Bimanual Test Research Articles

The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application

BackgroundAssistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance.MethodsFourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test.ResultsThe BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance.ConclusionThe BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.

Development of the Hand Assessment for Infants: evidence of internal scale validity.

The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3 to 12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy. The concepts of the test items and scoring criteria were developed. Internal scale validity and aspects of reliability were investigated on the basis of 156 assessments of infants at 3 to 12 months corrected age (mean 7.2mo, SD 2.5) with signs of asymmetric hand use. Rasch measurement model analysis and non-parametric statistics were used. The new test, the Hand Assessment for Infants (HAI), consists of 12 unimanual and five bimanual items, each scored on a 3-point rating scale. It demonstrated a unidimensional construct and good fit to the Rasch model requirements. The excellent person reliability enabled person separation to six significant ability strata. The HAI produced an interval-level measure of bilateral hand use as well as unimanual scores of each hand, allowing a quantification of possible asymmetry expressed as an asymmetry index. The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy. The Hand Assessment for Infants (HAI) measures the use of both hands and quantifies a possible asymmetry of hand use. HAI is valid for infants at 3 to 12 months corrected age at risk of unilateral cerebral palsy.

Proprioceptive bimanual test in intrinsic and extrinsic coordinates.

Is there any difference between matching the position of the hands by asking the subjects to move them to the same spatial location or to mirror-symmetric locations with respect to the body midline? If the motion of the hands were planned in the extrinsic space, the mirror-symmetric task would imply an additional challenge, because we would need to flip the coordinates of the target on the other side of the workspace. Conversely, if the planning were done in intrinsic coordinates, in order to move both hands to the same spot in the workspace, we should compute different joint angles for each arm. Even if both representations were available to the subjects, the two tasks might lead to different results, providing some cue on the organization of the “body schema”. In order to answer such questions, the middle fingertip of the non-dominant hand of a population of healthy subjects was passively moved by a manipulandum to 20 different target locations. Subjects matched these positions with the middle fingertip of their dominant hand. For most subjects, the matching accuracy was higher in the extrinsic modality both in terms of systematic error and variability, even for the target locations in which the configuration of the arms was the same for both modalities. This suggests that the matching performance of the subjects could be determined not only by proprioceptive information but also by the cognitive representation of the task: expressing the goal as reaching for the physical location of the hand in space is apparently more effective than requiring to match the proprioceptive representation of joint angles.

Bimanual Test (Two Finger Test) of Rape Victims: South Asia Case Study

The paper delves into an endeavor to provide a lucid account of the current state of law and procedure of medical test (i.e., bimanual test/finger test/DNA test) of the sexual assault survivor in South Asia. The paper makes an effort to churn out the present situation of all South Asian countries other than Bangladesh. At the outset, the paper dapples with brisk details of Bimanual Test (Two Finger Test) and viability of DNA test in medical exam of rape victims. After that the paper provides a compact scenario of medical test of rape victims in tandem with the available laws, case decisions and commission reports.

Impact of Tactile Dysfunction on Upper-Limb Motor Performance in Children With Unilateral Cerebral Palsy

Auld ML, Boyd RN, Moseley GL, Ware RS, Johnston LM. Impact of tactile dysfunction on upper-limb motor performance in children with unilateral cerebral palsy. ObjectiveTo determine the relationship between tactile function and upper-limb function in children with unilateral cerebral palsy (CP). DesignCross-sectional study. SettingAssessments were performed in community or hospital venues or in participants' homes. ParticipantsRecruitment information was sent to 253 possible participants with unilateral CP (aged 8–18y), and N=52 participated (median age [interquartile range], 12y [9–14y]; Gross Motor Functional Classification System level I=34; II=18; Manual Abilities Classification Scale level I=36; II=16). InterventionsNot applicable. Main Outcome MeasuresTactile assessment included 1 test of registration, 5 tests for spatial perception, and 1 test for texture perception. Upper-limb motor function was assessed using 2 unimanual tests, the Melbourne Unilateral Upper Limb Assessment (MUUL) and Jebsen-Taylor Test of Hand Function (JTTHF), and 1 bimanual test, the Assisting Hand Assessment (AHA). ResultsTactile registration and all tests of spatial perception were moderately related to the MUUL, JTTHF, and AHA (P<.001). Texture perception was not related to upper-limb motor function. Regression analysis showed that single point localization, a unilateral tactile spatial perception test, contributed most strongly to unimanual capacity (29% explained variance in MUUL and 26% explained variance in JTTHF), whereas double simultaneous, a bilateral tactile spatial perception test, contributed most strongly to bimanual performance (33% for the AHA). ConclusionsSpatial tactile deficits account for approximately 30% of the variance in upper-limb motor function in children with unilateral CP. This emphasizes the need for routine tactile assessment and targeted treatment of tactile spatial deficits in this population.

The use of bilateral stimulated hand grasp in the bimanual activities of persons with tetraplegia

Grasp and release has been provided to both upper extremities of subjects with tetraplegia using percutaneous and fully implanted stimulation. This is to determine quantitatively the performance of these subjects in three bimanual tests using two handed stimulation. Their performance here is compared with two separate cases: the same tests using single handed stimulation assisted by a nonstimulated hand and using two unstimulated hands. It was found that bilateral stimulation significantly improved the efficacy of performing the bimanual tests assessed over that using unilateral stimulation assisted by the nonstimulated hand (in two of three tests) or no stimulation three of three tests). These results show quantitative evidence of the benefits of providing bilateral stimulation for the completion of bimanual tasks for persons with tetraplegia who are appropriate candidates for stimulated grasp. These benefits were observed especially in cases where the ability of the subject in completing the task using unilateral stimulation was not strong.

Job-simulated phase II cardiac rehabilitation training: Part B. Effects of training

Part A of the paper dealt with the overall comparison between the job-simulated phase II CR training program and a conventional phase II CR training program (control). This is part B of the two-part paper and reports on the effects of job-simulated phase II CR physical training program on job-related physical capabilities. Fifteen male and two female coronary heart disease (CHD) survivors (angioplasty and bypass patients) participated in the field study. These participants underwent training activities that simulated performance of physical work elements. Three different categories of activities were included: flexibility activities, dexterity activities, and strength oriented upper and whole body activities. A number of response measures (dynamic strength, its endurance (as indicated by number of cycles performed, time, heart rate, and systolic and diastolic blood pressure), isokinetic strength (at five different speeds), time taken to complete various dexterity tests (Purdue pegboard test, O'Connor tweezer test, Pennsylvania bimanual test, and arm and shoulder hand tool set test), and angles achieved by various body parts (spine, neck, shoulder, knee, ankle, and wrist)) were recorded prior to training and after each set of six training sessions. A MANOVA was conducted to analyze the training effect for each dependent variable; training time (before beginning training and after each of the three sets of six training sessions) was the repeated measure. The results indicated that training had a very significant effect on most response measures ( p<0.01) and caused most response values to change appropriately (e.g. increase in strengths, reduction in dexterity tests' performance time, and increase in the flexibility of various joints). As indicated in part A of the paper, the job-simulated phase II CR training program fared better than conventional phase II CR training program (control) as far as the return to work (RTW) was concerned, and at least as good when comparing the physiological conditioning of the CHD survivors. With significant improvements in physical work capabilities, it is clear that the job-simulated phase II CR training program is a serious contender to replace conventional phase II CR training programs. Relevance to industry A new phase II cardiac rehabilitation training program, based on elements of physical work, is described. It is shown that such a program not only improves CHD survivors' work-related physical capabilities, it also improves their physiological conditioning and vastly increases their chances of returning to work when compared to a conventional phase II cardiac rehabilitation program.

Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: Reliability, validity, and responsiveness to therapeutic intervention

Objective: To assess measurement properties of motor performance tests when used with high-functioning stroke patients. Design: Test-retest reliability study with an interval of 2 days; responsiveness study with assessment before and after training; validity study assessing the tests' ability to discriminate between the high-functioning stroke patients and healthy subjects. Setting: Referral center for neurorehabilitation. Participants: Twenty-nine high motor-functioning stroke patients and 20 healthy control subjects. Intervention: Two special training sessions per day on 5 consecutive days, plus regular therapy. Outcome Measures: Scores on the motor performance series, a two-dimensional tracking test, and a kinematic task analysis. Results: All tests (except the bimanual test) were able to document performance deficits with these patients and showed a moderately high to high test-retest reliability without systematic trend from test to retest (intraclass correlation coefficients for main variables, .61 to .89). The kinematic task especially demonstrated changes after training (standardized response means for timing variables, .53 to .66). A subset of variables indicated a modifying effect of limb side, age, and gender. Conclusion: All tests (except the bimanual test) can be used for both cross-sectional and follow-up group studies with high-functioning stroke patients. Measurement properties and the lack of comprehensive normative data limit their use with individual patients.

Observations on the interhemisphreic transmission of information in 9 patients with corpus callosum defect.

1) This is a report of nine patients with agenesis of the corpus callosum. Three of them had a complete defect of the corpus callosum as seen on X-rays; in 4 patients there was a partial agenesis and two patients partial defect was combined with a lipoma. Most of these patients were epileptics. 2) In order to determine the interhemispheric transfer of somaesthetic patterns bimanual tests (comparison of lengths and weights and a maze test) were used. The test results obtained by the acallosal patients have been compared with those of two groups of control persons, one group of normal subjects and a second group of epileptics. 3) A slight impairment of interhemispheric transmission of somaesthetic patterns has been found in the weight test and in the maze test. In part of the tests these results could be established statistically. 4) With comparisons against the control groups the disturbances of the interhemispheric transfer in acallosal patients were more obvious with the more difficult and complex perceptuomotor tasks. 5) In testing the reactions to hemioptic informations we found no hints for special disturbances of interhemispheric transmission in the acallosal patients. 6) On the Hamburg-Wechsler intelligence scale the mean IQ of the nine patients was slightly below average. 7) The test results are discussed in regard to findings after split brain operations in humans and animals.