Correlation between Tapping and Inserting of Pegs in Parkinson's Disease

Abstract

Neurological examination of parkinsonian symptomatology encompasses a range of procedures that gauge the status of the extrapyramidal motor system. 1 These procedures typically consist of clinical rating scales, that estimate motor function but are variable from one examiner to the other and are relatively insensitive to subtle disease. [1][2][3][4] The subjective impression of the parkinsonian patient by the examiner may also influence the scores. 1 As a result, investigators have developed complex quantitative instruments for objective assessment of parkinsonian motor impairment. 4,5 These instruments objectively assess tremor and motor slowness, characterized by two components: failure to initiate a willed movement (akinesia) and A B S T R A C T: Background: Various investigators have developed complex quantitative instrumental procedures for objective assessment of parkinsonian motor impairment, since drawbacks of rating scales are interrater variability, subjective impression, and insensitivity to subtle modifications. O b j e c t i v e s : To determine whether performance of inserting of pegs and tapping (i) correlates with each other (ii) d i ff e r e n t i a t e s between parkinsonian subjects and healthy controls and (iii) reflects severity of Parkinson's disease (PD). Subjects and methods: In 157 previously untreated idiopathic parkinsonian patients and healthy controls, we measured (i) the total time taken to insert 25 pegs from a rack into a series of appropriate holes in a Purdue pegboard-like apparatus and (ii) the number of taps on a contact board with a contact pencil for a period of 32 seconds for assessment of fine motor skills. Results: Results of both tests correlated with each other, differed between parkinsonian subjects and controls and reflected scored severity of PD. Better correlation with intensity of PD was noted with the Purdue pegboard-like task. Conclusion: Both tapping and inserting of pegs represent useful tools for objective evaluation of severity of PD. Peg insertion correlated better with disease severity. Both approaches may be useful in future clinical studies. RÉSUMÉ: Corrélation entre le tapping et la planche à chevilles dans la maladie de Parkinson. Introduction:Différents investigateurs ont développé des méthodes instrumentales quantitatives complexes pour l'évaluation objective du déficit moteur parkinsonien à cause des inconvénients inhérents aux échelles d'évaluation, soit la variabilité entre les observateurs, la subjectivité et le peu de sensibilité à des modifications subtiles. Objectifs: Déterminer si la performance au tapping et à la planche à chevilles (i) sont en corrélées (ii) identifie les parkinsoniens et les contrôles et (iii) reflète la sévérité de la maladie de Parkinson (MP). Sujets et Méthodes: Nous avons mesuré (i) le temps total pour transférer 25 chevilles d'un support à une série de trous appropriés dans une planche à chevilles de type Purdue et (ii) le nombre de percussions avec un stylet sur une surface de contact pendant une période de 32 seconde...

Assessment of complex movements reflects dysfunction in Huntington?s disease

“…We assessed the time period for this task by a computer to 100 milliseconds (ms) accuracy. The total peg insertion score is the sum of the time intervals of task performance with the right and left hand in ms [16]. In order to minimize learning and training effects, we allowed all HD patients to practice for one minute on the day before.…”

“…■ Key words peg insertion · Huntington's disease · fine motor skills holes [15,16]. Thus this method avoids fatigue at the end of the test and circumvents the possibility that for some severely affected patients it would be impossible to complete the insertion of all 25 pegs in one column [16].…”

“…Thus this method avoids fatigue at the end of the test and circumvents the possibility that for some severely affected patients it would be impossible to complete the insertion of all 25 pegs in one column [16]. This instrumental tool assessed altered motor performance, in particular bradykinesia, in neurodegeneration [16].…”

“…Thus this method avoids fatigue at the end of the test and circumvents the possibility that for some severely affected patients it would be impossible to complete the insertion of all 25 pegs in one column [16]. This instrumental tool assessed altered motor performance, in particular bradykinesia, in neurodegeneration [16]. On the one hand results of motor tests are not specific and the instruments are sometimes not portable, but on the other hand this instrumental assessment does not require the services of an experienced clinician [4].…”

“…This scale estimates behavioural, cognitive and motor dysfunction, but may suffer from the physician's subjective impression of the HD patient. This may influence the rating process and the score [10,15,16,20,23,24]. Another reliable marker of the HD severity is the bicaudate diameter ratio (BDR), since progressive caudate atrophy runs parallel to the deterioration of functional capacity in HD [1,9,26,27].…”