Developing and assessing a new web-based tapping test for measuring distal movement in Parkinson\u2019s disease: a Distal Finger Tapping test

Noreen Akram,Aaron Ben-Joseph,Jonathan P. Bestwick,Cristina Simonet,Haoxuan Li,Alastair J. Noyce,David A. Gallagher,Caroline Budu,Anette Schrag

doi:10.1038/s41598-021-03563-7

Noreen Akram, Aaron Ben-Joseph + Show 7 more

Open Access

https://doi.org/10.1038/s41598-021-03563-7

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Abstract

Disability in Parkinson’s disease (PD) is measured by standardised scales including the MDS-UPDRS, which are subject to high inter and intra-rater variability and fail to capture subtle motor impairment. The BRadykinesia Akinesia INcoordination (BRAIN) test is a validated keyboard tapping test, evaluating proximal upper-limb motor impairment. Here, a new Distal Finger Tapping (DFT) test was developed to assess distal upper-limb function. Kinetic parameters of the test include kinesia score (KS20, key taps over 20 s), akinesia time (AT20, mean dwell-time on each key) and incoordination score (IS20, variance of travelling time between key taps). To develop and evaluate a new keyboard-tapping test for objective and remote distal motor function in PD patients. The DFT and BRAIN tests were assessed in 55 PD patients and 65 controls. Test scores were compared between groups and correlated with the MDS-UPDRS-III finger tapping sub-scores. Nine additional PD patients were recruited for monitoring motor fluctuations. All three parameters discriminated effectively between PD patients and controls, with KS20 performing best, yielding 79% sensitivity for 85% specificity; area under the receiver operating characteristic curve (AUC) = 0.90. A combination of DFT and BRAIN tests improved discrimination (AUC = 0.95). Among three parameters, KS20 showed a moderate correlation with the MDS-UPDRS finger-tapping sub-score (Pearson’s r = − 0.40, p = 0.002). Further, the DFT test detected subtle changes in motor fluctuation states which were not reflected clearly by the MDS-UPDRS-III finger tapping sub-scores. The DFT test is an online tool for assessing distal movements in PD, with future scope for longitudinal monitoring of motor complications.

Highlights

Bradykinesia relates to the slowness of movement, and it is a core clinical sign of Parkinson’s disease (PD)[1]
The aims of this study are to demonstrate proof-of-concept and investigate whether the Distal Finger Tapping (DFT) test correlated with MDS-UPDRS finger tapping subscores, differentiates PD patients from controls and whether it has potential in monitoring motor fluctuations
Fifty-five PD patients and sixty-five frequency-matched controls were included in the first stage of the study

Summary

Introduction

Bradykinesia relates to the slowness of movement, and it is a core clinical sign of Parkinson’s disease (PD)[1]. Finger tapping tests have been widely utilised in neurophysiological examinations to assess upper extremity bradykinesia. Finger tapping is assessed visually on a 5-point rating scale, using the gold standard Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)[2]. A clear need for objective and consistent methods of assessing motor dysfunction exists. Several methods focusing on objective finger tapping measurements have been explored. Hasan and colleagues described 33 of 47 technologies evaluating PD, focused on finger tapping movement; varying from optical systems, wearable sensors, electromagnetic motion capture devices and 3-D accelerometers and 3-D gyroscopes[6]. An up-to-date literature search was carried out to summarise recent quantitative measures of finger movement in PD from 2014 to 2021 (see Table 1). Smartphone camera DL tracking algorithm 3D FT measurement-sensor units and computer Videos and time series clustering

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