Purdue Pegboard Test Research Articles

The effect of wrist position sense and tactile recognition on manual skills in patients with upper extremity neuropathy.

Peripheral neuropathy affects fine motor skills in daily life. However, reports on the effects of position sense and tactile recognition on manual dexterity are quite scarce in the literature. The increasing focus on hand rehabilitation has created a need to examine the effects of sensation on manual dexterity. The purpose of this study is to compare the effect of tactile recognition and wrist position sense on manual skills in healthy and neuropathy individuals and to investigate the relationship between them. Cross-sectional, non-randomized comparative clinical study. Thirty-seven (50 hands) with median and ulnar nerve neuropathy between the ages of 18 and 65years and 32 (64 hands) healthy individuals of similar age and gender were included in the study. Wrist position sense was assessed using the K-FORCE Sens electrogoniometer as target angle, 30° wrist flexion and extension, and 10° radial and ulnar deviation. Shape-Texture Identification Test (STI), Purdue Pegboard test (PPT), and Michigan Hand Outcome Questionnaire were applied for tactile recognition, manual dexterity, and hand functions, respectively. The independent-sample t test and Mann-Whitney U test were used for K-FORCE Sens, STI, and PPT to compare groups. Correlation coefficient was used to determine the relationship between variables. The mean age of individuals with neuropathy and healthy individuals was 45.7±10.3 and 44.5±9.2years, respectively (p>0.05). Seventy-three percent of individuals had median neuropathy and 27% had ulnar neuropathy. Totally, 33 dominant and 17 non-dominant hands of patients with neuropathy were affected. When healthy and neuropathic hands were compared, the mean error values in the dominant hand, flexion (4.4±1.4; 6.5±2.9), and radial deviation (2.4±1.0; 3.3±1.7) degrees were higher in the neuropathic hands (p<0.05). Similar results were also found in the non-dominant hands. However, there was no difference between the mean error values in the extension and ulnar deviation degrees (p>0.05). STI and PPT subtest results were also lower in the neuropathic hands (p<0.05). There was a relationship between the mean error values of position sense in the flexion and radial deviation directions in the neuropathic dominant hands and all subtests of the PPT (p<0.05), while there was a relation in the flexion direction in the non-dominant hand (p<0.05). No relation was found in the Michigan Hand Outcome Questionnaire test (p>0.05). This study has shown that in neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored in determining participation in manual skills. This article can be used as a starting point for further studies and can be considered as one of the sensory focal points in rehabilitation in the development of manual skills.

The Bimanual Observation of The Hands (BOTH): Development, reliability, and validity for stroke rehabilitation.

To efficiently perform bimanual daily tasks, bimanual coordination is needed. Bimanual coordination is the interaction between an individual's hands, which may be impaired post-stroke, however clinical and functional assessments are lacking and research is limited. To develop a valid and reliable observation tool to assess bimanual coordination of individuals post-stroke. A cross-sectional study. Rehabilitation settings. Occupational therapists (OTs) with stroke rehabilitation experience and individuals post stroke. The development and content validity of BOTH included a literature review, review of existing tools and followed a 10-step process. The conceptual and operational definitions of bimanual coordination were defined as well as scoring criteria. Then multiple rounds of feedback from expert OTs were performed. OTs reviewed BOTH using the 'Template for assessing content validity through expert judgement' questionnaire. Then, BOTH was administered to 51 participants post-stroke. Cronbach's alpha was used to verify internal reliability of BOTH and construct validity of BOTH was assessed by correlating it to the bimanual subtests of The Purdue Pegboard Test. Expert validity was established in two-rounds with 11 OTs. Cronbach's alpha was α = 0.923 for the asymmetrical items, 0.897 for the symmetrical items and 0.949 for all eight items. The item-total correlations of BOTH were also strong and significant. The total score of BOTH was strongly significantly correlated with The Purdue-Both hands placement (r = .787, p < .001) and Assembly (r = .730, p < .001) subtests. BOTH is a new observation tool to assess bimanual coordination post-stroke. Expert validity of BOTH was established, excellent internal reliability and construct validity were demonstrated. Further research is needed, so in the future, BOTH can be used for clinical and research purposes to address bimanual coordination post-stroke.

Impact of a Dynamic Orthosis on Manual Dexterity Among People With Parkinson's Disease: A Randomized Trial.

A dynamic elastomeric fabric orthosis could be a novel nonpharmacological treatment of motor symptoms among people with Parkinson's disease (PD). To evaluate the efficacy of the orthosis in improving manual dexterity among people with PD. A randomized trial with 60 participants (control group, n = 20; experimental group, n = 40). Manual dexterity was assessed in on-off states of the disease, with and without the orthosis. Burgos University Hospital (Burgos, Spain). Consecutive nonprobabilistic sampling. Patients were included if they had been diagnosed with PD, had motor symptoms in at least one upper limb, and attended the hospital's neurology department. Participants were ages 48 to 89 yr, with an average disease duration of 5.38 yr (SD = 4.23). Exclusion criteria were tremor due to another neurological disease or a Montreal Cognitive Assessment score ≤26. The experimental group used the orthosis on the most affected upper limb for 2 mo; the control group participants did not receive the orthosis. Manual dexterity was measured with the Purdue Pegboard Test, Minnesota Manual Dexterity Test, and Square Test. Paired t tests for related samples and analysis of covariance tests were used. Some participants improved on some manual dexterity items while wearing the orthosis. However, it was not sustained when the orthosis was removed after 2 mo of use. The orthosis may improve certain aspects of manual dexterity and functionality among people with PD, but only while it is worn. Plain-Language Summary: The common motor symptoms and declines in manual dexterity that people with Parkinson's disease (PD) experience can significantly affect their ability to perform activities of daily living as well as their quality of life. Manual dexterity is a strong predictor of the level of functional independence for people with PD. This study evaluated the efficacy of an elastomeric fabric orthosis to improve manual dexterity for people with PD. The study found that while wearing the orthosis the motor symptoms of PD were reduced and manual dexterity and upper limb functionality improved. Wearing the orthosis has the potential to enhance functionality, foster greater autonomy, and substantially improve the quality of life of people with PD.

Does cervical radiculopathy affect eye hand coordination?

Purposes. This study was conducted to investigate the relationship between cervical radiculopathy and eye-hand coordination in patients with chronic unilateral cervical radiculopathy due to a discogenic lesion in the lower cervical spine. Methods. Sixty participants of both sexes participated in this study. Their age ranged from 30 to 50 years old. Patients were selected from governmental hospitals in Zagazig city, Egypt. Participants were divided into two groups: Group I (study group) included 30 patients with chronic unilateral cervical radiculopathy due to a discogenic lesion in the lower cervical spine. Group II (control group) included 30 healthy participants with no complaints. Neck pain intensity was assessed by the numeric pain rating scale. Weight and height were assessed by body mass index (BMI). All participants underwent eye-hand coordination assessment using the Purdue Pegboard Test, the Talking Pen by Wayne Engineering, the wall catch test, and the standardized finger-to-nose test. Results. There was a significant relationship between cervical radiculopathy and eye-hand coordination. There was a statistically significant difference between both groups (p = 0.001) in all eye-hand coordination tests as there was a significant decrease in Purdue Pegboard Test scores, dominant, non-dominant, bilateral, and assembly of the study group compared with that of the control group. There was a significant increase in Talking Pen test time and the number of errors of dominant and non-dominant hands in all tests of the study group compared with that of the control group. There was a significant decrease in standardized finger-to-nose scores and the wall catch test of the study group compared with that of the control group. There was a negative significant correlation between the numeric pain rating scale and Purdue Pegboard Test scores, standardized finger-to-nose test, and wall catch test. There was a positive significant correlation between the numeric pain rating scale and Talking Pen test time and the number of errors while using dominant and non-dominant hands. Conclusions. Patients with cervical radiculopathy have significant impairment in eye-hand coordination. This may give attention to physical therapists during the management of patients with cervical radiculopathy.

Effectiveness of manual dexterity assessment methods for preclinical training in Dentistry.

This study aimed to verify the predictive capacity of manual dexterity assessment methods for pre-clinical training in Dentistry. Students from the fifth year of the undergraduate course in Dentistry (N = 95) participated in this study. Manual dexterity was investigated as a variable of interest, measured by the O'Connor Finger Dexterity Test methods-Model 32021, Purdue Pegboard Test-Model 32020A, Dental Manual Dexterity Assessment-DMDA, Class One Cavity Preparation Assessent-COCA and Class One Composite Resin Restoration Assessment-COCRA. The average score obtained in the evaluation of the quality of the cavity preparations and restorations was considered as gold standard, and from these data the sensitivity and specificity of the tests were estimated. Receiver Operating Characteristic (ROC) curves were constructed to assess the diagnostic performance of each dexterity test. The analysis included calculating the Area Under the Curve (AUROC) to evaluate their discriminative power, and cutoff points were determined that optimize the balance between sensitivity and specificity. The DMDA test showed better performance, with statistical significance (p <0.001) and acceptable predictive ability (AUROC = 0.775), while the O'Connor test (AUROC = 0.644, p = 0.050) and Purdue Pegboard test (Purdue 1: AUROC = 0.542, p = 0.560; Purdue 2: AUROC = 0.564, p = 0.423; Purdue 3: AUROC = 0.517, p = 0.828; Purdue 4: AUROC = 0.608, p = 0.083) were not statistically significant. The DMDA test presented the best performance, with statistical significance and acceptable discrimination, showing greater effectiveness for assessing students' manual dexterity. Therefore, the implementation of the DMDA test can significantly contribute to the early identification of motor dexterity difficulties in dental students, enabling more effective and targeted interventions.

The Effects of Action Observation Training Combined With Occupation‐Based Intervention through Home Visits on Occupational Performance and Hand Function in Community‐Dwelling Patients with Stroke

AbstractBackgroundSince January 2023, South Korea has launched a pilot program of home‐based rehabilitation services for patients with acute and chronic conditions. However, research on the effectiveness of occupational therapy for homebound stroke patients, aimed at promoting independence and activity participation, is limited. Additionally, previous action observation training studies in home settings often overlooked clients' occupational priorities and meanings. Therefore, this study investigates the effect of combining action observation training with occupational therapy through home visits on occupational performance and hand function in community‐dwelling stroke patients.MethodIn this study, which employed a mixed methods research design, the quantitative component utilized a single‐subject ABA' design, complemented by qualitative narrative interviews. The intervention involved two stroke outpatients, who participated in ten sessions conducted five times a week over two weeks. Each session began with the participants watching edited videos on the researcher’s laptop for 10 minutes in a quiet room, followed by 50 minutes of self‐training using selected equipment and tools, while imitating the actions from the videos. Assessment tools included the Purdue Pegboard Test and Pinch Gauge for evaluating hand function, while occupational performance was measured using the COPM pre‐ and post‐intervention.ResultFirst, twol participants showed clinically significant improvements with a score increase of two or more points in occupational performance and satisfaction. Second, twol participants demonstrated an improvement in the assembly task of the Purdue pegboard test during the intervention phase compared to the baseline phase, but this improvement was not maintained during the follow‐up baseline phase. Third, in the Pinch gauge, two participants showed an improvement in the affected side from the baseline to the intervention phase, and this improvement was maintained until the follow‐up baseline phase. However, there were no significant changes observed in the unaffected side. Fourth, qualitative research findings revealed that the participants exhibited an improvement in occupational performance, occupational motivation, occupatioanl patterns, and self‐efficacy.ConclusionAction observation training combined with home‐based interventions can be easily implemented at home without significant effort from patients post‐discharge. Therefore, it offers an alternative method for occupational therapy services, serving as a preparatory step before engaging in occupational activities.

Clinical utility of extracorporeal shock wave therapy in restoring hand function of patients with nerve injury and hypertrophic scars due to burns: a prospective, randomized, double-blinded study.

Joint contractures and nerve injuries are common after hand burns. Extracorporeal shock wave therapy (ESWT) is effective not only for the regeneration of various tissues, including scar tissues, but also for reducing pain and pruritus in patients with burns. Researchers have attempted to explore the effects of ESWT on hand dysfunction caused by nerve injury following burns. The authors evaluated the effects of ESWT (compared to sham stimulation) on hands with nerve injury and hypertrophic scars and, thereby, on hand function. The current study was a double-blind randomized controlled trial involving 120 patients. The ESWT parameters were as follows: energy flux density, 0.05-0.30mJ/mm 2 ; frequency, 4Hz; 1000-3000 impulses per treatment; and 12 treatments, one/week for 12 weeks. Outcome measures were as follows: 10-point visual analog scale for pain, Jebsen-Taylor hand function test, grip strength, Purdue Pegboard test, ultrasound measurement of scar thickness, and skin characteristics before and immediately after 12 weeks of treatment. No significant intergroup difference was noted after the initial evaluation ( P >0.05). More significant improvements were found in the ESWT group than in the sham group in terms of the VAS score ( P =0.004), extension ROMs of hand joints ( P =0.02), the JTT scores (writing, small, and light) ( P <0.001, P <0.001, and P =0.002), and skin characteristics (melanin, skin distensibility, and biologic skin elasticity) ( P =0.004, P <0.001, and P <0.001). Other measured outcomes did not differ between the two groups after the treatment. The authors identified the clinically beneficial effects of ESWT in promoting hand function, improving scarring, and alleviating scarring-related pain, thereby highlighting its advantages in improving hand function that has been impaired due to nerve injury and hypertrophic scars after burns.

Neurobehavioral Performance in Preschool Children Exposed Postnatally to Organophosphates in Agricultural Regions, Northern Thailand.

Evidence of the effects of postnatal exposure to organophosphates (OPs) on children's neurodevelopment remains limited but crucial. This cross-sectional study evaluated exposure to OPs and neurobehavioral performance in 172 preschool children. Urinary dialkyl phosphate (DAP) metabolites, biomarkers for exposure to OPs, were measured. The neurobehavioral assessments included motor skills, memory, and cognitive function, measured using the Purdue pegboard test, digit span test, object memory test, and visual-motor integration. Multiple linear regression models were employed to explore the associations between urinary DAP metabolite levels and neurobehavioral performance, adjusting for potential confounders. Findings revealed that children of farming parents had higher urinary levels of dimethylphosphate (DMP) (Beta = 0.730, 95% CI = 0.138, 1.322, p value = 0.016) and diethylphosphate (DEP) (Beta = 0.668, 95% CI = 0.044, 1.291, p value = 0.036). Additionally, high fruit consumption correlated with increased urinary DEP levels (Beta = 0.398, 95% CI = 0.063, 0.733, p value = 0.020). Critically, elevated urinary DEP was associated with poorer fine motor coordination, affecting performance in the Purdue pegboard test for the dominant hand (Beta = -0.428, 95% CI = -0.661, -0.194, p value < 0.001), the preferred hand (Beta = -0.376, 95% CI = -0.603, -0.149, p value = 0.001), and both hands (Beta = -0.524, 95% CI = -0.773, -0.276, p value < 0.001). These findings highlight the role of parental occupation and diet in children's OP exposure and suggest that OP exposure negatively impacts fine motor coordination. Targeted interventions, such as promoting organic diets, enhancing workplace safety, and ongoing biomonitoring, are vital to reduce neurodevelopmental risks for vulnerable populations.

Health changes from trans-theoretical model-based education in older adults with mild cognitive impairment: A randomized controlled trial

Low awareness and misconceptions surrounding mild cognitive impairment highlight the urgent need for effective health education. Reluctance to seek intervention and poor adherence to management strategies make behavior-oriented health education essential. To assess the effectiveness and clinical significance of a trans-theoretical model-based health education program on cognitive-behavioral outcomes in older adults with mild cognitive impairment. A two-arm and assessor-blinded randomized controlled trial. 100 community-dwelling older adults with mild cognitive impairment in Huzhou, China. Participants were randomly assigned to a trans-theoretical model-based health education program (weekly 45-60min sessions for 8weeks, followed by 12weeks of unsupervised practice) or a wait-list control group receiving standard health education. Disease knowledge, behavioral stage, and adherence to health management behaviors were assessed at baseline, 8-week, and 20-week. Effects were evaluated at the group level via generalized estimating equation and at the individual level using reliable and clinically significant change. The trans-theoretical model-based health education program demonstrated significant effects over the wait-listed control. Generalized estimating equation analyses showed statistically significant effects on behavioral stage (β8-week=1.04, 95%CI=0.34-1.75; β20-week=1.72, 95%CI=0.95-2.49), disease knowledge (β8-week=1.14, 95%CI=0.26-2.02; β20-week=1.78, 95%CI=0.87-2.69), and adherence to health management behaviors (β8-week=6.20, 95%CI=2.03-10.37; β20-week=10.74, 95%CI=6.47-15.01) at both measured intervals. Additionally, global cognitive function (β8-week=0.60, 95%CI=-0.18-1.38; β20-week=2.42, 95%CI=1.64-3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β8-week=0.16/0.38, 95%CI=-0.21-0.53/-0.18-0.94; β20-week=0.96/1.80, 95%CI=0.57-1.35/1.17-2.43) improved significantly over time. Reliable and clinically significant change analyses at 8weeks indicated significant improvements in the intervention group: 57% of participants improved in disease knowledge (22% clinically significant), 90% in adherence to health management behaviors (17% clinically significant), and 61% in global cognitive function (10% clinically significant). By 20weeks, these rates increased to 63% (29%), 100% (25%), and 78% (27%). However, non-significant improvements in depression symptoms and sleep quality were found at individual-level assessment. This study shows that the trans-theoretical model-based health education program effectively enhances cognitive-behavioral health outcomes in older adults with mild cognitive impairment, with benefits persisting for 12weeks. Future research should further explore the potential mechanisms underlying the cognition and behavior-enhancing effects of this program. ChiCTR1900028351.

G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities Using Guitar): A Randomized Controlled Trial Using Guitar Lessons for Restoring Hand Function among Patients with Unilateral Hand Impairment.

To determine the effects of guitar lessons (intervention group) in comparison to conventional occupational therapy (OT) sessions (control group) on hand function of chronic stroke patients with unilateral hand impairment. This randomized controlled trial enrolled 34 chronic stroke patients with unilateral hand impairment. Participants were grouped randomly into intervention (guitar lessons) and control (conventional occupational therapy) groups. Each group participant underwent a total of eight consecutive therapy sessions, twice weekly for an hour each session, at the designated treatment rooms in the Department of Rehabilitation Medicine of the Philippine General Hospital. Pre- and post-treatment evaluations were done to assess range of motion, grip and pinch strength, and hand functions. Satisfaction surveys were answered at the end of the 8-therapy session. Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and post-treatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength.In evaluating the satisfaction of participants in both groups, higher mean scores were observed in the control group. No statistically significant difference in most of the questions in the satisfaction survey in both groups.All participants in both groups displayed 100% compliance in attending onsite treatments. Despite not showing statistically significant difference between groups (p = 0.721), an 11.8% tendency for better compliance is found in the intervention group. The specific guitar lesson created and performed in this study as used by 17 participants of the intervention group have brought about improvement in hand function that is comparable with those who underwent traditional occupational therapy. This may be most helpful in areas with limited access to rehabilitation facilities and occupational therapy services. This may also be used as a continuing activity of chronic stroke patients at home to help improve hand function.

Effect of visual biofeedback on fine motor function and activity daily of life in stroke patients: A pilot study

Many stroke patients suffer from dysfunction in their upper limbs, which can lead to difficulties in performing activities of daily living (ADL) as well as social and work interactions. This is particularly true for patients whose dominant side has been affected. The aim of the current study was to explore how effective visual biofeedback could improve fine motor function in the hand and ADL for people suffering from a stroke. Ten individuals who had experienced a stroke with aged from 60 to 74 years old (mean: 64.3 years) were randomly divided into two groups. Patients in study group (n: 5) received 15 sessions of visual biofeedback therapy along with routine occupational therapy. Control group (n: 5) received only routine occupational therapy. Fine motor function was measured by Fugl Meyer Scale (FMS), box and block test (BBT), and Purdue pegboard test (PPBT). Also, ADL was measured by functional independence measure (FIM). These clinical outcomes were evaluated before, after, and 1.5 months following the interventions. The results showed that the study group experienced a significant increase in fine motor function after receiving visual biofeedback, compared to the control group. The ADL also improved in both the study and control groups after the intervention, but there was no significant difference between the two groups during the intervention and follow-up stages for ADL. It seems that combining biofeedback with routine occupational therapy could be a promising method to enhance fine motor function in individuals with stroke.

Comparison of Hand Function after Single-Digit Replantation in Elderly and Younger Patients.

Background: With ageing of the population, there is an increasing likelihood that elderly people will seek employment, with a resultant increase in the incidence of hand injuries, including digital amputations. However, the surgical indication for replantation of an amputated digit in elderly patients is controversial. The purpose of this study was to compare functional outcomes after single-digit replantation of the thumb to long finger in older (≥65 years old) and younger (<65 years old) patients to assess the feasibility of digit replantation in the elderly population. Methods: A retrospective cohort study was performed in 25 patients (12 elderly and 13 younger) with successful replantation of the thumb, index or long finger at our hospital. All patients were followed up for more than 1 year. Key pinch strength, Semmes-Weinstein (S-W) test, % total active motion (TAM), Purdue Pegboard Test score (hand dexterity) and Disabilities of the Arm, Shoulder and Hand (DASH) score were investigated. Results: Elderly patients showed significantly worse results for the S-W test and Purdue Pegboard Test score. The % TAM, key-pinch strength and DASH scores were similar in the two groups. Conclusions: Replantation surgery in elderly patients results in similar postoperative hand function (finger mobility and pinch strength) and activities of daily living to those in younger patients. Level of Evidence: Level III (Therapeutic).

Utility of Orthosis in the Conservative Treatment of Proximal Phalanx Fractures: A Preliminary Study in Healthy Participants.

The standard treatment for the conservative management of a proximal phalanx fracture of the little finger involves immobilizing the fracture site with a cast. However, cast immobilization presents challenges in maintaining hygiene during treatment and restricts the fine motor movements of the fingers. In this study, we developed a removable orthosis that immobilizes only the ring and little fingers. We examined the splint's effectiveness in joint immobilization and its impact on fine motor movements of the fingers. Twenty healthy adults were included in this study conducted at the Yokohama Minami Kyosai Hospital, Yokohama, Japan. While wearing a cast and an orthosis, the range of motion of the metacarpophalangeal (MP) joints of the index and little fingers was measured using X-ray fluoroscopy. The Purdue Pegboard Test evaluated fine motor skills, handwriting tasks, and chopstick use tests. We statistically compared the range of motion and fine motor skills of the MP joints in the cast and orthosis. The range of motion of the MP joint in the index finger was significantly greater with the orthosis than with the cast (p < 0.001). In contrast, in the little finger, the cast allowed a greater range of motion than the orthosis (p < 0.077). Additionally, regarding fine motor skills, in the chopstick task, the orthosis showed significantly better performance than the cast. The developed orthosis, which immobilized only the ring and little fingers, provided sufficient stability to the little finger while maintaining the index finger's mobility. Additionally, it imposed minimal restrictions on fine motor movements and the use of chopsticks.

The effects of Baduanjin on fine motor skills in mild and moderate Parkinson’s disease: A randomized controlled trial

Fine motor impairment is common in Parkinson's disease (PD), which reduces patients' quality of life. There are few suitable targeted treatments. We conducted a clinical trial to determine whether Baduanjin Qigong exercise would increase fine motor skills in PD patients. Sixty PD patients (Hoehn-Yahr stage 1-4) with hand fine motor impairment were randomly assigned to the Baduanjin group and the physical activity group. Baduanjin group practiced Baduanjin exercise five times weekly for 40min (warm-up 5min, Baduanjin 30min, cool-down 5min). The usual physical activity groups maintained their habit of usual physical activities. The participants underwent assessments in the "ON" medication state at baseline and 4-week follow-up time points. The Purdue Pegboard Test (PPT) was used as the primary outcome to assess manual dexterity. The secondary outcomes included the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III), and the Parkinson's disease questionnaire (PDQ-39). The results of PPT revealed the Baduanjin group showed statistically significant improvement in the "non-dominant hand" and "assembly" scores compared to the usual physical activity group (P<0.05), but with no significant difference in "dominant hand" and "both hands" (P>0.05). Additionally, the Baduanjin group showed better performance in the PDQ-39 (P<0.05). Our study concludes that a 4-week Baduanjin exercise is effective in improving fine motor function and quality of life in patients with mild and moderate PD. The results suggest a promising intervention to be implemented in community or home settings for managing fine motor impairment in PD.

Efficacy of a new video observational training method (intensive visual simulation) for motor recovery in the upper limb in subacute stroke: a feasibility and proof-of-concept study.

To demonstrate the feasibility and efficacy of a new video-observation training method (intensive visual simulation) to improve upper limb function. Small sample, randomized, evaluator-blind, monocentric study. Seventeen early subacute ischaemic stroke patients with complete hemiplegia were randomly assigned to the therapeutic group (n = 8) or control group (CG, n = 9). Thirty sessions of intensive visual simulation combined with corrected visual feedback (therapeutic group) or uncorrected visual feedback (control group) were performed over 6 weeks on top of a standard rehabilitation programme. 400-point hand assessment test (400p-HA). Box and Blocks (B&B), Purdue Pegboard test, Minnesota. The 400p-HA test improved significantly from T0 to 6 months for both groups, with a significant difference between groups at 3 months (MW-UT p = 0.046) and 4 months (MW-UT p = 0.046) in favour of the therapeutic group. One-phase exponential modelling of 400p-HA showed a greater plateau for the therapeutic group (F test p = 0.0021). There was also faster recovery of the ability to perform the B&B tests for the therapeutic group (log-rank test p = 0.03). This study demonstrated the feasibility and potential efficacy of an intensive visual simulation training programme to improve upper limb function in subacute stroke patients. A larger study is needed to confirm these results.

Functional and free-water imaging in rapid eye movement behaviour disorder and Parkinson's disease.

It is established that one of the best predictors of a future diagnosis of Parkinson's disease is a current diagnosis of rapid eye movement behaviour disorder (RBD). In such patients, this provides a unique opportunity to study brain physiology and behavioural motor features of RBD that may precede early-stage Parkinson's disease. Based on prior work in early-stage Parkinson's disease, we aim to determine if the function of corticostriatal and cerebellar regions are impaired in RBD using task-based functional MRI and if structural changes can be detected within the caudate, putamen and substantia nigra in RBD using free-water imaging. To assess motor function, we measured performance on the Purdue Pegboard Test, which is affected in patients with RBD and Parkinson's disease. A cohort of 24 RBD, 39 early-stage Parkinson's disease and 25 controls were investigated. All participants were imaged at 3 Telsa. Individuals performed a unimanual grip force task during functional imaging. Participants also completed scales to assess cognition, sleep and motor symptoms. We found decreased functional activity in both RBD and Parkinson's disease within the motor cortex, caudate, putamen and thalamus compared with controls. There was elevated free-water-corrected fractional anisotropy in the putamen in RBD and Parkinson's disease and elevated free-water in the putamen and posterior substantia nigra in Parkinson's disease compared with controls. Participants with RBD and Parkinson's disease performed significantly worse on all tasks of the Purdue Pegboard Test compared with controls. The both hands task of the Purdue Pegboard Test was most sensitive in distinguishing between groups. A subgroup analysis of early-stage RBD (<2 years diagnosis) confirmed similar findings as those in the larger RBD group. These findings provide new evidence that the putamen is affected in early-stage RBD using both functional and free-water imaging. We also found evidence that the striatum, thalamus and motor cortex have reduced functional activity in early-stage RBD and Parkinson's disease. While the substantia nigra shows elevated free-water in Parkinson's disease, we did not observe this effect in early-stage RBD. These findings point to the corticostriatal and thalamocortical circuits being impaired in RBD patients.

The Effect of Powerball Training on Hand Tremors and Manual Dexterity of Older Adults With Parkinson’s Disease

Background and Aims The most important problems in people with Parkinson’s disease (PD) are hand tremors and manual dexterity. The present study aims to evaluate the effect of a Powerball training program on hand tremors and manual dexterity of older people with PD. Methods In this quasi-experimental study, participants were 40 patients with PD referred to Rasool-e Akram Hospital in Tehran, Iran (mean age= 66.3±4.15 years). They were divided into two groups: Training (n=20) and control (n=20). After taking the pre-test assessments (the resting/postural tremor test and the Purdue pegboard test) for both groups, the training group performed Powerball training based on the defined protocol for 8 weeks, 3 times per week. Then, both groups underwent post-test assessments, and their data were compared and analyzed. The Shapiro–Wilk test was used to test the normality of data. The Wilcoxon test was used for within-group comparisons, and the Mann-Whitney U test was used for between-group comparisons Results For hand tremors, the data analysis results showed a significant decrease in the frequency of resting tremors in the training group (Z=-3.43). In the control group, no significant difference was observed after 8 weeks. Also, there was no significant difference in the frequency of postural tremor in any group. For manual dexterity, the results showed a significant difference between the training and control groups in all four subtests (preferred hand, non-preferred hand, both hands, and assemblies) (P&lt;0.05). Conclusion Training with Powerball can be effective in reducing hand tremors at rest and improving the manual dexterity of older patients with PD.

Portable Touchscreen Assessment of Motor Skill: A Registered Report of the Reliability and Validity of EDNA MoTap.

Portable and flexible administration of manual dexterity assessments is necessary to monitor recovery from brain injury and the effects of interventions across clinic and home settings, especially when in-person testing is not possible or convenient. This paper aims to assess the concurrent validity and test-retest reliability of a new suite of touchscreen-based manual dexterity tests (called EDNA™MoTap) that are designed for portable and efficient administration. A minimum sample of 49 healthy young adults will be conveniently recruited. The EDNA™MoTap tasks will be assessed for concurrent validity against standardized tools (the Box and Block Test [BBT] and the Purdue Pegboard Test) and for test-retest reliability over a 1- to 2-week interval. Correlation coefficients of r > .6 will indicate acceptable validity, and intraclass correlation coefficient (ICC) values > .75 will indicate acceptable reliability for healthy adults. The sample were primarily right-handed (91%) adults aged 19 and 34 years (M = 24.93, SD = 4.21, 50% female). The MoTap tasks did not demonstrate acceptable validity, with tasks showing weak-to-moderate associations with the criterion assessments. Some outcomes demonstrated acceptable test-retest reliability; however, this was not consistent. Touchscreen-based assessments of dexterity remain relevant; however, there is a need for further development of the EDNA™MoTap task administration.

Motor cortex activation mediates associations between striatal dopamine depletion and manual dexterity in Parkinson's disease

Parkinson's disease (PD) presents with a progressive decline in manual dexterity, attributed to dysfunction in the basal ganglia-thalamus-cortex loop, influenced by dopaminergic deficits in the striatum. Recent research suggests that the motor cortex may play a pivotal role in mediating the relationship between striatal dopamine depletion and motor function in PD. Understanding this connection is crucial for comprehending the origins of manual dexterity impairments in PD. Therefore, our study aimed to explore how motor cortex activation mediates the association between striatal dopamine depletion and manual dexterity in PD. We enrolled 26 mildly affected PD patients in their off-medication phase to undergo [18F]FDOPA PET/CT scans for evaluating striatal dopaminergic function. EEG recordings were conducted during bimanual anti-phase finger tapping tasks to evaluate motor cortex activity, specifically focusing on Event-Related Desynchronization in the beta band. Manual dexterity was assessed using the Purdue Pegboard Test. Regression-based mediation analysis was conducted to examine whether motor cortex activation mediates the association between striatal dopamine depletion and manual dexterity in PD. Mediation analysis revealed a significant direct effect of putamen dopamine depletion on manual dexterity for the affected hand and assembly tasks (performed with two hands), with motor cortex activity mediating this association. In contrast, while caudate nucleus dopamine depletion showed a significant direct effect on manual dexterity, motor cortex mediation on this association was not observed. Our study confirms the association between striatum dopamine depletion and impaired manual dexterity in PD, with motor cortex activity mediating this relationship.

Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study.

Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants' attention, executive functioning, and cognitive abilities. The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients' cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care.