Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke?

Marcos R M Rodrigues,Gevorg Chilingaryan,Mindy F Levin,Matthew Slimovitch

doi:10.1186/s12984-016-0213-y

Marcos R M Rodrigues, Gevorg Chilingaryan + Show 2 more

Open Access

https://doi.org/10.1186/s12984-016-0213-y

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Abstract

BackgroundWe aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity.MethodsExperimental, criterion standard study. Both clinical and experimental evaluations were done at a research facility in a rehabilitation hospital. Forty individuals (20 individuals with chronic stroke and 20 healthy, age- and gender-matched individuals) participated.. Both groups performed two blocks of 10 to-and-fro pointing movements (non-dominant/affected arm) between a sagittal target and the nose (ReachIn, ReachOut) at a self-paced speed. Time to perform the test was the main outcome. Kinematics (Optotrak, 100Hz) and clinical impairment/activity levels were evaluated. Spatiotemporal coordination was assessed with slope (IJC) and cross-correlation (LAG) between elbow and shoulder movements.ResultsCompared to controls, individuals with stroke (Fugl-Meyer Assessment, FMA-UE: 51.9 ± 13.2; Box & Blocks, BBT: 72.1 ± 26.9%) made more curved endpoint trajectories using less shoulder horizontal-abduction. For construct validity, shoulder range (β = 0.127), LAG (β = 0.855) and IJC (β = −0.191) explained 82% of FNT-time variance for ReachIn and LAG (β = 0.971) explained 94% for ReachOut in patients with stroke. In contrast, only LAG explained 62% (β = 0.790) and 79% (β = 0.889) of variance for ReachIn and ReachOut respectively in controls. For convergent validity, FNT-time correlated with FMA-UE (r = −0.67, p < 0.01), FMA-Arm (r = −0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and BBT (r = −0.56, p < 0.01). A cut-off time of 10.6 s discriminated between mild and moderate-to-severe impairment (discriminant validity). Each additional second represented 42% odds increase of greater impairment.ConclusionsFor this version of the FNT, the time to perform the test showed construct, convergent and discriminant validity to measure UL coordination in stroke.

Highlights

We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity
FNT-time correlated with FMA-UE (r = −0.67, p < 0.01), FMA-Arm (r = −0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and Box and Blocks Test (BBT) (r = −0.56, p < 0.01)
Difficulties in reaching with the affected arm were evident in all individuals with stroke (Fig. 2c, d)

Summary

Introduction

We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity. Goal-directed movement requires synchronized interaction (coordination) between multiple effectors [1,2,3]. Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada. Definitions usually describe coordinated movement as involving specific patterns of temporal (timing between joints) and spatial (joint movement pattern) variability [1, 2, 8]. Coordination can be defined as the skill of adjusting temporal and spatial aspects of joint rotations according to the task [11]

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