Abstract
BackgroundIdentifying highly sensitive and reliable neurological exam components are crucial in recognizing clinical deficiencies. This study aimed to investigate finger tapping performance differences between patients with CNS demyelinating lesions and healthy control subjects.MethodsTwenty-three patients with multiple sclerosis or clinically isolated syndrome with infratentorial and/or cervical cord lesions on MRI, and 12 healthy controls were videotaped while tapping the tip of the index finger against the tip and distal crease of the thumb using both the dominant and non-dominant hand. Videos were assessed independently by 10 evaluators (three MS neurologists, four neurology residents, three advanced practice providers). Sensitivity and inter-evaluator reliability of finger tapping interpretations were calculated.ResultsA total of 1400 evaluations (four videos per each of the 35 subjects evaluated by 10 independent providers) were obtained. Impairments in finger tapping against the distal thumb crease of the non-dominant hand, identified by neurologists, had the greatest sensitivity (84%, p < 0.001) for detecting impairment. Finger tapping against the thumb crease was more sensitive than the thumb tip across all categories of providers. The best inter-evaluator reliability was associated with neurologists’ evaluations for the thumb crease of the non-dominant hand (kappa = 0.83, p < 0.001).ConclusionsImpaired finger tapping against the distal thumb crease of the non-dominant hand was a more sensitive technique for detecting impairments related to CNS demyelinating lesions. Our findings highlight the importance of precise examinations of the non-dominant side where impaired fine motor control secondary to an upper motor injury might be detectable earlier than the dominant side.
Highlights
Identifying highly sensitive and reliable neurological exam components are crucial in recognizing clinical deficiencies
Our findings suggest that the specific technique of finger tapping against the distal thumb crease was more sensitive for identifying upper motor neuron injury due to demyelinating lesions when compared to tapping against the thumb tip
We identified that finger tapping using the non-dominant hand was associated with greater sensitivities amongst all healthcare providers in identifying a central nervous system (CNS) demyelinating focus as compared to when the technique was executed with the dominant hand
Summary
Identifying highly sensitive and reliable neurological exam components are crucial in recognizing clinical deficiencies. This study aimed to investigate finger tapping performance differences between patients with CNS demyelinating lesions and healthy control subjects. An unmet need exists for high quality research on neurological examination techniques aimed at identifying the most pragmatic, time-effective, and reliable components with a high degree of sensitivity for appreciating central nervous system (CNS) abnormalities that may be utilized by a wide variety of healthcare providers [2]. Upper extremity dysfunction has been reported in up to 80% of patients with multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS) [9]. A number of studies have examined upper extremity-related fine motor control tasks in patients with MS [10,11,12]. Recent neuroimaging evidence from patients with long-standing MS suggests that the mean upper cervical cord area, and the presence of cervical and infratentorial lesions, appear to be predictors of motor dysfunction, having the potential to be used in the real-world clinic practice as predictive metrics for physical function [13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
