Background and purpose
The timed 25‐foot walk (T25FW) and nine‐hole peg test (NHPT) exhibit random variability in the short term. A threshold of ≥20% change from baseline has been used to indicate ...true disability change, but other threshold definitions may be better suited to exclude false and include true change events. The aim of this study was to use patient‐level original trial data to investigate the short‐term variation in T25FW and NHPT, and to compare its extent with disability change at 12‐month follow‐up in people with primary progressive multiple sclerosis (PPMS).
Methods
We used original patient‐level data from PROMISE, a large PPMS trial. In this trial, three separate T25FW and NHPT measurements were performed 1 week apart during screening. We used these repeated measures to describe the extent of short‐term variation. We used binary logistic regression models to investigate the association between screening characteristics and unacceptable short‐term variation.
Results
The traditional 20% threshold excluded a reasonable number of false change events, while also yielding a large number of change events at follow‐up. Increasing index values on the T25FW and NHPT were associated with higher short‐term variation.
Conclusions
The traditional ≥20% change threshold for the T25FW and NHPT represents a reasonable compromise between reducing the number of false change events and achieving the largest number of change events in people with PPMS. Our analyses inform the design of clinical trials in PPMS.
Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported ...outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This article addresses the NHPT, the proposed MSOAC measure for upper extremity function. We find that the NHPT is reliable within and between test sessions, discriminates between healthy subjects and MS patients with different levels of upper limb impairment, and shows high convergent validity with other manual dexterity as well as more comprehensive upper limb measures. Ecological validity is established by its relation to perceived upper limb use in daily life and perceived difficulty in performing activities of daily living. The NHPT is responsive to deterioration in longitudinal studies, and research suggests that a 20% change in test score is commonly used to define clinically meaningful worsening, a definition that needs further validation in all stages of the disease.
Introduction
We aimed to evaluate the relationship between the hand fine motor skills of peritoneal dialysis (PD) practitioners and PD‐related peritonitis.
Methods
This multicenter prospective ...observational study was conducted with 120 incident PD patients. Patients were divided into two groups who had PD‐related peritonitis within the first year as Group 1, and those who did not as Group 2. Hand fine motor skills were evaluated by Nine‐Hole Peg Test (NHPT) and Nut Screwing Test (NST).
Results
Initial NHPT (28.5 ± 6.0 s vs. 25.8 ± 5.0 s, p = 0.011) and NST (82.3 (61.5–102.8) s versus 65.3 (52.3–88.5) s p = 0.023) scores were significantly higher in Group 1 than Group 2. In multivariate logistic regression analysis, NHPT, Body Mass Index, Mini‐Mental Test, self PD practitioner, and catheter complications were found to be independent variables in predicting PD‐related peritonitis.
Conclusion
Decreased hand fine motor skills of PD patients is a risk factor for peritonitis.
A body-powered functional and cosmetically appeasing hand with moving interphalangeal joints (IPJ-Hand) was created. Function and satisfaction with the IPJ-Hand, conventional hand (CH) and functional ...hook (FH) in trans-radial prosthesis users were evaluated.
Eight participants with trans-radial amputations were provided with three prosthetic hands and performed the Nine Hole Peg Test (NHPT), Brief Activity Measure of Upper Limb Amputees (BAM-ULA) and Quebec User Evaluation of Satisfaction with Assistive Technology QUEST).
The data are shown as the median and interquartile range (IQR) due to skewed data distribution. Differences across hands were seen in NHPT with CH 57 (13.3), FH 49.5 (26.5), IPJ-H and 49 (14.8) seconds respectively. BAM-ULA, 10 (1.5), FH 10 (0.7), and IPJ-Hand 10 (1.7). QUEST scores, FH 28.5 (7.2) with the highest score, IPJ-Hand 26 (6.8), and lastly CH 25.5 (9.2).
Individual participant results varied, with some participants performing better on the NHPT when using the IPJ-Hand when compared to the CH and FH. No differences between hands on the BAM-ULA were seen, and although no large differences in QUEST were observed, users performed best using IPJ-Hand.
Key messages
An interphalangeal joint prosthetic hand (IPJ-Hand) offers the similar function of a prosthetic hook, and the appearance of a conventional hand, but with improved dexterity.
Minimal resources are needed to create the IPJ-Hand for prosthesis wearers.
Neurological damage in Multiple Sclerosis (MS) affects the motor, sensory, visual, cognitive and sphincteric systems, resulting in different degrees of disability. Upper limb dysfunction is a core ...deficit affecting MS patients. However, since upper limb function impairment is not properly recorded in the Expanded Disability Status Scale (EDSS) for MS, other tests have been developed in the last decades. The Nine Hole Peg Test (9HPT) is widely considered a gold standard metric for manual dexterity. Unfortunately, its quantification strongly depends on the subjectivity of each clinician.
The aim of this work is to standardize the measurement process of the 9HPT. Instead of a human interpretation of the time needed to complete the exercise, this paper aims to objectively extract multiple kinematic information of the subject’s hand (period, velocity, time). This information is used to detect the presence and the state of the disease more accurately and classify the patients automatically. The manuscript describes a developed framework to automate and objectivize the 9HPT. The framework evaluates the performance of different Machine Learning models and Artificial Neural Networks on MS diagnosis. The built system analyzes videos of subjects performing the 9HPT, extracts the hand’s pose using Convolutional Neural Networks, acquires the hand’s kinematic features and classifies the severity of the disease using Machine Learning algorithms. For the framework validation, two classification approaches are proposed. The first one is a binary classification problem, separating the subjects between control and patients. The second one is a multiclass classification problem, where the patients are separated into three different classes based on the severity assessed by the clinicians. A technical validation has been implemented with an accuracy of up 96.67% for the binary classification and 92.22% for the multiclass classification.
Objective: The aim of this study was to develop a personal computer (PC)-coupled nine-hole peg test (NHPT) incorporating an engineering device that could accurately measure the travel time of ...individual pegs and use it to provide standard data in healthy young women for future reference.Methods: We produced a nine-hole pegboard consisting of a container with an accelerometer, a small photo reflector, and an amplifier. Four temporal variables were calculated using software developed by the researcher. NHPTs were performed by 37 healthy right-handed young women with dominant and non-dominant hands. The hand used, the distance from the container to the peg hole (index of difficulty; ID), task (container to the board and board to the container), and phase (peg movement time, reaching time) were used as independent variables.Results: The developed pegboard was found to accurately measure the time in each of the assumed phases. The total performance time with the dominant hand was significantly shorter than that of the non-dominant hand (P < 0.001). Time to move the peg from the container to the board accounted for approximately 54% of the total performance time for both the left and right hands. The peg movement time increased performance time as the task difficulty increased (P < 0.001).Conclusions: Our pegboard accurately measures movement times with individual pegs and the time to reach pegs without stopwatch assessments in young women. Baseline data on the right- and left-hand peg travel times and reach times for healthy young women were provided for future reference.
Upper extremity involvement is one of the most common motor impairments in children with unilateral spastic cerebral palsy (CP). One tool for the assessment of manual function in CP is the Nine Hole ...Peg Test (NHPT). However, the reliability of the NHPT in patients with unilateral CP is unknown. This study aimed to analyze the intra-rater inter-session reliability of the NHPT in unilateral spastic CP, for its use in clinical practice and research. A total of 27 participants with spastic unilateral CP were included. Reliability was verified by the intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland–Altman method. An excellent intra-rater reliability was observed for the non-affected side (ICC = 0.94) and the affected side (ICC = 0.96). The minimal detectable change was 4 and 12 s for the non-affected and affected side, respectively. There were no significant biases between repetitions.
Conclusions
: The NHPT showed excellent intra-rater inter-session reliability in patients with spastic unilateral CP. In addition, the test shows adequate agreement and proportionally small errors to assess manual dexterity.
What is Known:
• The Nine Hole Peg Test (NHPT) is widely used to assess dexterity in patients with neurological conditions.
• The NHPT has demonstrated appropriate measurement properties in healthy children and adults with neurological conditions.
What is New:
• The NHPT presents excellent reliability, small measurement errors, and adequate agreement for the assessment of patients with cerebral palsy.
• The measurement error of the NHPT in unilateral cerebral palsy may be up to 13% of the total time to perform it.
Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We ...examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (
p
< 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (
p
< 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.
Abstract Background Patients with Parkinson's disease exhibit disturbed manual dexterity. This impairment leads to difficulties in activities of daily, such as buttoning a shirt or hand-writing. The ...aim of the present study was to investigate the effectiveness of a home-based dexterity program on fine motor skills in a single-blinded, randomized controlled trial, in patients with Parkinson's disease. Methods One hundred and three patients with Parkinson's disease (aged between 48 and 80 years, Hoehn & Yahr stage I-IV) were randomized to either a home-based dexterity program (HOMEDEXT) or Thera-band program. All patients trained over a period of 4 weeks, 5 times/week, 30 min for each session. A baseline, post-intervention, and follow-up assessment (12 weeks later, time period without intervention) were done. The primary outcome measure was dexterity as measured with the Nine Hole peg test (9-HPT). Secondary outcome measures included strength, motor parkinsonian symptoms, dexterity-related activities of daily living (ADL) and Health-related Quality of Life (HrQoL). Results There was a significant difference in favor of the HOMEDEXT group as compared to the Thera-band group on the primary outcome 9-HPT (p = 0.006) and dexterity-related ADL (p = 0.02) at post intervention. No significant differences were found for the other outcome, nor at follow-up. Conclusion This is the first randomized controlled trial showing that an intensive, task specific home-based dexterity program significantly improved fine motor skills in Parkinson's disease. The effect generalized to dexterity-related ADL functions. As these improvements did not sustain, the finding suggest that continuous training is required to maintain the benefit.
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