Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke?

Marcos R M Rodrigues; Matthew Slimovitch; Gevorg Chilingaryan; Mindy F Levin

doi:10.1186/s12984-016-0213-y

Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke?

J Neuroeng Rehabil. 2017 Jan 23;14(1):6. doi: 10.1186/s12984-016-0213-y.

Authors

Marcos R M Rodrigues^{1

2}, Matthew Slimovitch³, Gevorg Chilingaryan^{1

2}, Mindy F Levin^{4

5}

Affiliations

¹ School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.
² Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada.
³ Faculty of Medicine, McGill University, Montreal, Canada.
⁴ School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. [email protected].
⁵ Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada. [email protected].

Abstract

Background: We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity.

Methods: Experimental, criterion standard study. Both clinical and experimental evaluations were done at a research facility in a rehabilitation hospital. Forty individuals (20 individuals with chronic stroke and 20 healthy, age- and gender-matched individuals) participated.. Both groups performed two blocks of 10 to-and-fro pointing movements (non-dominant/affected arm) between a sagittal target and the nose (ReachIn, ReachOut) at a self-paced speed. Time to perform the test was the main outcome. Kinematics (Optotrak, 100Hz) and clinical impairment/activity levels were evaluated. Spatiotemporal coordination was assessed with slope (IJC) and cross-correlation (LAG) between elbow and shoulder movements.

Results: Compared to controls, individuals with stroke (Fugl-Meyer Assessment, FMA-UE: 51.9 ± 13.2; Box & Blocks, BBT: 72.1 ± 26.9%) made more curved endpoint trajectories using less shoulder horizontal-abduction. For construct validity, shoulder range (β = 0.127), LAG (β = 0.855) and IJC (β = -0.191) explained 82% of FNT-time variance for ReachIn and LAG (β = 0.971) explained 94% for ReachOut in patients with stroke. In contrast, only LAG explained 62% (β = 0.790) and 79% (β = 0.889) of variance for ReachIn and ReachOut respectively in controls. For convergent validity, FNT-time correlated with FMA-UE (r = -0.67, p < 0.01), FMA-Arm (r = -0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and BBT (r = -0.56, p < 0.01). A cut-off time of 10.6 s discriminated between mild and moderate-to-severe impairment (discriminant validity). Each additional second represented 42% odds increase of greater impairment.

Conclusions: For this version of the FNT, the time to perform the test showed construct, convergent and discriminant validity to measure UL coordination in stroke.

Keywords: CVA (cerebrovascular accident); Motor skills disorders; Outcomes assessment; Upper extremity.

Publication types

Validation Study

MeSH terms

Adult
Aged
Biomechanical Phenomena
Chronic Disease
Female
Humans
Male
Middle Aged
Muscle Spasticity / diagnosis*
Muscle Spasticity / etiology
Neurologic Examination / methods*
Psychomotor Performance
Stroke / complications
Stroke / physiopathology*
Upper Extremity