Finger and foot tapping as alternative outcomes of upper and lower extremity function in multiple sclerosis

Abstract

BackgroundWhile magnetic resonance imaging contrast-enhancing lesions represent an excellent screening tool for disease-modifying treatments in relapsing–remitting multiple sclerosis (RRMS), this biomarker is insensitive for testing therapies against compartmentalized inflammation in progressive multiple sclerosis (MS). Therefore, alternative sensitive outcomes are needed. Using machine learning, clinician-acquired disability scales can be combined with timed measures of neurological functions such as walking speed (e.g. 25-foot walk; 25FW) or fine finger movements (e.g. 9-hole peg test; 9HPT) into sensitive composite clinical scales, such as the recently developed combinatorial, weight-adjusted disability scale (CombiWISE). Ideally, these complementary simplified measurements of certain neurological functions could be performed regularly at patients’ homes using smartphones.ObjectivesWe asked whether tests amenable to adaptation to smartphone technology, such as finger and foot tapping have comparable sensitivity and specificity to current non-clinician-acquired disability measures.ResultsWe observed that finger and foot tapping can differentiate RRMS and progressive MS in a cross-sectional study and can also measure yearly and two-year disease progression in the latter, with better power (based on z-scores) in comparison to currently utilized 9HPT and 25FW.ConclusionsReplacing the 9HPT and 25FW with simplified tests broadly adaptable to smartphone technology may enhance the power of composite scales for progressive MS.

Identifying and Quantifying Neurological Disability via Smartphone

“…The tapping test goal was similar to previously validated non-smartphone administered tapping tests ( 9 ), where users had to tap as quickly as possible over a 10 s duration and the final score is the average of two attempts. The test uses touch recognition over a rectangular area covering the bottom half of a vertically oriented phone screen (Figure 1A ).…”

“…Measuring neurological functions by patients via smartphones ( 6 – 8 ) may pose a solution for all aforementioned problems, while additionally empowering patients for greater participation in their neurological care. We have previously found comparable sensitivity and specificity of simple, smartphone-amenable measurements of finger and foot taps to 9HPT and 25FW, respectively ( 9 ). In this study, we explored iterative development/optimization of smartphone-based measurements of neurological functions by: 1.…”

Comparison of Upper and Lower Extremity Functions in Primary and Secondary Progressive Multiple Sclerosis Patients

“…17 In a study conducted by Tanigawa et al, in which patients with RRMS and patients with progressive MS were compared, the comparison of patients treated for two years and those untreated showed that fine motor skills and walking functions were better in the treated group. 18 In a study by Ontaneda et al, 9-HPT was used to measure the efficacy of fingolimod and rituximab, and significant improvements were observed. 19 Since MS is a progressive disease, as disability increases during the course of the disease, upper and lower extremity functions and work capacity decrease.…”

Upper Extremity Capability Tests in Multiple Sclerosis

“…Upper extremity capacity tests are used in MS patients to measure both clinical progression and patients' responses to rehabilitation types. Ninehole pegs are the most commonly used tests in the evaluation of upper extremity functions in MS patients in clinical trials (31)(32)(33). EDSS testing, which is insufficient to show disease progression, is supported by additional tests in studies.…”