Posts Tagged Nine Hole Peg Test

[ARTICLE] A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke – Full Text

Abstract

Background

Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinematics to clinical assessments of upper extremity function (convergent validity), and to establish the within-session reliability.

Methods

The NHPT was modified and standardized (S-NHPT) by 1) replacing the original peg container with an additional identical nine hole pegboard, 2) adding a specific order of which peg to pick, and 3) specifying to insert the peg taken from the original pegboard into the corresponding hole of the target pegboard. Eight optical cameras registered upper body kinematics of 30 persons post-stroke and 41 controls during the S-NHPT. Four sequential phases of the task were identified and analyzed for kinematic group differences. Clinical assessments were performed.

Results

The stroke group performed the S-NHPT slower (total movement time; mean diff 9.8 s, SE diff 1.4), less smoothly (number of movement units; mean diff 0.4, SE diff 0.1) and less efficiently (path ratio; mean diff 0.05, SE diff 0.02), and used increased scapular/trunk movements (acromion displacement; mean diff 15.7 mm, SE diff 3.5) than controls (P < 0.000, r ≥ 0.32), indicating discriminant validity. The stroke group also spent a significantly longer time grasping and releasing pegs relative to the transfer phases of the task compared to controls. Within the stroke group, kinematics correlated with time to complete the S-NHPT and the Fugl-Meyer Assessment (rs 0.38–0.70), suggesting convergent validity. Within-session reliability for the S-NHPT was generally high to very high for both groups (ICCs 0.71–0.94).

Conclusions

The S-NHPT shows adequate discriminant validity, convergent validity and within-session reliability. Standardization of the test facilitates kinematic analysis of movement performance, which in turn enables identification of differences in movement control between persons post-stroke and controls that may otherwise not be captured through the traditional time-based NHPT. Future research should ascertain further psychometric properties, e.g. sensitivity, of the S-NHPT.

Background

Impaired upper limb dexterity is evident as in many as 45–70% of the stroke victims one year post-stroke [12]. Such impairment is often evaluated in clinics by performance of the Nine Hole Peg Test (NHPT) [3], which is a frequently used dexterity task in many clinical populations [4567]. The NHPT equipment consists of a container with nine small pegs and a target pegboard with nine holes. Performance of the NHPT requires the pegs to be picked up from the container one-by-one unimanually and transferred and inserted into the holes of the pegboard until it is filled, upon which the pegs are returned unimanually to the container. The test is performed as quickly as possible and the only outcome variable is the total time to complete the task. Consequently, motor performance is currently not analyzed during the NHPT despite potentially providing valuable information relating to upper limb dexterity, especially among persons with a neurological dysfunction.

Among persons with stroke, the NHPT is considered reliable [8], valid [7910], and sensitive to change [71011]. Nevertheless, and despite overall good test-retest reliability post-stroke, low test-retest reliability has been found in persons post-stroke who have spasticity in the affected hand [8]. Further, the measurement errors are large; the minimal detectable change of the NHPT is estimated to 33 s for an individual post-stroke, and even doubled in the presence of spasticity [8]. The measurement properties of computer-assisted assessments of NHPT in virtual environments have been investigated with promising results [1213]. However, high intra-subject variation indicates that haptic and virtual reality technologies are more demanding for a stroke population and for instance require more practice trials prior to the actual test than when performing a conventional NHPT.

Advantages of the NHPT include the simple, cheap and easily portable equipment as well as the test being easy to administer and time-efficient [710]. There are, however, some drawbacks when testing persons post-stroke. First, the outcome score of the test is based solely on the time for task accomplishment [14]. Hence, a time reduction of the NHPT in rehabilitation of a person post-stroke may represent either a true motor recovery (i.e. performing movement patterns in a similar way as before the stroke) or compensation (performing different movement patterns than prior to the stroke) [15]. Compensatory strategies are common during upper limb tasks post-stroke, and thus plausible in a fine manipulative task like the NHPT. Secondly, the current NHPT test procedure may provide unreliable results for repeated measures or group comparisons as there is no standardized procedure with regard to the order in which the pegs are inserted into the target holes. To increase the stringency of the NHPT, we modified and standardized the test, which we henceforth refer to as the Standardized Nine Hole Peg test (S-NHPT). The experimental setup with two pegboards was in analogy with that of a study exploring three different methods of completing the NHPT, focusing on comparisons to tests in a virtual setting [12]. However, we have standardized the experimental setup even further by stipulating the order in which the pegs should be transferred.

Kinematic assessments may detect changes in movement performance that are not captured by only considering the time taken to complete the NHPT [14], and provide objective measures that may be more sensitive and not vulnerable to ceiling effects [16]. Recent research calls for parameters indicating quality of movements in persons post-stroke by means of kinematic analysis in order to better understand motor recovery [141517]. However, a test of fine upper limb fine dexterity like the NHPT has not been investigated. Our modifications and standardization enabled our first aim to kinematically characterize S-NHPT performance in a group of persons post-stroke and compare it to that of a non-disabled control group (discriminant validity). A second aim was to determine the convergent validity of the S-NHPT by comparing kinematics (movement time, peak speed, number of movement units, reach-grasp ratio, path ratio, acromion vertical displacement and trunk displacement) to the total movement time and to other clinical assessments (the Fugl-Meyer Assessment, the Stroke Impact Scale and grip strength). A third aim was to establish the within-session reliability of the S-NHPT, i.e., the consistency of the hand trajectories during the nine pick-up and transfer movements of the test.[…]

 

Continue —-> A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1Experimental setup and movement phases. a) Marker positions used for the calculations of the kinematic variables. Markers displayed with a dot in the center of the marker were positioned on the trunk. The enlarged pegboard shows the standardized order of which peg to pick and which hole to fill, referred to as the “vertical row strategy”. The S-NHPT consists of 9 pegs (3.8 cm long, 0.64 cm wide) and two pegboards (12.7 cm × 12.7 cm) with 9 holes (0.70 cm wide) spaced 3.2 cm apart. The two pegboards were attached to a wooden panel with a distance of 18 cm between the center holes of the pegboards. The arrow indicates the direction of the movement. b) The velocity of the index finger marker in the medial direction displays the events defining the transfer phases Peg Transfer (positive curve) and Hand Return (negative curve). The manipulative phases Peg Grip and Peg In Hole are between those transfer movements (see Methods)

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[ARTICLE] Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review – Full Text

Abstract

Background

Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.

Objective

In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.

Methods

Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.

Results

In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.

Conclusions

The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.

Continue —> PLOS ONE: Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

Fig 2. Frequency of use of different upper limb outcome measures (in % of studies). Frequency of use varies widely, between 36% and 1%. Only 15 measures were used in more than 5% of studies (dotted line). The 48 outcome measures are in alphabetic order: AMAT = Arm Motor Ability Test, ARAT = Action Research Arm Test, Ashworth = Ashworth scale, BBT = Box and Blocks Test, CAHAI = Chedoke Arm Hand Inventory, CMSA = Chedoke McMaster Stroke Assessment, COPM = Canadian Occupational Performance Measure, DAS = Disability Assessment Scale, DTI = Diffusion Tensor Imaging, EMG = Electromyography, FAT = Frenchay Arm Test, FC = Force Control, fMRI = Functional Magnetic Resonance Imaging, FMT = Fugl-Meyer Test, FTHUE = Functional Test for the Hemiplegic Upper Extremity, FTT = Finger Tapping Test, GOT = Grating Orientation Task, GRT = Grasp Release Test, HFS = Hand Function Survey, HFT = Hand Function Test, JTHT = Jebsen Taylor Hand Test, KIN = Kinematics, MAL = Motor Activity Log, MAM36 = Manual Ability Measurement 36, MAS = Motor Assessment Scale, MHS = Mini Hand Score, MI = Motricity Index, MMDT = Minnesota Manual Dexterity Test, NHPT = Nine Hole Peg Test, NSA = Nottingham Sensory Assessment, PT = Pegboard Test, RELHFT = Rehabilitation Engineering Laboratory Hand Function Test, RMA = Rivermead Motor Assessment, ROM = Range of Movement, SHFT = Shollerman Hand Function Test, SHPT = Sixteen Hole Peg Test, SIAS = Stroke Impairment Assessment Set, SMES = Sodring Motor Evaluation Scale, SSDI = Standardized Somatosensory Deficit Index, STEF = Simple Test for Hand Function, TDT = Tactile Discrimination Test, TMS = Transcranial Magnetic Stimulation, TS = Tardieu Scale, UEFT = Upper Extremity Function Test, ULIS = Upper Limb Impairment Scale, VAS = Visual Analogue Scale, VFHT = Von-Frey Hair Test, WMFT = Wolf Motor Function Test. http://dx.doi.org/10.1371/journal.pone.0154792.g002

 

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