Limb‐kinetic apraxia affects activities of daily living in Parkinson's disease: a multi‐center study

Abstract

Background and purpose Impaired dexterity (fine hand movements) is often present in Parkinson’s disease (PD), even at early to moderate disease stages. It has a detrimental impact on activities of daily living (ADL) such as buttoning, contributing to reduced quality of life. Limb-kinetic apraxia, a loss of the ability to make precise, independent but coordinated finger and hand movements, may contribute to impaired dexterity even more than bradykinesia per se. However, the impact of limb-kinetic apraxia on ADL remains controversial. Our aim was to identify the strongest predictor of buttoning and unbuttoning in PD. It was hypothesized that coin rotation (a surrogate of limb-kinetic apraxia) represents the most important determinant. Methods Sixty-four right-handed, early to moderate PD patients were recruited from three movement disorder centers (Hoehn and Yahr stages 1–3). Buttoning, unbuttoning and coin rotation (right and left hand) represented the target tasks. Motor impairment was assessed according to the Unified Parkinson’s Disease Rating Scale. Results Multiple linear regression analysis showed that coin rotation with the right hand was the only significant predictor of buttoning (P < 0.001) and unbuttoning (P = 0.002). Notably, measures of bradykinesia or overall motor impairment did not represent significant predictors. Conclusions Constituting the novel key finding, limb-kinetic apraxia seems to be particularly relevant for ADL requiring dexterity skills in PD, even at early to moderate disease stages. Our results prompt research into the pathophysiological background and therapeutic options to treat limb-kinetic apraxia. The simple coin rotation test provides valuable information about ADL-related dexterity skills.

Limb Kinetic Apraxia Is an Independent Predictor for Quality of Life in Parkinson's Disease

“…LKA was measured by the CR task, which is a valid and sensitive screening for dexterity and has been used in several studies to assess LKA in PD . During the CR task, the participants were instructed to flip a 20‐Rappen coin between thumb, index finger, and middle finger as fast as possible.…”

“…Interestingly, the dexterous deficit may remain even when patients are in good on state; that is, when motor functioning is rather good . Therefore, it has been suggested that limb kinetic apraxia (LKA), a disorder of fine motor control not explained by elementary sensorimotor deficits being assessed by a coin rotation (CR) task, may explain impaired dexterity in PD . LKA has been described as an higher order (i.e., apraxic) motor disorder characterized by impaired control of selective and coordinated hand and finger movements not explained by motor or sensory deficits .…”

Activities of daily living and manual hand dexterity in persons with idiopathic parkinson disease

“…Foki et al attempted to identify the strongest predictor of buttoning and unbuttoning by investigating the relationship between limb-kinetic apraxia and ADL in persons with PD. The novel key finding in their study was that limb-kinetic apraxia seemed to be particularly relevant to ADL that require dexterity skills, even in mild to moderate PDs4 ) . Mak et al investigated the test-retest reliability of the Jebsen Taylor Hand Function Test (JTT) among older patients with PD and compared the JTT scores between patients with PD and healthy adults.…”

“…Performance in ADL is also affected by upper and lower extremity function such as postural instability, gait disturbance, reaching and grasping, manipulation, and manual dexterity4 ) . Therefore, these factors should be maintained for independent daily living by persons with PD.…”

Contribution to hand functional assessment based on its kinematics

“…Therefore the core of the thesis is established in the search of contributions to the functional assessment of the hand, focusing on its kinematics. As far as functionality of the hand is concerned, the field of study for this thesis is oriented to assess the ability to perform ADL, to provide a general method suitable for dependency assessment in accordance with many other works (Meiners et al 2002;Foki et al 2016;Brinkhorst et al 2016) and with the widely spread physiotherapists' belief that ADL should be considered in treatments . The state of the art has allowed identifying the lack of agreement in the ADL considered in the different works from literature (Light et al 1999;Light et al 2002), which could be solved using the ICF WHO 2001) as it is the only worldwide recognized reference to assess health aspects.…”