The Click Test: A Novel Tool to Quantify the Age-Related Decline of Fast Motor Sequencing of the Thumb

International audienceAbstract : Background: The thumb plays a critical role for manual tasks during the activities of daily life and the incidence of neurological or musculoskeletal disorders affecting the voluntary movements of the thumb is high in the elderly. There is currently no tool to assess repetitive motor sequencing of the thumb during ageing.Objectives: To report a novel procedure (the Click Test) assessing the effects of ageing on fast motor sequencing of the thumb.Methods : Healthy subjects (n = 252; mean age +/- SD: 49.76 +/- 19.97 years; range: 19-89 years; F/M: 151/101) were asked to perform fast repeated flexion/extension movements of the thumb using a mechanical counter.Results: Motor performances (assessed by the number of clicks during 3 time periods: 15, 30 and 45 sec), significantly decreased as a function of age for both the dominant (age effect; p< 0.0001 for 15, 30 and 45 sec) and the non-dominant hand (p<0.0001 for 15, 30 and 45 sec). The number of clicks was significantly higher in males (gender effect; p<0.001) and was higher on the dominant side as compared to the non-dominant side (handedness effect: p<0.001). The Click Test is characterized by high repeatability (coefficients of variation from 3.20 to 4.47%), excellent intra-rater reliability (intra-class coefficients ICC ranging from 0.89 to 0.98), high inter-rater reproducibility (Pearson’s product correlation ranging from 0.85 to 0.96), high internal consistency (Cronbach alpha coefficient=0.95) and is highly correlated in terms of relative performances with the box and block test and the 9-hole peg test (positive linear correlation with the results of the box and block test: p<0.001 for 15, 30 and 45 sec for both the dominant and the non-dominant hand; negative linear correlation with the results of the 9-hole peg test: p<0.001 for 15, 30 and 45 sec for both the dominant and the non-dominant hand).Conclusion : The Click Test is an entirely novel and very low cost tool to reliably discriminate the ageing effects upon the performances during fast repetitive motor sequencing of the thumb. The potential clinical and research applications for motor functions are multiple, especially in acute and chronic neurological disorders affecting the thumb as well as in the field of rheumatology and orthopedics

Practice-Based Evidence to Support Return to Work in Cancer Patients

BackgroundInternational research emphasizes the importance of providing early, hospital-based support in return to work (RTW) for cancer patients. Even though oncology health professionals are aware of the scientific evidence, it remains unclear whether they implement this knowledge in current practice. This paper presents the knowledge and viewpoints of health care professionals (HCPs) on their potential role in their patients' RTW process.MethodsSemi-structured interviews with oncology HCPs were used to describe current practice. Results of these interviews served as input for focus group discussions with managers in oncology hospitals, which led to an agreement on of best practice.ResultsThis research had the participation of 75% of Belgian institutions involved in oncology health care services. Five themes were identified that influence care providers and staff to implement scientific evidence on RTW in cancer patients: (1) Opinions on the role that care institutions can take in RTW support; (2) Current content of RTW support during oncology care; (3) Scientific bases; (4) Barriers and success factors; and (5) Legislation and regulations. The key elements of the best practice included a generic approach adapted to the needs of the cancer patient supported by a RTW coordinator.ConclusionsHealth care providers include RTW support in their current care, but in very varied ways. They follow a process that starts with setting the indication (meaning the identification of patients for whom the provision of work-related care would be useful) and ends with a clear objective agreed upon by HCPs and the patient. We recommend that specific points of interest be included in regulation at both the patient and hospital levels

A simple bedside test to detect and evaluate intentional neglect

The detection of intentional neglect requires time and equipment. In order to simplifyits detection, we developed new software running on Microsoft Windows®, invertingright-left horizontal movements of the mouse cursor while leaving its vertical movementsunchanged. We observed on eight successive subjects, that the software increased theexpression of attentional neglect and detected intentional neglect. To conclude, wedeveloped a simple, fast and objectively analyzable bedside test to detect and evaluateintentional neglect. © 2007 by Nova Science Publishers, Inc. All rights reserved.Chapter 14SCOPUS: ch.binfo:eu-repo/semantics/publishe

Evaluation of a wearable orthosis and an associated algorithm for tremor suppression.

We describe a wearable orthosis and an associated algorithm for the simultaneous assessment and treatment of essential tremor, one of the most common movement disorders in humans involving an overactivity of the olivo-cerebellar pathways. A motor providing effective viscosity is fixed on a wearable orthosis in the upper limbs. The motor is controlled by a personal computer with software processing in real time the position and rate of rotation of the joint detected by a chip gyroscope. The orthosis can be used in a monitoring mode and in an active mode. The range of tremor suppression of the signals above the orthosis operational limit ranges from about 3% (percentile 5) to about 79% (percentile 95) in relation to energy in the monitoring mode. Considering both postural and kinetic, the mean tremor energy decreased from 55.49 +/- 22.93 rad2 s(-3) in the monitoring mode to 15.66 +/- 7.29 rad2 s(-3) in the active mode. Medians of power reduction were below 60% for the wrist and the elbow. In addition to supplying new information on the interactions between kinematics, dynamics and tremor genesis, this non-invasive technique is an alternative to current therapies. This new approach will provide new insights into the understanding of motor control.Clinical TrialJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Mechanical suppression of essential tremor.

This paper describes a new treatment for essential tremor. A wearable orthosis, which can be adapted to each configuration of each joint of the upper limb, is able to apply effective dynamic force between consecutive segments of the upper limb and change its biomechanical characteristics. The orthosis is controlled by a computer with a dedicated software application that distinguishes between real time tremor and voluntary movement. The wearable orthosis is able to detect position, rate and acceleration of rotation of the joint by means of a chip gyroscope. This technology was evaluated in six patients suffering from essential tremor. The technique is non invasive and represents an alternative to medication and deep brain stimulation.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

The electronic counting arm movement test (eCAM test)

A novel transportable electronic platform aiming to characterize the performance of successive fast vertical visually guided pointing movements toward two fixed targets (eCAM test: electronic counting arm movement test) is described and one validation test is presented. This platform is based on an Arduino H micro-controller and a Processing® routine. It records both the pointing performance (number of clicks) and the elapsed time between two successive pointing movements. Using this novel platform, we studied the effects of functional electrical stimulation (FES) applied on the dominant upper limb in 15 healthy volunteers (mean age ± SD: 22.3 ± 4.3 years; 5 males/10 females). The following muscles were stimulated: flexor carpi radialis (FCR), extensor carpi radialis (ECR), biceps brachii (BB), and triceps brachii (TB). The intensities of the stimulation were 2 and 3 mA above the sensory threshold (ST). Movement times were lesser when performed against gravity and pointing performance improved with FES. We provide the first demonstration that low-intensity FES impacts on motor performances during successive vertical goaldirected pointing movements under visual guidance. The eCAM test is currently the sole electronic tool to assess quickly and easily the performances of successive vertical pointing movements. Future potential applications include, in particular, the follow-up of the effects of neurorehabilitation of neurological/ neurosurgical disorders associated with hand-eye incoordination, the functional evaluation of upper limb prosthesis or orthosis, and the analysis of the effects of FES in central or peripheral nervous system disorders.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The CAM test: a novel tool to quantify the decline in vertical upper limb pointing movements with ageing.

Although upper limb movements in the vertical plane are very commonly used during the activities of daily life, there is still a lack of a reliable and easy standardized procedure to quantify them. In particular, ageing is associated with a decline in performances of coordinated movements, but a tool to quantify this decline is missing.SCOPUS: ar.jinfo:eu-repo/semantics/publishe