Abstract
BackgroundThe pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients.MethodsThe iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later.ResultsThere was a strong correlation between the average degree of pronation and drift measured by the iPronator (r = 0.741, p<0.001). The degrees of average and maximum in pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7–40.3 vs. 3.8° (IQR 0.3–7.5), p<0.001], in maximum, 33.0° (IQR 24.0–52.1) vs. 6.2° (IQR 1.4–9.4), p<0.001]. The degree of oscillation in pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of pronation and drift compared with baseline parameters.ConclusionsThe iPronator can reliably detect mild arm weakness of stroke patients and was also useful in detecting functional recovery for one week in patients with acute stroke.
Highlights
Several examination methods have been developed to uncover mild motor weakness
Neither the National Institute of Health Stroke Scale (NIHSS) score nor the Medical Research Council (MRC) grade was correlated with the degree of pronation or drift
The average degree of pronation in the patient group was 28.9u (IQR 18.7– 40.3), which was greater than the control group [3.8u (IQR 0.3– 7.5), P,0.001] (Figure 3A)
Summary
Several examination methods have been developed to uncover mild motor weakness. The pronator drift test is widely used to detect mild arm weakness and to lateralize lesions. The pronator drift test is simple and easy, can be quickly performed by the patient’s bedside, and does not require additional equipment. Regardless of its usefulness, the sensitivity of the pronator drift test is fairly low [1,2]. The lack of objective parameters and reliance on the subjective decisions of the examiner limit the usefulness of the pronator drift test. The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients
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