger tapping were easily obtained using a smartphone app. The measures demonstrated acceptable reliability and known groups validity. They, however, may not reflect performance at other measures of voluntary movement functions.

Fractional Anisotropy in Selected, Motor-Related White Matter Tracts and Its Cross-Sectional and Longitudinal Associations With Motor Function in Healthy Older Adults

Background

While it is well-known that deficits in motor performance and brain structural connectivity occur in the course of healthy aging, it is still unclear if and how these changes are related to each other. While some cross-sectional studies suggest that white matter (WM) microstructure is positively associated with motor function in healthy older adults, more evidence is needed. Moreover, longitudinal data is required to estimate whether similar associations can be found between trajectories of change in WM microstructure and motor function. The current study addresses this gap by investigating age-associations and longitudinal changes in WM microstructure and motor function, and the cross-sectional (level-level) and longitudinal (level-change, change-change) association between these two domains.

Method

We used multiple-occasion data (covering 4 years) from a large sample (N = 231) of healthy older adults from the Longitudinal Healthy Aging Brain (LHAB) database. To measure WM microstructure, we used diffusion-weighted imaging data to compute mean FA in three selected WM tracts [forceps minor (FMIN); superior longitudinal fasciculus (SLF); corticospinal tract (CST)]. Motor function was measured via two motor speed tests (grooved pegboard, finger tapping) and one motor strength test (grip force test), separately for the left and the right hand. The statistical analysis was conducted with longitudinal growth curve models in the structural equation modeling framework.

Results

The results revealed longitudinal decline and negative cross-sectional age-associations for mean WM FA in the FMIN and SLF, and for motor function in all tests, with a higher vulnerability for left than right hand motor performance. Regarding cross-domain associations, we found a significant positive level-level correlation among mean WM FA in the FMIN with motor speed. Mean FA in SLF and CST was not correlated with motor performance measures, and none of the level-change or change-change associations were significant. Overall, our results (a) provide important insights into aging-related changes of fine motor abilities and FA in selected white matter tracts associated with motor control, (b) support previous cross-sectional work showing that neural control of movement in older adults also involves brain structures outside the core motor system and (c) align with the idea that, in healthy aging, compensatory mechanisms may be in place and longer time delays may be needed to reveal level-change or change-change associations.

GABA levels are differentially associated with bimanual motor performance in older as compared to young adults

Although gamma aminobutyric acid (GABA) is of particular importance for efficient motor functioning, very little is known about the relationship between regional GABA levels and motor performance. Some studies suggest this relation to be subject to age-related differences even though literature is scarce. To clarify this matter, we employed a comprehensive approach and investigated GABA levels within young and older adults across multiple motor tasks as well as multiple brain regions. Specifically, 30 young and 30 older adults completed a task battery of three different bimanual tasks. Furthermore, GABA levels were obtained within bilateral primary sensorimotor cortex (SM1), bilateral dorsal premotor cortex, the supplementary motor area and bilateral dorsolateral prefrontal cortex (DLPFC) using magnetic resonance spectroscopy. Results indicated that older adults, as compared to their younger counterparts, performed worse on all bimanual tasks and exhibited lower GABA levels in bilateral SM1 only. Moreover, GABA levels across the motor network and DLPFC were differentially associated with performance in young as opposed to older adults on a manual dexterity and bimanual coordination task but not a finger tapping task. Specifically, whereas higher GABA levels related to better manual dexterity within older adults, higher GABA levels predicted poorer bimanual coordination performance in young adults. By determining a task-specific and age-dependent association between GABA levels across the cortical motor network and performance on distinct bimanual tasks, the current study advances insights in the role of GABA for motor performance in the context of aging.

Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials

Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel–lesion–symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

Functional connectivity of supplementary motor area during finger-tapping in major depression

Psychomotor disturbance has been consistently regarded as an essential feature of depressive disorders. Studying objectively measurable motor behaviors like finger-tapping may help advance the diagnostic methods. Twenty-five patients with major depressive disorder (MDD) and 15 healthy participants underwent functional magnetic resonance imaging (fMRI) measurements while tapping their index fingers. The finger-tapping (FT) task was performed by the right hand (the tapping frequency varied between 1, 2 and 4 Hz) or both hands either in synchrony or alternation (the tapping frequency varied between 1 and 2 Hz). A mixed-model ANOVA was used for between- and within-group comparisons of the task accuracy and fMRI percent signal change in the supplementary motor area (SMA) during 26-second sequences of finger-tapping. Furthermore, using seed-based correlation analyses we compared the connectivity of the SMA between the two samples. At the behavioral level, no significant group differences in FT performance between the patient and control groups was observed. The mean fMRI percent signal change of the SMA was significantly elevated at higher levels of speed in both groups. In the MDD group, an increased connectivity of the left SMA with the bilateral cortical and cerebellar motor- and vision-related regions was found. Most importantly, a decreased connectivity between the SMA and the basal ganglia was found at frequencies of 4 Hz. Our findings support the contention that, in depression, brain connectivity measures during motor performance may reveal deviant neural processes that are potentially relevant to measurable (bio)markers for individual diagnosis and treatment.

Temporal and Force Characteristics of Rapid Single-Finger Tapping in Healthy Older Adults

The purpose of this study was to examine finger motor function in terms of temporal and force characteristics during rapid single-finger tapping in older adults. Ten older and 10 young males performed maximum frequency tapping by the index, middle, ring, or little finger. Nontapping fingers were maintained in contact with designated keys during tasks. Key-contact force for each of the fingers was monitored using four force transducers. The older subjects had slower tapping rates of all fingers during single-finger tapping than the young subjects. The average forces exerted by the nontapping fingers were larger for the older subjects than for the young subjects during tapping with the ring and little fingers. The ranges of the nontapping finger forces were larger for the older subjects during tapping by the middle, ring, and little fingers than for the young subjects. Thus, the motor abilities of the fingers evaluated by rapid single-finger tapping decline in older adults compared with young adults in terms of both movement speed and finger independence.

The upper limb Physiological Profile Assessment: Description, reliability, normative values and criterion validity

A progressive decline in upper limb function is associated with ageing and disease. In this cross-sectional study we assessed the performance of 367 healthy individuals aged of 20 to 95 years across a battery of upper limb clinical tests, which we have termed the upper limb Physiological Profile Assessment (PPA). The upper limb PPA was designed to quantify the performance of the multiple physiological domains important for adequate function in the upper extremities. Included are tests of muscle strength, unilateral movement and dexterity, position sense, skin sensation, bimanual coordination, arm stability, along with a functional task. We report age and gender normative values for each test. Test-retest reliability ranged from good to excellent in all tests (intra-class correlation coefficients from 0.65 to 0.98) with the exception of position sense (0.31). Ten of the thirteen tests revealed differences in performance between males and females, twelve showed a decline in performance with increasing age, and eight discriminated between older people with and without upper limb functional impairment. Furthermore, most tests showed good external validity with respect to age, an upper limb functional test and self-reported function. This profiling approach provides a reference range for clinical groups with upper limb sensory and motor impairments and may assist in identifying undiagnosed deficits in the general population. Furthermore, the tests are sufficiently reliable to detect motor impairments in people with compromised upper limb function and evaluate the effectiveness of interventions.

Can Long-Term Regular Practice of Physical Exercises Including Taichi Improve Finger Tapping of Patients Presenting With Mild Cognitive Impairment?

Background: Mild cognitive impairment (MCI) is a brain disease with both anatomical and functional alterations. There is clear evidence that individuals that are diagnosed with MCI have a high risk to develop dementia in the next 2–5 years compared to an age-matched population with a non-MCI diagnosis. The present study aimed to investigate whether the finger tapping frequency of patients with MCI was different from that of healthy individuals without MCI, and whether Tai Chi, a traditional Chinese movement discipline, could improve the finger tapping frequency of MCI patients.

Methods: The study population consisted of subjects of ≥50 years of age. Group one included 40 subjects without exercise habits from communities of Yangpu District in Shanghai, and group two included 60 subjects from a Tai Chi class in Shanghai Elderly University of Huangpu District. The Montreal Cognitive Assessment (MoCA) and a finger tapping test were conducted to assess the finger tapping frequency of all subjects.

Results: The MoCA score of MCI subjects was significantly lower compared to subjects without MCI (P < 0.01), and was not influenced by age, weight, or height. The finger tapping frequency of MCI subjects’ left hands was significantly lower compared to that of healthy subjects without MCI (P < 0.01), and a similar trend was observed for the subjects’ right hand. The MoCA score of MCI subjects in the Tai Chi class was significantly lower than that of healthy subjects without MCI (P < 0.01), which was not influenced by age, weight or height. The finger tapping frequency of MCI subjects’ right hands was lower compared to that of healthy subjects in the Tai Chi class without MCI (P < 0.05), but no significant difference regarding the finger tapping frequency of the left hand was observed.

Conclusion: These findings suggested that finger tapping frequency of MCI subjects was significantly lower compared to normal subjects without MCI, and long-term Tai Chi exercise could reduce this significant difference. Moreover, there was no significant difference between groups for the subjects’ non-dominant (left) hand.

Finger Tapping Outperforms the Traditional Scale in Patients With Peripheral Nerve Damage

Objective: This study aimed to investigate whether there exist the limits of finger tapping frequency in the peripheral nerve injury detection in upper limb, and the effects of rehabilitation treatment on upper limb with peripheral nerve injury through finger tapping.

Methods: Here, 54 patients with peripheral nerve injury in upper limb were selected. We conducted finger tapping frequency test and Lind-mark hand function assessment score on the 54 subjects, and recorded the data 2-week before and after rehabilitation treatment.

Results: Finger tapping frequency and Lind-mark hand function assessment score have a high positive correlation regardless of the side of upper limb with peripheral nerve injury before and after the rehabilitation treatment. Finger tapping frequency of the right affected hand after treatment is significantly higher than that of before treatment (male: P < 0.05; female: P < 0.01), while finger tapping frequency of the left affected hand after treatment shows no significant difference compared to before treatment. Meanwhile, finger tapping frequency of the female subjects' unaffected hand after treatment is significantly higher than before treatment (left: P < 0.01; right: P < 0.05), however, this was not observed in male subjects. Based on data analysis, there is a high-correlation between finger tapping frequency and Lind-mark score of the patients' affected hand with brachial plexus nerve injury. A trend of the patients' affected hand with radial nerve injury is similar with brachial plexus nerve injury.

Conclusion: Compared with Lind-mark score, finger tapping frequency outperformed in the aspect of speed of neural impulse conduction in patients with peripheral nerve damage.

Action observation training modifies brain gray matter structure in healthy adult individuals

Action observation training (AOT) is thought to facilitate motor system function. We applied voxelwise methods to assess the regional modifications of brain gray matter (GM) volumes and white matter (WM) architecture in healthy subjects following AOT and their correlations with improvements at motor and cognitive functional scales. Forty-two righ-handed healthy subjects were randomized into an experimental (AOT-G, n = 20) and a control (C-G, n = 22) group. The training lasted 2 weeks and consisted of 10 sessions of 45 min each during which subjects watched videos of daily-life actions (AOT-G) or landscapes (C-G), alternated by the execution with the right hand of actions presented in the AOT-G videos. At baseline and follow up, motor and cognitive functional measures as well as brain structural MRI scans were obtained. Tensor-based morphometry and tract-based spatial statistics were used to map longitudinal modifications of GM and WM structures and their correlation with functional scales. After training, both groups improved at cognitive tests, whereas the AOT-G also improved hand motor performance. Following training, no modifications of WM diffusion tensor MRI indexes were detected. After training, compared to C-G, AOT-G had increased volume of the left superior frontal gyrus and decreased volume of the right lingual gyrus. Compared to AOT-G, C-G showed increased volume of the right middle frontal gyrus and left inferior temporal gyrus. In AOT-G, GM volume changes correlated with improvements at cognitive tests. Ten-day AOT in healthy individuals modifies GM structure, promoting structural brain plasticity and functional competence.

The Dyad-Adaptive Paced Auditory Serial Addition Test (DA-PASAT): Normative data and the effects of repeated testing, simulated malingering, and traumatic brain injury

The Paced Auditory Serial Addition Test (PASAT) is widely used to evaluate processing speed and executive function in patients with multiple sclerosis, traumatic brain injury, and other neurological disorders. In the PASAT, subjects listen to sequences of digits while continuously reporting the sum of the last two digits presented. Four different stimulus onset asynchronies (SOAs) are usually tested, with difficulty increasing as SOAs are reduced. Ceiling effects are common at long SOAs, while the digit delivery rate often exceeds the subject’s processing capacity at short SOAs, causing some subjects to stop performing altogether. In addition, subjects may adopt an “alternate answer” strategy at short SOAs, which reduces the test’s demands on working-memory and processing speed. Consequently, studies have shown that the number of dyads (consecutive correct answers) is a more sensitive measure of PASAT performance than the overall number of correct sums. Here, we describe a 2.5-minute computerized test, the Dyad-Adaptive PASAT (DA-PASAT), where SOAs are adjusted with a 2:1 staircase, decreasing after each pair of correct responses and increasing after misses. Processing capacity is reflected in the minimum SOA (minSOA) achieved in 54 trials. Experiment 1 gathered normative data in two large populations: 1617 subjects in New Zealand ranging in age from 18 to 65 years, and 214 Californians ranging in age from 18 to 82 years. Minimum SOAs were influenced by age, education, and daily hours of computer-use. Minimum SOA z-scores, calculated after factoring out the influence of these factors, were virtually identical in the two control groups, as were response times (RTs) and dyad ratios (the proportion of hits occurring in dyads). Experiment 2 measured the test-retest reliability of the DA-PASAT in 44 young subjects who underwent three test sessions at weekly intervals. High intraclass correlation coefficients (ICCs) were found for minSOAs (0.87), response times (0.76), and dyad ratios (0.87). Performance improved across test sessions for all measures. Experiment 3 investigated the effects of simulated malingering in 50 subjects: 42% of simulated malingerers produced abnormal (p< 0.05) minSOA z-scores. Simulated malingerers with abnormal scores were distinguished with 87% sensitivity and 69% specificity from control subjects with abnormal scores by excessive differences between training performance and the actual test. Experiment 4 investigated patients with traumatic brain injury (TBI): patients with mild TBI performed within the normal range while patients with severe TBI showed deficits. The DA-PASAT reduces the time and stress of PASAT assessment while gathering sensitive measures of dyad processing that reveal the effects of aging, malingering, and traumatic brain injury on performance.

Combining olfactory test and motion analysis sensors in Parkinson's disease preclinical diagnosis: a pilot study

OBJECTIVES

Preclinical diagnosis of Parkinson's disease (PD) is nowadays a topic of interest as the neuropathological process could begin years before the appearance of motor symptoms. Several symptoms, among them hyposmia, could precede motor features in PD. In the preclinical phase of PD, a subclinical reduction in motor skills is highly likely. In this pilot study, we investigate a step-by-step method to achieve preclinical PD diagnosis.

MATERIAL AND METHODS

We used the IOIT (Italian Olfactory Identification Test) to screen a population of healthy subjects. We identified 20 subjects with idiopathic hyposmia. Hyposmic subjects underwent an evaluation of motor skills, at baseline and after 1 year, using motion analysis sensors previously created by us.

RESULTS

One subject showed significant worsening in motor measurements. In this subject, we further conducted a dopaminergic challenge test monitored with the same sensors and, finally, he underwent [¹²³ I]-FP/CIT (DaTscan) SPECT brain imaging. The results show that he is probably affected by preclinical PD.

CONCLUSIONS

Our pilot study suggests that the combined use of an olfactory test and motor sensors for motion analysis could be useful for a screening of healthy subjects to identify those at a high risk of developing PD.

Beneficial effects of an investigational wristband containing Synsepalum dulcificum (miracle fruit) seed oil on the performance of hand and finger motor skills in healthy subjects: A randomized controlled preliminary study

Miracle fruit (Synsepalum dulcificum) seed oil (MFSO) contains phytochemicals and nutrients reported to affect musculoskeletal performance. The purpose of this study was to assess the safety and efficacy of a compression wristband containing MFSO on its ability to measurably improve the hand and finger motor skills of participants. Healthy right-handed participants (n = 38) were randomized in this double-blind, placebo-controlled study of MFSO and vehicle wristbands. Subjects wore the wristband on their left hand 4-6 weeks and then only on their right hand 2-4 weeks; the contralateral untreated hand served as an additional control. Twelve hand/finger motor skills were measured using quantitative bio-instrumentation tests, and subject self-assessment questionnaires were conducted. With each hand, in 9/12 tests, the MFSO group showed a clinically meaningful average improvement compared with an average worsening in the vehicle group. Statistical superiority to the control treatment group was exhibited in 9/12 tests for each hand (p < .01). After discontinuing the MFSO wristband on the left hand, test values regressed toward baseline levels. Subjects favored the MFSO wristband over the control, rating it as effective in improving their motor skills. Use of the MFSO wristband may improve an individual's manual dexterity skills and ability to maintain this performance.

The Influence of Planning and Response Inhibition on Cognitive Functioning of Non-Psychotic Unipolar Depressed Suicide Attempters

Depression is one of the main risk factors for suicide. However, little is known about the intricate relationships among depressive symptomatology in unipolar depression, suicide risk, and the characteristics of executive dysfunction in depressed patients. We compared 20 non-psychotic unipolar depressed suicide attempters to 20 matching depressed non-attempters and to 20 healthy controls to further investigate the possible differences in neuropsychological performance. Depressed subjects were controlled for current suicidal ideation, and their neuropsychological profile was assessed using a range of measures of executive functioning, attention, verbal memory, processing speed, and psychomotor speed. Depressed groups were outperformed by healthy controls. Depressed attempters presented more cognitive impairment than depressed non-attempters on a simple Go/No-go response inhibition task and performed better than non-attempters on the Tower of London planning task. Depressed attempters were clearly distinguished by a deficit in response inhibition (Go/No-go commission errors). The normative planning performance (Tower of London extra moves) of the suicide attempters was unexpected, and this unanticipated finding calls for further research. Normative planning may indicate an increased risk of suicidal behavior.

Split-arm swinging: the effect of arm swinging manipulation on interlimb coordination during walking

Human locomotion is defined by bilateral coordination of gait (BCG) and shared features with the fore-hindlimb coordination of quadrupeds. The objective of the present study is to explore the influence of arm swinging (AS) on BCG. Sixteen young, healthy individuals (eight women; eight right motor-dominant, eight left-motor dominant) participated. Participants performed 10 walking trials (2 min). In each of the trials AS was unilaterally manipulated (e.g., arm restriction, weight on the wrist), bilaterally manipulated, or not manipulated. The order of trials was random. Walking trials were performed on a treadmill. Gait kinematics were recorded by a motion capture system. Using feedback-controlled belt speed allowed the participants to walk at a self-determined gait speed. Effects of the manipulations were assessed by AS amplitudes and the phase coordination index (PCI), which quantifies the left-right anti-phased stepping pattern. Most of the AS manipulations caused an increase in PCI values (i.e., reduced lower limb coordination). Unilateral AS manipulation had a reciprocal effect on the AS amplitude of the other arm such that, for example, over-swinging of the right arm led to a decrease in the AS amplitude of the left arm. Side of motor dominance was not found to have a significant impact on PCI and AS amplitude. The present findings suggest that lower limb BCG is markedly influenced by the rhythmic AS during walking. It may thus be important for gait rehabilitation programs targeting BCG to take AS into account.NEW & NOTEWORTHY Control mechanisms for four-limb coordination in human locomotion are not fully known. To study the influence of arm swinging (AS) on bilateral coordination of the lower limbs during walking, we introduced a split-AS paradigm in young, healthy adults. AS manipulations caused deterioration in the anti-phased stepping pattern and impacted the AS amplitudes for the contralateral arm, suggesting that lower limb coordination is markedly influenced by the rhythmic AS during walking.

MotorBrain: A mobile app for the assessment of users' motor performance in neurology

BACKGROUND AND OBJECTIVE

Human motor skills or impairments have been traditionally assessed by neurologists by means of paper-and-pencil tests or special hardware. More recently, technologies such as digitizing tablets and touchscreens have offered neurologists new assessment possibilities, but their use has been restricted to a specific medical condition, or to stylus-operated mobile devices. The objective of this paper is twofold. First, we propose a mobile app (MotorBrain) that offers six computerized versions of traditional motor tests, can be used directly by patients (with and without the supervision of a clinician), and aims at turning millions of smartphones and tablets available to the general public into data collection and assessment tools. Then, we carry out a study to determine whether the data collected by MotorBrain can be meaningful for describing aging in human motor performance.

METHODS

A sample of healthy participants (N= 133) carried out the motor tests using MotorBrain on a smartphone. Participants were split into two groups (Young, Old) based on their age (less than or equal to 30 years, greater than or equal to 50 years, respectively). The data collected by the app characterizes accuracy, reaction times, and speed of movement. It was analyzed to investigate differences between the two groups.

RESULTS

The app does allow measuring differences in neuromotor performance. Data collected by the app allowed us to assess performance differences due to the aging of the neuromuscular system.

CONCLUSIONS

Data collected through MotorBrain is suitable to make meaningful distinctions among different kinds of performance, and allowed us to highlight performance differences associated to aging. MotorBrain supports the building of a large database of neuromotor data, which can be used for normative purposes in clinical use.

Finger tapping impairments are highly sensitive for evaluating upper motor neuron lesions

BACKGROUND

Identifying highly sensitive and reliable neurological exam components are crucial in recognizing clinical deficiencies. This study aimed to investigate finger tapping performance differences between patients with CNS demyelinating lesions and healthy control subjects.

METHODS

Twenty-three patients with multiple sclerosis or clinically isolated syndrome with infratentorial and/or cervical cord lesions on MRI, and 12 healthy controls were videotaped while tapping the tip of the index finger against the tip and distal crease of the thumb using both the dominant and non-dominant hand. Videos were assessed independently by 10 evaluators (three MS neurologists, four neurology residents, three advanced practice providers). Sensitivity and inter-evaluator reliability of finger tapping interpretations were calculated.

RESULTS

A total of 1400 evaluations (four videos per each of the 35 subjects evaluated by 10 independent providers) were obtained. Impairments in finger tapping against the distal thumb crease of the non-dominant hand, identified by neurologists, had the greatest sensitivity (84%, p < 0.001) for detecting impairment. Finger tapping against the thumb crease was more sensitive than the thumb tip across all categories of providers. The best inter-evaluator reliability was associated with neurologists' evaluations for the thumb crease of the non-dominant hand (kappa = 0.83, p < 0.001).

CONCLUSIONS

Impaired finger tapping against the distal thumb crease of the non-dominant hand was a more sensitive technique for detecting impairments related to CNS demyelinating lesions. Our findings highlight the importance of precise examinations of the non-dominant side where impaired fine motor control secondary to an upper motor injury might be detectable earlier than the dominant side.

The Bay Area Verbal Learning Test (BAVLT): Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

Verbal learning tests (VLTs) are widely used to evaluate memory deficits in neuropsychiatric and developmental disorders. However, their validity has been called into question by studies showing significant differences in VLT scores obtained by different examiners. Here we describe the computerized Bay Area Verbal Learning Test (BAVLT), which minimizes inter-examiner differences by incorporating digital list presentation and automated scoring. In the 10-min BAVLT, a 12-word list is presented on three acquisition trials, followed by a distractor list, immediate recall of the first list, and, after a 30-min delay, delayed recall and recognition. In Experiment 1, we analyzed the performance of 195 participants ranging in age from 18 to 82 years. Acquisition trials showed strong primacy and recency effects, with scores improving over repetitions, particularly for mid-list words. Inter-word intervals (IWIs) increased with successive words recalled. Omnibus scores (summed over all trials except recognition) were influenced by age, education, and sex (women outperformed men). In Experiment 2, we examined BAVLT test-retest reliability in 29 participants tested with different word lists at weekly intervals. High intraclass correlation coefficients were seen for omnibus and acquisition scores, IWIs, and a categorization index reflecting semantic reorganization. Experiment 3 examined the performance of Experiment 2 participants when feigning symptoms of traumatic brain injury. Although 37% of simulated malingerers showed abnormal (p < 0.05) omnibus z-scores, z-score cutoffs were ineffective in discriminating abnormal malingerers from control participants with abnormal scores. In contrast, four malingering indices (recognition scores, primacy/recency effects, learning rate across acquisition trials, and IWIs) discriminated the two groups with 80% sensitivity and 80% specificity. Experiment 4 examined the performance of a small group of patients with mild or severe TBI. Overall, both patient groups performed within the normal range, although significant performance deficits were seen in some patients. The BAVLT improves the speed and replicability of verbal learning assessments while providing comprehensive measures of retrieval timing, semantic organization, and primacy/recency effects that clarify the nature of performance.

Computerized Analysis of Verbal Fluency: Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

In verbal fluency (VF) tests, subjects articulate words in a specified category during a short test period (typically 60 s). Verbal fluency tests are widely used to study language development and to evaluate memory retrieval in neuropsychiatric disorders. Performance is usually measured as the total number of correct words retrieved. Here, we describe the properties of a computerized VF (C-VF) test that tallies correct words and repetitions while providing additional lexical measures of word frequency, syllable count, and typicality. In addition, the C-VF permits (1) the analysis of the rate of responding over time, and (2) the analysis of the semantic relationships between words using a new method, Explicit Semantic Analysis (ESA), as well as the established semantic clustering and switching measures developed by Troyer et al. (1997). In Experiment 1, we gathered normative data from 180 subjects ranging in age from 18 to 82 years in semantic ("animals") and phonemic (letter "F") conditions. The number of words retrieved in 90 s correlated with education and daily hours of computer-use. The rate of word production declined sharply over time during both tests. In semantic conditions, correct-word scores correlated strongly with the number of ESA and Troyer-defined semantic switches as well as with an ESA-defined semantic organization index (SOI). In phonemic conditions, ESA revealed significant semantic influences in the sequence of words retrieved. In Experiment 2, we examined the test-retest reliability of different measures across three weekly tests in 40 young subjects. Different categories were used for each semantic ("animals", "parts of the body", and "foods") and phonemic (letters "F", "A", and "S") condition. After regressing out the influences of education and computer-use, we found that correct-word z-scores in the first session did not differ from those of the subjects in Experiment 1. Word production was uniformly greater in semantic than phonemic conditions. Intraclass correlation coefficients (ICCs) of correct-word z-scores were higher for phonemic (0.91) than semantic (0.77) tests. In semantic conditions, good reliability was also seen for the SOI (ICC = 0.68) and ESA-defined switches in semantic categories (ICC = 0.62). In Experiment 3, we examined the performance of subjects from Experiment 2 when instructed to malinger: 38% showed abnormal (p< 0.05) performance in semantic conditions. Simulated malingerers with abnormal scores could be distinguished with 80% sensitivity and 89% specificity from subjects with abnormal scores in Experiment 1 using lexical, temporal, and semantic measures. In Experiment 4, we tested patients with mild and severe traumatic brain injury (mTBI and sTBI). Patients with mTBI performed within the normal range, while patients with sTBI showed significant impairments in correct-word z-scores and category shifts. The lexical, temporal, and semantic measures of the C-VF provide an automated and comprehensive description of verbal fluency performance.

Solvent exposure and cognitive function in automotive technicians

Automotive technicians are commonly exposed to organic and chlorinated solvents, particularly through use of cleaning products. Occupational solvent exposures have been associated with deficits in cognitive function but, to our knowledge, no previous studies have investigated automotive technicians. The purpose of the present study was to investigate whether previous exposures to n-hexane, in particular, or general solvents posed a persistent neurotoxic hazard to automotive workers. Enrolled in the study were 830 San Francisco Bay Area automotive repair workers. Each participant underwent a battery of cognitive function tests to investigate central nervous system impairment, with a primary focus on the domains of psychomotor speed, fine motor function, memory and mood. Cognitive test results regressed against estimated hexane and total solvent exposures showed little evidence of associations. Exposures to both solvents and hexane were well below the occupational exposure limits. Our results provide some reassurance about persistent neuropsychological effects in automotive workers who use solvent-based products and those who previously used hexane-containing automotive cleaning products, since this solvent is believed no longer to be used in automotive cleaning products. The lack of observed effect in this study may be attributable to low exposures, or it may reflect improved cognitive function since hexane use in automotive cleaning products was discontinued. However, impacts on results of exposure misclassification and/or the healthy worker survivor effect cannot be discounted. Irrespective of the outcome of this study, the main known neurologic effect of n-hexane is peripheral neuropathy, and such an association in automotive technicians is not excluded by these results.

A Computerized Test of Design Fluency

Tests of design fluency (DF) assess a participant’s ability to generate geometric patterns and are thought to measure executive functions involving the non-dominant frontal lobe. Here, we describe the properties of a rapidly administered computerized design-fluency (C-DF) test that measures response times, and is automatically scored. In Experiment 1, we found that the number of unique patterns produced over 90 s by 180 control participants (ages 18 to 82 years) correlated with age, education, and daily computer-use. Each line in the continuous 4-line patterns required approximately 1.0 s to draw. The rate of pattern production and the incidence of repeated patterns both increased over the 90 s test. Unique pattern z-scores (corrected for age and computer-use) correlated with the results of other neuropsychological tests performed on the same day. Experiment 2 analyzed C-DF test-retest reliability in 55 participants in three test sessions at weekly intervals and found high z-score intraclass correlation coefficients (ICC = 0.79). Z-scores in the first session did not differ significantly from those of Experiment 1, but performance improved significantly over repeated tests. Experiment 3 investigated the performance of Experiment 2 participants when instructed to simulate malingering. Z-scores were significantly reduced and pattern repetitions increased, but there was considerable overlap with the performance of the control population. Experiment 4 examined performance in veteran patients tested more than one year after traumatic brain injury (TBI). Patients with mild TBI performed within the normal range, but patients with severe TBI showed reduced z-scores. The C-DF test reliably measures visuospatial pattern generation ability and reveals performance deficits in patients with severe TBI.

The Effects of Repeat Testing, Malingering, and Traumatic Brain Injury on Computerized Measures of Visuospatial Memory Span

Spatial span tests (SSTs) such as the Corsi Block Test (CBT) and the SST of the Wechsler Memory Scale are widely used to assess deficits in spatial working memory. We conducted three experiments to evaluate the test-retest reliability and clinical sensitivity of a new computerized spatial span test (C-SST) that incorporates psychophysical methods to improve the precision of spatial span measurement. In Experiment 1, we analyzed C-SST test-retest reliability in 49 participants who underwent three test sessions at weekly intervals. Intraclass correlation coefficients (ICC) were higher for a psychophysically derived mean span (MnS) metric (0.83) than for the maximal span and total correct metrics used in traditional spatial-span tests. Response times (ReTs) also showed high ICCs (0.93) that correlated negatively with MnS scores and correlated positively with response-time latencies from other tests of processing speed. Learning effects were insignificant. Experiment 2 examined the performance of Experiment 1 participants when instructed to feign symptoms of traumatic brain injury (TBI): 57% showed abnormal MnS z-scores. A MnS z-score cutoff of 3.0 correctly classified 36% of simulated malingerers and 91% of the subgroup of 11 control participants with abnormal spans. Malingerers also made more substitution errors than control participants with abnormal spans (sensitivity = 43%, specificity = 91%). In addition, malingerers showed no evidence of ReT slowing, in contrast to significant abnormalities seen on other malingered tests of processing speed. As a result, differences between ReT z-scores and z-scores on other processing speed tests showed very high sensitivity and specificity in distinguishing malingering and control participants with either normal or abnormal spans. Experiment 3 examined C-SST performance in a group of patients with predominantly mild TBI: neither MnS nor ReT z-scores showed significant group-level abnormalities. The C-SST improves the reliability and sensitivity of spatial span testing, can accurately detect malingering, and shows that visuospatial working memory is largely preserved in patients with predominantly mild TBI.

The Effects of Age, Gender, and Hand on Force Control Capabilities of Healthy Adults

OBJECTIVE

The present study examined the effects of age (20s to 70s), gender (male and female), and hand (dominant and nondominant) on force control capabilities (FCCs) in four force control phases (initiation, development, maintenance, and termination).

BACKGROUND

Normative data of FCCs by force control phase are needed for various populations in age and gender to identify a type of motor performance reduction and its severity.

METHOD

FCCs of 360 participants (30 for each combination of age group and gender) were measured using a finger dynamometer and quantified in terms of initiation time (IT), development time (DT), maintenance error (ME), and termination time (TT).

RESULTS

Although gradual increases (1%~28%) by age were shown in IT, DT, and TT, a dramatic increase in ME was observed among participants in their 50s (26%), 60s (68%), and 70s (160%) compared to those in their 20s~40s. The most distinctive interaction effect of age and gender was found in ME out of the four FCC measures. Lastly, hand and its related interactions were not found significant.

CONCLUSION

Normative FCC data were established for four age groups (20s~40s, 50s, 60s, and 70s) and gender.

APPLICATION

The normative FCC data can be used for evaluating an individual's motor performance, screening patients with brain disorders, and designing input devices triggered and/or operated by the finger.

The Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury on High-Precision Measures of Simple Visual Reaction Time

Simple reaction time (SRT), the latency to respond to a stimulus, has been widely used as a basic measure of processing speed. In the current experiments, we examined clinically-relevant properties of a new SRT test that presents visual stimuli to the left or right hemifield at varying stimulus onset asynchronies (SOAs). Experiment 1 examined test-retest reliability in 48 participants who underwent three test sessions at weekly intervals. In the first test, log-transformed (log-SRT) z-scores, corrected for the influence of age and computer-use, were well predicted by regression functions derived from a normative population of 189 control participants. Test-retest reliability of log-SRT z-scores was measured with an intraclass correlation coefficient (ICC = 0.83) and equaled or exceeded those of other SRT tests and other widely used tests of processing speed that are administered manually. No significant learning effects were observed across test sessions. Experiment 2 investigated the same participants when instructed to malinger during a fourth testing session: 94% showed abnormal log-SRT z-scores, with 83% producing log-SRT z-scores exceeding a cutoff of 3.0, a degree of abnormality never seen in full-effort conditions. Thus, a log-SRT z-score cutoff of 3.0 had a sensitivity (83%) and specificity (100%) that equaled or exceeded that of existing symptom validity tests. We argue that even expert malingerers, fully informed of the malingering-detection metric, would be unable to successfully feign impairments on the SRT test because of the precise control of SRT latencies that would be required. Experiment 3 investigated 26 patients with traumatic brain injury (TBI) tested more than 1 year post-injury. The 22 patients with mild TBI showed insignificantly faster SRTs than controls, but a small group of four patients with severe TBI showed slowed SRTs. Simple visual reaction time is a reliable measure of processing speed that is sensitive to the effects of malingering and TBI.

A study of tapping by the unaffected finger of patients presenting with central and peripheral nerve damage

AIM

Whether the unaffected function of the hand of patients presenting with nerve injury is affected remains inconclusive. We aimed to evaluate whether there are differences in finger tapping following central or peripheral nerve injury compared with the unaffected hand and the ipsilateral hand of a healthy subject.

METHODS

Thirty right brain stroke patients with hemiplegia, 30 left arm peripheral nerve injury cases, and 60 healthy people were selected. We tested finger tapping of the right hands, and each subject performed the test twice.

RESULTS

Finger tapping following peripheral nerve injury as compared with the unaffected hand and the dominant hand of a healthy person was markedly higher than was found for central nerve injury (P < 0.05). Finger tapping of the male peripheral group's unaffected hand and the control group's dominant hand was significantly higher than the central group (P < 0.001). However, finger tapping of the female control group's dominant hand was significantly higher than the central group's unaffected hand (P < 0.01, P = 0.002), the peripheral group's unaffected hand (P < 0.05, P = 0.034).

CONCLUSION

The unaffected function of the hand of patients with central and peripheral nerve injury was different as compared with the ipsilateral hand of healthy individuals. The rehabilitation therapist should intensify the practice of normal upper limb fine activities and coordination of the patient.

Polyphasic Temporal Behavior of Finger-Tapping Performance: A Measure of Motor Skills and Fatigue

Successive voluntary motor movement involves a number of physiological mechanisms and may reflect motor skill development and neuromuscular fatigue. In this study, the temporal behavior of finger tapping was investigated in relation to motor skills and fatigue by using a long-term computer-based test. The finger-tapping performances of 29 healthy male volunteers were analyzed using linear and nonlinear regression models established for inter-tapping interval. The results suggest that finger-tapping performance exhibits a polyphasic nature, and has several characteristic time points, which may be directly related to muscle dynamics and energy consumption. In conclusion, we believe that future studies evaluating the polyphasic nature of the maximal voluntary movement will lead to the definition of objective scales that can be used in the follow up of some neuromuscular diseases, as well as, the determination of motor skills, individual ability, and peripheral fatigue through the use of a low cost, easy-to-use computer-based finger-tapping test.

Age-related slowing of response selection and production in a visual choice reaction time task

Aging is associated with delayed processing in choice reaction time (CRT) tasks, but the processing stages most impacted by aging have not been clearly identified. Here, we analyzed CRT latencies in a computerized serial visual feature-conjunction task. Participants responded to a target letter (probability 40%) by pressing one mouse button, and responded to distractor letters differing either in color, shape, or both features from the target (probabilities 20% each) by pressing the other mouse button. Stimuli were presented randomly to the left and right visual fields and stimulus onset asynchronies (SOAs) were adaptively reduced following correct responses using a staircase procedure. In Experiment 1, we tested 1466 participants who ranged in age from 18 to 65 years. CRT latencies increased significantly with age (r = 0.47, 2.80 ms/year). Central processing time (CPT), isolated by subtracting simple reaction times (SRT) (obtained in a companion experiment performed on the same day) from CRT latencies, accounted for more than 80% of age-related CRT slowing, with most of the remaining increase in latency due to slowed motor responses. Participants were faster and more accurate when the stimulus location was spatially compatible with the mouse button used for responding, and this effect increased slightly with age. Participants took longer to respond to distractors with target color or shape than to distractors with no target features. However, the additional time needed to discriminate the more target-like distractors did not increase with age. In Experiment 2, we replicated the findings of Experiment 1 in a second population of 178 participants (ages 18–82 years). CRT latencies did not differ significantly in the two experiments, and similar effects of age, distractor similarity, and stimulus-response spatial compatibility were found. The results suggest that the age-related slowing in visual CRT latencies is largely due to delays in response selection and production.

Factors influencing the latency of simple reaction time

Simple reaction time (SRT), the minimal time needed to respond to a stimulus, is a basic measure of processing speed. SRTs were first measured by Francis Galton in the 19th century, who reported visual SRT latencies below 190 ms in young subjects. However, recent large-scale studies have reported substantially increased SRT latencies that differ markedly in different laboratories, in part due to timing delays introduced by the computer hardware and software used for SRT measurement. We developed a calibrated and temporally precise SRT test to analyze the factors that influence SRT latencies in a paradigm where visual stimuli were presented to the left or right hemifield at varying stimulus onset asynchronies (SOAs). Experiment 1 examined a community sample of 1469 subjects ranging in age from 18 to 65. Mean SRT latencies were short (231, 213 ms when corrected for hardware delays) and increased significantly with age (0.55 ms/year), but were unaffected by sex or education. As in previous studies, SRTs were prolonged at shorter SOAs and were slightly faster for stimuli presented in the visual field contralateral to the responding hand. Stimulus detection time (SDT) was estimated by subtracting movement initiation time, measured in a speeded finger tapping test, from SRTs. SDT latencies averaged 131 ms and were unaffected by age. Experiment 2 tested 189 subjects ranging in age from 18 to 82 years in a different laboratory using a larger range of SOAs. Both SRTs and SDTs were slightly prolonged (by 7 ms). SRT latencies increased with age while SDT latencies remained stable. Precise computer-based measurements of SRT latencies show that processing speed is as fast in contemporary populations as in the Victorian era, and that age-related increases in SRT latencies are due primarily to slowed motor output.

Delayed finger tapping and cognitive responses in preterm-born male teenagers with mild spastic diplegia

BACKGROUND

Information on fine motor and basic cognitive functions in spastic diplegia is sparse in the literature. The aim of this study was to investigate index finger's tapping speed and cognitive functions in categorization and old/new recognition of pictures in patients with mild spastic diplegia.

METHODS

Fifteen preterm-born male teenagers with mild spastic diplegia and 15 healthy male teenagers participated in this study. Finger-tapping tests and cognitive tests were performed on all participants. Outcomes were compared between the two groups.

RESULTS

In the finger-tapping tests, the tapping speed was significantly slower in patients than in controls. In the tests of tapping one key persistently and tapping two keys alternately, the reaction time gaps between the left and right digits were larger in patients than in controls. In the categorization tests, the accuracies and reaction times for animal/plant and girl face pictures, but not for boy face pictures, were significantly worse in patients than in controls. In the recognition tests, the accuracies for old/new, animal/plant, and boy/girl face pictures were significantly lower in patients than in controls. The reaction times for old/new, animal/plant, and new face pictures, but not for old face pictures, were significantly longer in patients compared with controls.

CONCLUSIONS

Our results demonstrate delayed finger tapping and cognitive responses in preterm-born male teenagers with mild spastic diplegia. Our experimental paradigm is sensitive for the study of fine motor and cognitive functions between patients and healthy controls.