Finger Tapping Research Articles

Design and Validation of a Novel Hand-Worn Sensor for Assessment of Dexterity in Neurological Conditions

Abstract Sensitive measurement of hand dexterity is important in many neurological conditions such as Stroke, Parkinson's Disease, or Amyotrophic Lateral Sclerosis (ALS). Current multi-item rating scales and performance-based tests lack sensitivity and contain subjective biases. This paper presents the design and validation of an objective, novel hand-worn dexterity measurement device that digitizes the finger tapping test (FTT), a widely used test in neurological practice. The device was designed to address predefined user needs and design requirements. It comprises two distinct sections, a mechanical system that attaches to a participant's thumb and index finger and an electronic system that captures/transmits data to a secure cloud storage. The accuracy (for four devices) was validated by plotting the known displacements against the calculated displacements, which returned slopes approximately equal to one. A maximum extension force of 0.51 N was required to extend the cord to 200 mm extension. Clinical testing was carried out on a small sample of healthy people (n = 3) and people with Amyotrophic Lateral Sclerosis (n = 3). Clean datasets were produced from participant's raw data graphs, from which new features describing a participant's FTT were extracted. The proposed dexterity device digitizes the FTT and provides clean, accurate, sensitive, and reliable data.

Design of piezoelectric nanogenerator based onBiFeO3/epoxy resin with potential application for wearable electronic devices

AbstractGrowing demand for electric energy in newly developed electronic systems causes increasing interest in research on piezoelectric nanogenerators (PENGs). Design and fabrication of such devices is challenging, considering cost of materials used in their construction. This is the main reason why intensive research has begun on 0‐3 composites with piezoelectric properties. One of the most promising constituent materials for composites fabrication are polymers, due to their low cost and easy processing. Herein, we present fabricated wearable PENG with good impact and vibration energy conversion properties. Correlation between matrix stiffness and piezoelectric properties of 0‐3 type composite is proposed. It was found that composite with 10 wt.% of BiFeO3particles exhibits power output density for vibrations, finger tapping, and air stream pressureP = 11.12 nW cm−3,P = 4.83 μW cm−3, andP = 769.2 μW cm−3, respectively. Decrease in stiffness of epoxy matrix results at least in two‐times lower power output density for this same PENG. The obtained results demonstrate that the fabricated BFO/epoxy composites show the wide applicability and potential to be integrated with other functional devices, for example, as a part of wearable devices in smart shoes.

Clinically Informed Automated Assessment of Finger Tapping Videos in Parkinson's Disease.

The utilization of Artificial Intelligence (AI) for assessing motor performance in Parkinson's Disease (PD) offers substantial potential, particularly if the results can be integrated into clinical decision-making processes. However, the precise quantification of PD symptoms remains a persistent challenge. The current standard Unified Parkinson's Disease Rating Scale (UPDRS) and its variations serve as the primary clinical tools for evaluating motor symptoms in PD, but are time-intensive and prone to inter-rater variability. Recent work has applied data-driven machine learning techniques to analyze videos of PD patients performing motor tasks, such as finger tapping, a UPDRS task to assess bradykinesia. However, these methods often use abstract features that are not closely related to clinical experience. In this paper, we introduce a customized machine learning approach for the automated scoring of UPDRS bradykinesia using single-view RGB videos of finger tapping, based on the extraction of detailed features that rigorously conform to the established UPDRS guidelines. We applied the method to 75 videos from 50 PD patients collected in both a laboratory and a realistic clinic environment. The classification performance agreed well with expert assessors, and the features selected by the Decision Tree aligned with clinical knowledge. Our proposed framework was designed to remain relevant amid ongoing patient recruitment and technological progress. The proposed approach incorporates features that closely resonate with clinical reasoning and shows promise for clinical implementation in the foreseeable future.

A Deep Learning Approach for Automatic and Objective Grading of the Motor Impairment Severity in Parkinson's Disease for Use in Tele-Assessments.

Wearable sensors provide a tool for at-home monitoring of motor impairment progression in neurological conditions such as Parkinson's disease (PD). This study examined the ability of deep learning approaches to grade the motor impairment severity in a modified version of the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) using low-cost wearable sensors. We hypothesized that expanding training datasets with motion data from healthy older adults (HOAs) and initializing classifiers with weights learned from unsupervised pre-training would lead to an improvement in performance when classifying lower vs. higher motor impairment relative to a baseline deep learning model (XceptionTime). This study evaluated the change in classification performance after using expanded training datasets with HOAs and transferring weights from unsupervised pre-training compared to a baseline deep learning model (XceptionTime) using both upper extremity (finger tapping, hand movements, and pronation-supination movements of the hands) and lower extremity (toe tapping and leg agility) tasks consistent with the MDS-UPDRS. Overall, we found a 12.2% improvement in accuracy after expanding the training dataset and pre-training using max-vote inference on hand movement tasks. Moreover, we found that the classification performance improves for every task except toe tapping after the addition of HOA training data. These findings suggest that learning from HOA motion data can implicitly improve the representations of PD motion data for the purposes of motor impairment classification. Further, our results suggest that unsupervised pre-training can improve the performance of motor impairment classifiers without any additional annotated PD data, which may provide a viable solution for a widely deployable telemedicine solution.

56 Predictors of Finger Tapping Variability in Older Adults Evaluated for a Neurodegenerative Memory Disorder

Objective:Patients with early Alzheimer Disease (AD) and Mild Cognitive Impairment of the Amnestic type (MCI-A) have been reported to show large variability of tapping scores. Factors that contribute to that variability remain undetermined. This preliminary study aimed to identify predictors of finger tapping variability in older adults evaluated for a neurodegenerative memory disorder. Based on earlier research with normally functioning adults, we predicted that the number of “invalid” tapping responses (i.e. failure of the index finger to adequately lift off the tapping key once it is depressed to produce the next number on a mechanical counter) and the female gender would predict finger tapping variability, but age and educational level would not predict variability.Participants and Methods:This preliminary study included 4 groups of participants, comprised of 8 healthy controls (HC, 3 males; 73±7years); 12 persons with subjective memory complaints (SMC, 3 males; 69±5 years); 12 with MCI-A (7 males; 76±5 years) and 7 early AD (5 males; 75±6years). All participants were administered a modified version of the Halstead Finger Tapping Test (HFTT). Mean, range of tapping score (i.e. a measure of variability), and number of invalid taps across 7 trials in each hand were calculated. ANOVA was performed for the HFTT metrics with the main effect of group. Tukey HSD tests were used for post hoc comparisons between groups. Multiple regression analysis was performed to determine the degree to which the number of invalid tapping responses, sex, age, and educational level predicted finger tapping variability using all 4 groups.Results:Mean tapping score did not vary significantly across groups in the dominant [F (3, 35) = 0.633, p = 0.599] or non-dominant [F (3, 35) = 2.345, p = 0.090] hand. Range score approached a significant difference between groups in the dominant hand [F (3, 35) = 2.745, p = 0.058], with a clear significant effect of group on range score in the non-dominant hand [F (3, 35) = 4.078, p = 0.014]. Range score in the nondominant hand was significantly higher in the AD compared to SMC (p = 0.018) and HC (p = 0.024). Regression analysis revealed statistically significant findings for the dominant hand (R2 = 0.327, F (4, 34) = 4.130, p = 0.008) and for the non-dominant hand (R2 = 0.330, F (4, 34) = 4.180, p = 0.007). For both the dominant and non-dominant hands, number of invalid taps significantly predicted range score (ß = 0.453, p = 0.044, and ß = 0.498, p = 0.012, respectively). Sex, age, and education years did not predict range scores.Conclusions:Variability of finger tapping in patients evaluated for neurodegenerative memory disorders and aged matched controls is predicted by the number of invalid tapping responses (comprising over 30% of the variance), but not by demographic variables in this clinical sample. Neurodegenerative disorders may eliminate a sex effect.

1 Race, Ethnicity, Education, Sex and Gender Effects on Neuropsychological Test Scores: Limitations of Current Evidence and Impact on Clinical Trials and Clinical Practice

Objective:Interpretation of neuropsychological (NP) tests depends on the quality of the normative standards available for the tests. Co-norming across tests is necessary when interpreting differences between scores on different tests. The relevance of specific norms for an individual examinee further depends on multiple design features of the standardization studies, including: when the studies were conducted, sampling strategy, inclusion/exclusion criteria, age, sex/gender, education, race and ethnicity, socioeconomic status, and region. This paper examines the standardization studies of the most widely used NP tests, identifies their strengths and weaknesses, and makes recommendations for interpretive caveats based on these analyses.Participants and Methods:We reviewed the standardization strategies and coded information about the sampling frames, inclusion/exclusion criteria, stratification methods, demographic characteristics, and sample sizes overall and within each stratum where relevant. These methods were applied to the WAIS-IV, WMS-IV, CVLT3, D-KEFS, Pearson Advanced Clinical Solutions (ACS), Rey Complex Figure Test, WCST, Symbol Digit Modalities Test, RBANS, BVMT-R, HVLT, Halstead-Reitan (“Heaton et al”) Norms for Boston Naming, Finger Tapping, Grooved Pegboard), MOANS, and MOAANS (Boston Naming, Trail Making Test, Judgement of Line Orientation). We calculated multiple indexes for each test, including standard errors and confidence intervals for scaled scores.Results:Most tests used age only as a stratification factor, providing “age corrected” scores for selected age bands. The sample sizes for the age strata range from 1 to ∼200 but were usually less than 100 participants/stratum. Sex differences were rarely reported and some studies had markedly uneven distributions of sex. Education was not used as a stratification factor in any study, and few norms attempted corrections for education. The possible interactions of age and education on test scores are seldom reported and cell sizes for combinations of age and education may be too small to enable robust estimates of scores, especially at lower levels of education and older ages. The possible impact of race and ethnicity are rarely interrogated except in ACS, Heaton and MOAANS norms, which all focus on “African American” participants. Discrepancies in scores across ACS, Heaton and MOAANS suggest marked sampling differences.Conclusions:Existing norms have major limitations which may impact the clinical assessment of individuals and result in inappropriate treatment recommendations as well as lead to inappropriate classification in clinical trials, which may include score “cutoffs” based on widely used normative standards. Most norms use only age as a stratification factor, despite robust impacts of education on scores. Race and ethnicity are poorly represented, fail to reflect current demographic characteristics of the United States, and existing norms present major conflicts for African American groups, with the same raw scores differing by a full standard deviation depending only on the source of normative data. Sex differences are examined infrequently and it remains unclear to what extent sex or gender differences may affect some scores. There is an urgent need for new, preferably “dynamic” normative standards, that include sampling by socially and demographically meaningful metrics, to provide greater precision in assessment of neuropsychological scores and score discrepancies, and for evaluating the inclusion/exclusion criteria, and criteria for efficacy in clinical trials that use neurocognitive endpoints.

93 Acceptability and Usability of Tablet-Based Neuropsychological Tests among South African and Ugandan Adolescents With and Without HIV

Objective:Neuropsychological (NP) tests are increasingly computerized, which automates testing, scoring, and administration. These innovations are well-suited for use in resource-limited settings, such as low- to middle- income countries (LMICs), which often lack specialized testing resources (e.g., trained staff, forms, norms, equipment). Despite this, there is a dearth of research on their acceptability and usability which could affect performance, particularly in LMICs with varying levels of access to computer technology. NeuroScreen is a tablet-based battery of tests assessing learning, memory, working memory, processing speed, executive functions, and motor speed. This study evaluated the acceptability and usability of NeuroScreen among two groups of LMIC adolescents with and without HIV from Cape Town, South Africa and Kampala, Uganda.Participants and Methods:Adolescents in Cape Town (n=131) and Kampala (n=80) completed NeuroScreen and questions about their use and ownership of, as well as comfort with computer technology and their experiences completing NeuroScreen. Participants rated their technology use -comfort with and ease-of-use of computers, tablets, smartphones, and NeuroScreen on a Likert-type scale: (1) Very Easy/Very Comfortable to (6) Very Difficult/Very Uncomfortable. For analyses, responses of Somewhat Easy/Comfortable to Very Easy/Comfortable were collapsed to codify comfort and ease. Descriptive statistics assessed technology use and experiences of using the NeuroScreen tool. A qualitative question asked how participants would feel receiving NeuroScreen routinely in the future; responses were coded as positive, negative, or neutral (e.g., “I would enjoy it”). Chi-squares assessed for group differences.Results:South African adolescents were 15.42 years on average, 50.3% male, and 49% were HIV-positive. Ugandan adolescents were 15.64 years on average, 50.6% male, and 54% HIVpositive. South African participants were more likely than Ugandan participants to have ever used a computer (71% vs. 49%; p<.005), or tablet (58% vs. 40%; p<.05), whereas smartphone use was similar (94% vs 87%). South African participants reported higher rates of comfort using a computer (86% vs. 46%; p<.001) and smartphone (96% vs. 88%; p<.05) compared to Ugandan participants. Ugandan adolescents rated using NeuroScreen as easier than South African adolescents (96% vs. 87%; p<.05).). Regarding within-sample differences by HIV status, Ugandan participants with HIV were less likely to have used a computer than participants without HIV (70% vs. 57%; p<.05, respectively).The Finger Tapping test was rated as the easiest by both South African (73%) and Ugandan (64%) participants. Trail Making was rated as the most difficult test among Ugandan participants (37%); 75% of South African participants reported no tasks as difficult followed by Finger Tapping as most difficult (8%). When asked about completing NeuroScreen at routine doctor’s visits, most South Africans (85%) and Ugandans (72%) responded positively.Conclusions:This study found that even with low prior tablet use and varying levels of comfort in using technology, South African and Ugandan adolescents rated NeuroScreen with high acceptability and usability. These data suggest that scaling up NeuroScreen in LMICs, where technology use might be limited, may be appropriate for adolescent populations. Further research should examine prior experience and comfort with tablets as predictors NeuroScreen test performance.

74 Timed Motor Performance in Children Medically Cleared for Return to Activities Post Mild Traumatic Brain Injury

Objective:Children who sustain a mild traumatic brain injury (mTBI) are at increased odds of additive injury and continue to show altered motor performance relative to never-injured peers after being medically cleared (MC) to return to normal activities. There is a critical need to determine when children can return to activities without risk of short and long-term adverse effects, with research showing high reinjury rates for 3-12 months after RTP. The Physical and Neurological Examination for Subtle Signs (PANESS) measures subtle signs of motor impairment during gait, balance, and timed motor functions. Recent literature has demonstrated that PANESS timed motor function can distinguish between children medically cleared post-mTBI compared to never-injured controls. The present study examined performance on timed motor tasks in youth medically cleared from mTBI following medical clearance and 3-months later, compared to never-injured peers.Participants and Methods:25 children (Mage=14.16, SD=2.46; Male=68%) were enrolled within 6 weeks of medical clearance from mTBI (Mdays post MC=33, SD=13.4, Range=2-59) along with 66 typically developing, never-injured controls (Mage=13.9, SD=2.22; Male=50%). Group differences were evaluated for the Timed Motor section of the PANESS at enrollment and at a 3-month follow-up (Mdays from enrollment to follow-up=95.90, SD=12.69, Range=62-129). This 3-month follow-up occurred on average 4 months after medical clearance (Mdays from MC to follow-up=130.08, SD=17.58, Range=92 - 164). The Timed Motor section includes Repetitive (foot tapping, hand patting, and finger tapping) and Sequential (heel-toe rocking, hand pronate/supinate, finger sequencing) raw time scores, measured in seconds. The Total Timed Motor Speed score is the combination of Repetitive and Sequential Movement and the side-to-side tongue item.Results:At 3-month follow-up, mTBI participants (M=67.55, SD=8.26, Range=53.66-83.88) performed worse than controls (M=63.09, SD=10.23, Range=39.86-100.51) on Total Timed Motor Speed, t(89)= 1.95, p<0.05), including when controlling for age and sex, F(1, 87)=4.67, p<0.05. At the same time point, mTBI participants (M=36.54, SD=5.47, Range=28.74-49.17) performed worse on Sequential Speed than controls (M=32.93, SD=6.1, Range=21.49-56.76), t(89)=2.59, p<0.01, including when controlling for age and sex, F(1, 87)=7.687, p<0.01). Although groups performed similarly on Sequential Speed at the initial time point, mTBI participants exhibited a trend of less improvement from initial to follow-up (MmTBI=-1.69, Mcontrol=-3.68, t(90)=1.445, p=0.076).Conclusions:Although groups did not significantly differ on Timed Motor Speed items at the initial time point, the mTBI group showed consistently lower scores than controls at both time points and less improvement over time. Results indicate that Total Timed Motor Speed, specifically Sequential Speed, may be a sensitive marker of persisting differences in high-level motor and cognitive learning/control in children who have been medically cleared after mTBI. More data are needed to evaluate these findings over a longer time period, and future studies should examine behavioral markers concurrently with physiologic brain recovery over time.

6 Remote Smartphone Cognitive and Motor Testing in Frontotemporal Dementia Research: Feasibility, Reliability, and Validity

Objective:Therapeutics targeting frontotemporal dementia (FTD) are entering clinical trials. There are challenges to conducting these studies, including the relative rarity of the disease. Remote assessment tools could increase access to clinical research and pave the way for decentralized clinical trials. We developed the ALLFTD Mobile App, a smartphone application that includes assessments of cognition, speech/language, and motor functioning. The objectives were to determine the feasibility and acceptability of collecting remote smartphone data in a multicenter FTD research study and evaluate the reliability and validity of the smartphone cognitive and motor measures.Participants and Methods:A diagnostically mixed sample of 207 participants with FTD or from familial FTD kindreds (CDR®+NACC-FTLD=0 [n=91]; CDR®+NACC-FTLD=0.5 [n=39]; CDR®+NACC-FTLD>1 [n=39]; unknown [n=38]) were asked to remotely complete a battery of tests on their smartphones three times over two weeks. Measures included five executive functioning (EF) tests, an adaptive memory test, and participant experience surveys. A subset completed smartphone tests of balance at home (n=31) and a finger tapping test (FTT) in the clinic (n=11). We analyzed adherence (percentage of available measures that were completed) and user experience. We evaluated Spearman-Brown split-half reliability (100 iterations) using the first available assessment for each participant. We assessed test-retest reliability across all available assessments by estimating intraclass correlation coefficients (ICC). To investigate construct validity, we fit regression models testing the association of the smartphone measures with gold-standard neuropsychological outcomes (UDS3-EF composite [Staffaroni et al., 2021], CVLT3-Brief Form [CVLT3-BF] Immediate Recall, mechanical FTT), measures of disease severity (CDR®+NACC-FTLD Box Score & Progressive Supranuclear Palsy Rating Scale [PSPRS]), and regional gray matter volumes (cognitive tests only).Results:Participants completed 70% of tasks. Most reported that the instructions were understandable (93%), considered the time commitment acceptable (97%), and were willing to complete additional assessments (98%). Split-half reliability was excellent for the executive functioning (r’s=0.93-0.99) and good for the memory test (r=0.78). Test-retest reliabilities ranged from acceptable to excellent for cognitive tasks (ICC: 0.70-0.96) and were excellent for the balance (ICC=0.97) and good for FTT (ICC=0.89). Smartphone EF measures were strongly associated with the UDS3-EF composite (ß's=0.6-0.8, all p<.001), and the memory test was strongly correlated with total immediate recall on the CVLT3-BF (ß=0.7, p<.001). Smartphone FTT was associated with mechanical FTT (ß=0.9, p=.02), and greater acceleration on the balance test was associated with more motor features (ß=0.6, p=0.02). Worse performance on all cognitive tests was associated with greater disease severity (ß's=0.5-0.7, all p<.001). Poorer performance on the smartphone EF tasks was associated with smaller frontoparietal/subcortical volume (ß's=0.4-0.6, all p<.015) and worse memory scores with smaller hippocampal volume (ß=0.5, p<.001).Conclusions:These results suggest remote digital data collection of cognitive and motor functioning in FTD research is feasible and acceptable. These findings also support the reliability and validity of unsupervised ALLFTD Mobile App cognitive tests and provide preliminary support for the motor measures, although further study in larger samples is required.

2 Clinical Validity and Cut-Off Scores of a Brief Neuropsychological Battery for a Large Rural Population in Community Setting

Objective:There is a dearth of an appropriate standardized tool to assess neuropsychological functions in rural population, which has low literacy rates, are culturally diverse, and have limited access to healthcare resources. The NIREH Neuropsychological Battery for Rural Population (NINB-RP) is a relatively brief and easy-to-administer battery comprising multiple tests that are modified or adopted as per rural community settings to evaluate verbal learning, fine coordination, attention efficiency, executive task, concentration, and visual attention, mental flexibility, and motor coordination in rural populations. The present study aimed to examine the clinical validity and establish cut-off scores for impairment of neuropsychological functions for different age, gender, and education levels of NINB-RP in a rural community in central India.Participants and Methods:This was a prospective cross-sectional study conducted in participants aged > 18 years (n=2952, M: F=1407:1545) recruited through a stratified sampling technique from 23 randomly selected villages from central India. The data of nine neuropsychological tests [(Finger and Tweezer dexterity test (FDT, TDT); Digit Forward and Backward test (DFT, DBT); Serial subtraction test (SST); Trail Making-A and B; Finger Tapping test (FTT); and Letter Digit Substitution test, LDST)] from 215 cognitively impaired and 2737 healthy control subjects were analyzed. The tests were performed in a village school/community hall or an outdoor camp. Independent sample t-test, Chi-square test, and Receiver Operating Characteristic (ROC) curve were used to calculate the area under the curve (AUC), cut-off scores, and sensitivity (ST)/specificity (SP) values for seven conditions, i.e., gender (male vs. female), age groups (up to 49 years and above 50 years); and educational levels (illiterate, intermediate and college). For those variables where ST/SP values were lower than 0.70, a unique cut-off score was calculated for the entire sample, adjusting by age and educational levels.Results:A significant difference in mean (median) scores between the healthy control and cognitively impaired groups were observed in all tests except Trail Making A and B and LDST. The AUC for most of the tests ranged from 0.70 to 0.81, and the ST/SP values ranged from 69-73% and 65-75%, respectively. The results showed that most tests of NINB-RP reached moderate to good sensitivity and specificity for gender, age and education levels, except for DBT for females, above 50 years, and illiterate and intermediate education groups. FDT for males [AUC: 0.85 (95%CI0.80-0.91], ST/SP=76/82%] and females [(AUC=0.78 (95%CI0.74-0.82), ST/SP=71/70%], TDT for intermediate education group [AUC=0.82 (95%CI0.60-1.00), ST/SP=86/83%] and FTT for less than 49 years age group [AUC=0.75 (95%CI0.67-0.84), ST/SP=71/76%] were the most useful tests to discriminate among healthy control and cognitively impaired rural population.Conclusions:The present study is an attempt to establish the cut-off scores of a neuropsychological battery for a large rural population in the community setting. The proposed cut-off values might be helpful in clinical assessment in rural areas where clinical neuropsychology services are not readily available. NINB-RP can be a valuable tool for clinical research studies in rural communities. Further studies on similar samples in other countries need to be undertaken.

42 Real-time Associations Among MS Symptoms and Cognitive Dysfunction Using Ecological Momentary Assessment

Objective:The current study aimed to examine real-time associations between non-cognitive symptoms and cognitive dysfunction (latter measured both objectively and subjectively in real-time) using ecological momentary assessment (EMA).Participants and Methods:Forty-five persons with MS completed EMA four times per day for three weeks. For each EMA, participants completed mobile versions of the Trail-Making Test part B (mTMT-B) and a finger tapping task, as well as surveys about symptom severity. Trait (usual levels of a symptom) and state (when symptom level was higher or lower than the individual's usual levels) aspects of each symptom's severity were calculated. Multilevel models were conducted to account for within-person clustering, with performance on the mTMT-B and self-reported rating of cognitive dysfunction as primary outcomes.Results:A total of 3,174 EMA sessions were collected; compliance rate was 84%. There was significant intra-day variability in mTMT-B performance, anxiety, fatigue, and pain. More severe state depressive symptoms predicted lower performance on the mTMT-B in real-time. Self-reported difficulties with sleeping the night before predicted mTMT-B performance the following day. In contrast, state (but not trait) fatigue, depression, anxiety, and pain all predicted self-reported cognitive dysfunction in real time. Further, state self-reported cognitive dysfunction (but not mTMT-B performance) was associated with a higher perceived sense of accomplishment.Conclusions:Self-reported cognitive dysfunction was more susceptible to influences of other MS symptoms (especially when the symptom is more severe than the individual's usual levels) and better predicted perceived sense of accomplishment than objectively measured executive functioning in real-time. Objective executive functioning performance was sensitive to effects of depressive symptoms and sleep difficulties. The current study demonstrated the feasibility of assessing real-time associations among MS symptoms using smartphone-administered EMA.

86 The Examination Between Credible and Non-Credible Groups on Embedded PVT Tests

Objective:Performance validity tests (PVTs) are included in neuropsychological testing to ensure examinees are performing to the best of their abilities. There are two types of PVTs: embedded and free standing. Embedded PVTs are tests that are derived from standard neuropsychological tests of various cognitive domains. Freestanding PVTs are tests that are designed with the intention of being a PVT. Research studies show that undergraduate samples do not always performed to the best of their abilities. The purpose of this study was to cross-validate previous research on the topic of performance validity in a college sample. It was predicted that the non-credible group would demonstrate higher failure rates on embedded PVTs compared to the credible group.Participants and Methods:The sample consisted of 198 neurologically and psychologically healthy undergraduate students with a mean age of 19.69 (SD = 2.11). Participants were broken into two groups: non-credible (i.e., participants that failed two or more PVTs) and credible (i.e., participants that did not failed two or more PVTs). The Rey-Osterrith copy test, Comalli Stroop part A (CSA), B (CSB), and C (CSC), Trail Making Test part A and B, Symbol Digit Modalities Test written (SDMT-W) and oral (SDMT-O) parts, Controlled Oral Word Association Test (COWAT) letter fluency, and Finger Tapping Test were used to evaluate failure rates in our sample. PVT cutoff scores were use from previously validated in the literature. Chi-square analysis was used to evaluate failure rates between the groups.Results:Chi-square analysis revealed significant failure rate differences between groups on several PVTs. Results revealed that 15% of the non-credible group failed the CSA compared to 1% of the credible group, X2=14.77, p=.000. Meanwhile, 26% of the non-credible group failed the CSB compared to 2% of the credible group, X2=24.72, p=.000. Furthermore, results showed that 11% of the non-credible group failed the CSC compared to 1% of the credible group, X2=13.05, p=.000.Next, 48% of the non-credible group failed the Trail Making Test part A compared to 8% of the credible group, X2=31.61, p=.000. We also found that 15% of the non-credible group failed the SDMT-W part compared to 1% of the credible group,X2=19.18, p=.000. Meanwhile, on the SDMT-O part 19% of the non-credible group failed compared to 1% of the credible group, X2=25.52, p =.000. On the COWAT letter fluency task 74% of the non-credible group failed compared to 19% of the credible group, X2=36.90, p=.000. Finally, results revealed on the Finger Tapping Test 19% of the non-credible group failed compared to 3% of the credible group, X2=10.01, p=.002.Conclusions:As expected, the non-credible participants demonstrated significantly higher PVT failure rates compared to credible participants. A possible explanation driving higher failure rates in our sample can be due to cultural variables (e.g., bilingualism). It was suggested by researchers that linguistic factors may be impacting higher PVT failure rates and developing a false-positive error. Future research using undergraduate samples need to identify which PVT’s are being impacted by linguist factors.

35 Pairwise Concurrence Rates Between Standalone and Embedded Performance Validity Tests

Objective:Determine the classification concordance between a standalone performance validity test (PVT) and embedded PVTs from multiple cognitive domains.Participants and Methods:Participants were 106 patients (49.1% female; 69% white) that underwent neuropsychological evaluation at an outpatient university doctoral clinical psychology training and research clinic (M/SD: age = 32.38/11.95; education = 13.7/2.75). A comprehensive neuropsychological battery included the Medical Symptom Validity Test (MSVT) and embedded PVTs from different cognitive domains: attention - Wechsler Adult Intelligence Scale - Fourth Edition Reliable Digit Span and Digit Span age-corrected scaled score (DS ACSS); memory - California Verbal Learning Test, 3rd Edition (CVLT-3) Forced-Choice Recognition (FCR), executive functions -Wisconsin Card Sorting Test (WCST) Failure to Maintain Set (FMS); visual-spatial/construction -Rey Complex Figure Test (RCFT) Copy raw score; language - Boston Diagnostic Aphasia Examination Complex Ideation Material (CIM); and motor functions - Finger Tapping Test (FTT). All participants were administered the MSVT but not all participants were administered all seven embedded PVTs. Credible/noncredible classification concordance rates and kappa correlations (i.e., percentage of agreement) were computed for each pairwise PVT combination.Results:Twenty-two percent (n = 23) of the sample failed at least one PVT, with 17.0% (n = 18) failing at least two. DS ACSS was the embedded PVT with the highest MSVT concordance rate at 92.4% and a fair kappa coefficient of .39; WCST FMS had the lowest concordance with MSVT at 82.9% and a slight kappa coefficient of .19. The highest concordance among embedded PVTs from different cognitive domains was CVLT-3 FCR and RCFT Copy raw score at 89.7% with a fair kappa coefficient of .35; the lowest agreement among embedded PVTs was WCST FMS and FTT at 74.0% with a kappa coefficient of -.02. More conservative kappa coefficients among all pair-wise embedded PVT combinations from different cognitive domains ranged from -.02 to .36. For all standalone and embedded PVT pairwise concordance rates, only two fell below the recommended minimum agreement of 80%: FCR vs. FMS = 79.3% and FMS vs. FTT = 74.0%.Conclusions:Embedded PVTs across various cognitive domains have high agreement with a standalone PVT to aid in classifying noncredible performance, in the 83-92% range. Embedded PVTs from different cognitive domains also have mostly high agreement classification rates amongst themselves in aiding to determine noncredible performance, in the 74-90% range, with the lowest agreement rate between executive function and motor tests at 74%. More conservative kappa-based agreements between PVT pair-wise combinations were fairly consistent with other studies, with most being in the fair range. Finally, these findings indicate about a 17% base rate of noncredible cognitive performance in an outpatient university-based clinic.

KEAP1 polymorphisms and neurodevelopmental outcomes in children with exposure to prenatal MeHg from the Seychelles Child Development Study Nutrition Cohort 2

BackgroundHumans differ in the metabolism of the neurotoxicant methyl mercury (MeHg). This variation may be partially due to variation in genes encoding the transcription factor Nuclear factor E2-related factor 2 (NRF2) and its negative regulator Kelch-like ECH-Associated Protein 1 (KEAP1), which regulate glutathione and related transporter and antioxidant proteins that play a role in the metabolism and neurotoxicity of MeHg. AimTo elucidate a potential risk from genetic variation in NFE2L2 (encoding NRF2) and KEAP1 toward prenatal mercury exposure and child neurodevelopmental outcomes at 20 months and 7 years of age in a population with variable prenatal exposure to MeHg from maternal fish consumption. Material and MethodsNutrition Cohort 2 is a mother–child cohort in the Republic of Seychelles. Children were genotyped for NFE2L2 (rs2364723, rs13001694) and KEAP1 (rs8113472, rs9676881) polymorphisms (N = 1285 after removing siblings). Total mercury (Hg) was measured in cord blood as a biomarker for prenatal MeHg exposure. Child neurodevelopmental outcomes included the Bayley Scales of Infant Development II administered at 20 months of age, and outcomes across multiple neurodevelopmental domains from 14 tests administered in children and 3 instruments completed by parents when children were 7 years of age. ResultsThe mean cord blood MeHg concentration was 34 (95% CI 11, 75) µg/L. None of the four polymorphisms had a significant association (p < 0.05) with either cord MeHg or neurodevelopmental test results at 20 months. There were no significant associations between either NFE2L2 polymorphism and any developmental test scores. At 7 years, children carrying KEAP1 rs8113472 CA showed significantly worse performance on psychomotor function than children with the CC variant (finger tapping, dominant hand: β − 1.19, SE 0.34; finger tapping, non-dominant hand: β − 0.92, SE 0.31) and worse social communication (SCQ Total: β 0.65, SE 0.27). Children carrying rs8113472 AA, versus children with CC, showed significantly better performance on social communication (SRS Total: β − 8.88, SE 3.60). Children carrying KEAP1 rs9676881 AG, versus children with GG, showed significantly worse performance on psychomotor function (trailmaking A time: β 8.66, SE 3.37) and cognition (KBIT Matrices: β − 0.96, SE 0.36). ConclusionNo associations between NFE2L2 and KEAP1 polymorphisms and MeHg concentration were identified. However, at 7 years, KEAP1 polymorphisms were associated with differences in neurodevelopmental outcomes in children from a population with high fish intake.

Using Cognitive-Motor Dual-Tasks and Functional Near-Infrared Spectroscopy to Characterize Older Adults with and without Subjective Cognitive Decline.

Subjective cognitive decline (SCD) refers to individuals who report persistent cognitive deficits but perform normally on neuropsychological tests. Performance may be facilitated by increased prefrontal cortex activation, known as neural compensation, and could be used to differentiate between older adults with and without SCD. This cross-sectional pilot study measured changes in the hemodynamic response (ΔHbO2) using functional near-infrared spectroscopy (fNIRS) as well as cognitive and motor performance during fine and gross motor dual-tasks in older adults with and without SCD. Twenty older adults over 60 years old with (n = 10) and without (n = 10) SCD were recruited. Two experiments were conducted using 1) gross motor walking and 2) fine motor finger tapping tasks that were paired with an n-back working memory task. Participants also completed neuropsychological assessments and questionnaires on everyday functioning. Repeated measures ANOVAs demonstrated slower response times during dual-task gait compared to the single task (p = 0.032) and in the non-SCD group, slower gait speed was also observed in the dual compared to single task (p = 0.044). Response times during dual-task finger tapping were slower than the single task (p = 0.049) and greater ΔHbO2 was observed overall in the SCD compared to non-SCD group (p = 0.002). Examining neural and performance outcomes revealed differences between SCD and non-SCD groups and single and dual-tasks. Greater brain activation during dual-task finger tapping may reflect neural compensation, which should be examined in a larger sample and longitudinally to better characterize SCD.

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation.

The supplementary motor area (SMA) is important for motor and language function. Damage to the SMA may harm these functions, yet tools for a preoperative assessment of the area are still sparse. The aim of this study was to validate a mapping protocol using repetitive navigated transcranial magnetic stimulation (rnTMS) and extend this protocol for both hemispheres and lower extremities. To this purpose, the SMA of both hemispheres were mapped based on a finger tapping task for 30 healthy subjects (35.97 ± 15.11, range 21-67 years; 14 females) using rnTMS at 20 Hz (120% resting motor threshold (RMT)) while controlling for primary motor cortex activation. Points with induced errors were marked on the corresponding MRI. Next, on the identified SMA hotspot a bimanual finger tapping task and the Nine-Hole Peg Test (NHPT) were performed. Further, the lower extremity was mapped at 20 Hz (140%RMT) using a toe tapping task. Mean finger tapping scores decreased significantly during stimulation (25.70taps) compared to baseline (30.48; p < 0.01). Bimanual finger tapping led to a significant increase in taps during stimulation (28.43taps) compared to unimanual tapping (p < 0.01). Compared to baseline, completion time for the NHPT increased significantly during stimulation (baseline: 13.6 s, stimulation: 16.4 s; p < 0.01). No differences between hemispheres were observed. The current study validated and extended a rnTMS based protocol for the mapping of the SMA regarding motor function of upper and lower extremity. This protocol could be beneficial to better understand functional SMA organisation and improve preoperative planning in patients with SMA lesions.

In2O3 nanocubes and ZnWO4 nanorod-based triboelectric nanogenerator for self-powered humidity sensors

In this study, a self-powered photo-induced humidity sensor was developed using ZnWO4/In2O3 heterostructure based Triboelectric Nanogenerator (TENG). The ZnWO4/In2O3 heterostructure-based TENG generates 44 V voltage and 1 µA current by finger tapping. The ZnWO4/In2O3 heterostructures were synthesized via hydrothermal method. SEM analysis confirmed the In2O3 nanocubes grown on ZnWO4 nanorods. XRD analysis confirmed the polycrystalline nature of ZnWO4/In2O3 heterostructures and the average crystallite size was found to be 32.66 nm. XPS analysis confirmed the presence of Zn2+, In3+, W4+, and O2- oxidation states. Optical properties were analyzed by UV–visible spectroscopy and maximum absorbance was found in the region (315–400 nm) since it is capable of absorbing UV light. In this work, the effect of very low-intensity UV light (2 mW/cm2) on a battery-less moisture detection was investigated at different moisture levels (10–90%RH). The sensor response was around 27.50 at 90%RH of photo-induced self-powered humidity sensor. Also, the fast response and recovery times were observed as 260 ms and 620 ms respectively in the illumination of UV light. The photo-induced self-powered humidity sensor showed highly sensitive and stable for a long time and it can be commercialized for indoor and outdoor humidity detection.

Time Course Effects of Different Intensities of Running Exercise on Cognitive and Motor Performances in Individuals With Intellectual Disability.

This study explored the acute effects of different running intensities on cognitive and motor performances in individuals with intellectual disability (ID). An ID group (age, M = 15.25years, SD = 2.76) and a control group without ID (age, M = 15.11years, SD = 1.54) performed visual simple and choice reaction times, auditory simple reaction time, and finger tapping tests before and after running at low or moderate intensity (30% and 60% of heart rate reserve [HRR], respectively). Visual simple reaction time values decreased (p < .001) after both intensities at all time points with higher (p = .007) extend after the 60% HRR intensity for both groups. After both intensities, the VCRT decreased (p < .001) in the ID group at all time points compared with preexercise (Pre-EX) while, in the control group, these values decreased (p < .001) only immediately (IM-EX) and after 10min (Post-10) of exercise cessation. Compared withs Pre-EX, in the ID group, the auditory simple reaction time values decreased (p < .001) at all time points after the 30% HHR intensity whereas, after the 60% HRR, these values decreased only at IM-EX (p < .001), Post-10 (p = .001) and Post-20 (p < .001). In the control group, auditory simple reaction time values decreased (p = .002) only after the 30% HRR intensity at IM-EX. The finger tapping test increased at IM-EX (p < .001) and at Post-20 (p = .001) compared to Pre-EX in both groups only after the 30% HHR intensity and for the dominant hand. The effect of physical exercise on cognitive performances in individuals with ID seems to depend on the cognitive test type as well as the exercise intensity.

Cervical proprioception in Parkinson's disease and its correlation with manual dexterity function.

Cervical proprioception has a crucial role in posture and movement control. The study aimed to determine the relationship of cervical proprioception, cervical muscle strength and endurance with manual dexterity and hand strength in individuals with idiopathic Parkinson's disease (PD). Twenty individuals with PD (mean age:63.9 years) and 20 healthy individuals as a control group (mean age: 61.9 years) were recruited. Cervical joint position error (JPE), static endurance of neck muscles, activation of deep cervical flexor muscles (Craniocervical Flexion Test-CCFT), manual dexterity using Purdue Pegboard Test (PPT), cognitive and motor task on PPT, finger tapping test (FTT) and pinch-grip strength were assessed. Cervical JPE was significantly higher in individuals with PD than controls (p<0.05). The strength and endurance of the cervical muscles were significantly decreased in individuals with PD (p<0.05). There was a significant negative correlation of cervical JPE measurements with PPT, cognitive and motor tasks on PPT in the PD group (p<0.05). There was a significant negative correlation of the endurance of cervical flexor muscles with PPT and cognitive task on PPT (p<0.05). In addition, a significant positive correlation was found between cervical flexor endurance and hand strength in the PD group (p<0.05). Cervical proprioception and the strength and endurance of cervical muscles decrease in individuals with PD compared to healthy individuals. Impairment of cervical proprioception appears to be associated with poorer upper extremity performance. Detailed evaluation of the cervical region in PD may be useful in determining the factors affecting upper extremity function.

Parkinson Disease Recognition Using a Gamified Website: Machine Learning Development and Usability Study.

Parkinson disease (PD) affects millions globally, causing motor function impairments. Early detection is vital, and diverse data sources aid diagnosis. We focus on lower arm movements during keyboard and trackpad or touchscreen interactions, which serve as reliable indicators of PD. Previous works explore keyboard tapping and unstructured device monitoring; we attempt to further these works with structured tests taking into account 2D hand movement in addition to finger tapping. Our feasibility study uses keystroke and mouse movement data from a remotely conducted, structured, web-based test combined with self-reported PD status to create a predictive model for detecting the presence of PD. Analysis of finger tapping speed and accuracy through keyboard input and analysis of 2D hand movement through mouse input allowed differentiation between participants with and without PD. This comparative analysis enables us to establish clear distinctions between the two groups and explore the feasibility of using motor behavior to predict the presence of the disease. Participants were recruited via email by the Hawaii Parkinson Association (HPA) and directed to a web application for the tests. The 2023 HPA symposium was also used as a forum to recruit participants and spread information about our study. The application recorded participant demographics, including age, gender, and race, as well as PD status. We conducted a series of tests to assess finger tapping, using on-screen prompts to request key presses of constant and random keys. Response times, accuracy, and unintended movements resulting in accidental presses were recorded. Participants performed a hand movement test consisting of tracing straight and curved on-screen ribbons using a trackpad or mouse, allowing us to evaluate stability and precision of 2D hand movement. From this tracing, the test collected and stored insights concerning lower arm motor movement. Our formative study included 31 participants, 18 without PD and 13 with PD, and analyzed their lower limb movement data collected from keyboards and computer mice. From the data set, we extracted 28 features and evaluated their significances using an extra tree classifier predictor. A random forest model was trained using the 6 most important features identified by the predictor. These selected features provided insights into precision and movement speed derived from keyboard tapping and mouse tracing tests. This final model achieved an average F1-score of 0.7311 (SD 0.1663) and an average accuracy of 0.7429 (SD 0.1400) over 20 runs for predicting the presence of PD. This preliminary feasibility study suggests the possibility of using technology-based limb movement data to predict the presence of PD, demonstrating the practicality of implementing this approach in a cost-effective and accessible manner. In addition, this study demonstrates that structured mouse movement tests can be used in combination with finger tapping to detect PD.