Parkinson’s disease (PD) is a progressive movement disorder that challenges the nervous system due to the selective degeneration of dopaminergic neurons. Its symptoms are tremor, hypertonia (much muscle tone), and bradykinesia (movement slowness) (Marsili et al., 2018; McDonald et al., 2019; Walusinski, 2018). Today, optimization of therapy for patients with PD is possible with tools that measure motor functions objectively. In this paper, the Fugl-Meyer Assessment scale, the Sødring Motor Evaluation, the Hoehn and Yahr Scale, the MDS-UPDRS, and other balance and posture, arm and hand, and gait and walking tests will be analyzed.
The Fugl-Meyer Assessment (FMA) is a common scale in stroke research. Its performance-based impairment index is effective in assessing movements and motor functions of upper and lower extremities in patients with stroke and PD (Lee et al., 2018; Opara et al., 2017). There are 155 items within five domains, namely motor functioning, sensory functioning, balance, joint range of motion, and joint pain (Simbaña et al., 2019). The choice of items depends on the area for evaluation for a patient. Scoring is determined by performance observation that usually takes 30 or more minutes (0 – not performed, 1 – partially performed, 2 – fully performed).
The Sødring Motor Evaluation is another way to evaluate motor function and PD patients’ activities. Its major characteristics include the assessment of motor activities with no assistance and motor performance quantity. It has three subscales to evaluate upper and lower limbs’ motor functions: the first two contain simple voluntary movements, and the last one is for functional tasks (Iruthayarajah et al., 2019). A 5-point scale is used to score 32 different items with inter-rate reliability.
The main idea of the Hoehn and Yahr (HY) scale is to measure the progress of symptoms and the level of disability in PD patients. There are five stages to PD progression, from 1 (when the signs are mild, with minimal or no functional impairment) to 5 (when confinement to a wheelchair or bed is observed) (Martinez-Martin et al., 2018; Modestino et al., 2018). The second stage is characterized by bilateral involvement without balance impairment, the third one has some postural instability, and the fourth includes severe disability.
The Movement Disorder Society Unified Parkinson’s Disease Rating Scale, also known as the MDS-UPDRS, is used to determine PD severity relying on patients’ or clinicians’ reports. Regnault et al. (2019) define it as the most widely used test as it is possible to gather enough information by answering 50 questions about PD-associated symptoms. The questions are divided into four parts to properly focus on non-motor and motor experiences, motor examination, and complications. This measurement allows gathering and analyzing factors with a more informed selection based on high reliability (Evers et al., 2019). It is possible to gather information in different settings like in hospitals or at home.
Balance assessment plays an important role in diagnosing and treating patients with PD, and the Berg Balance Scale (BBS) is another vital tool for clinicians to use. The BBS consists of 14 items that analyze everyday activities in adult populations with a score from 0 to 4 for each task (Krzysztoń et al., 2017). This clinical tool effectively assesses seniors’ balance abilities, but its ceiling effect contributes to its low predictive qualities (Jeon & Kim, 2017). To complete this test, a person should complete each task clearly within the required time limit and score the results.
The Timed Up and Go (TUG) test can be applied to evaluate PD older patients’ functional mobility. It helps measure the time that an individual should take to carry out certain functional maneuvers like sitting down, getting up, etc. (Da Silva et al., 2017). It is characterized by solid reliability and validity in quantifying functional mobility. Participants need to get up from a chair, walk three meters, turn around, return to the chair, and sit down (Mollinedo & Cancela, 2020). The average time to complete this task is about 15 seconds, and deviations define the severity of balance and posture problems.
The Purdue Pegboard Test (PPT) is recommended to gauge hand function in PD patients. A rectangular board consists of two sets with 25 vertically arranged holes and four concave cups above (Irie et al., 2020). A patient is given 30 seconds per hand to place a pin in a hole (Proud et al., 2020). The PPT score is calculated from the percentage of right- and left-handed pins with the assembled one.
The 9-Hole Peg Test (9HPT) usually goes in combination with the PPT for people with PD. This quantitative assessment aims at measuring finger dexterity, conducted with dominant and non-dominant hands (Feys et al., 2017). Participants should take a peg at a time and put it into an empty hole and then remove each peg and return it to the initial position (Johansson & Häger, 2019). The score of more than 30 seconds to complete the task proves PD.
The Jebsen and Taylor Hand Function Test evaluates the level of upper limb function within a certain period. It consists of several subsets: writing, turning, picking up small and large light objects, feeding, and stacking (Artilheiroa et al., 2018). Patients need about 15-45 minutes to complete this test, and the score is the time for all tasks done by each hand (Araneda et al., 2019). Shorter time indicates better performance, and clinicians make beforehand preparations to provide patients with the necessary material and safe settings.
Hand assessment plays an important role in understanding the severity of PD in patients. The Frenchay Arm Test (FAT) is a measure that clinicians use to check upper extremity proximal motor control (Germanotta et al., 2020). The procedure does not require complex steps: a person sits at a table with a hand on the lap, draws a line with a ruler and a pencil, works with a cylinder, drinks water from a half-full glass, and removes pegs. Each item is scored with 1 (pass) or 0 (fail), with a total score of 5 (Parry et al., 2019). About three minutes are given for the patient to take the FAT.
The Action Research Arm Test is a clinical tool to assess upper extremity function in patients after stroke and with PD. It contains 19 items that physical therapists use to check patients’ coordination, dexterity, and functioning by observing performance and transforming the results into treatment goals (Behrendt & Schuster-Amft, 2018). A 4-point scale (from no movement to normal movement) is developed to evaluate the tasks participants have to perform with a special truck within about 10 minutes (Dandekar, & Ganvir, 2019). Although direct cooperation between an examiner and a participant is not required, observations are necessary for this test.
The Wolf Motor Function Test is one more test that can be prescribed for older adults to assess their dexterity, strengths, and extremity function. There are 17 items divided into three parts with several function-based and strength-based tasks (Kim et al., 2017; “Wolf motor function test,” 2016). A 6-point ordinal scale with a maximum score of 75 is applied to see what a patient can do with the offered material.
The Finger-Tapping Test helps measure bradykinesia in patients with PD. This method is commonly used because no additional equipment and resources are necessary, except the patient and the instructor. A person is requested to tap the index finger and the thumb as quickly as possible (“Approach to the exam for Parkinson’s disease,” n.d.; Roalf et al., 2018). Alterations in finger taping say about the signs of PD and motor dysfunction that challenge the quality of life.
Three-dimensional analysis of movement is one of the current achievements in diagnosing and treating PD. Martinez et al. (2018) explain this tool with markerless systems as an alternative to traditional sensor-based systems for human movement kinematics and gait. Despite its high cost and special technical knowledge, the advantages like non-invasiveness, accuracy, and variety of areas for assessment attract attention (Buckley et al., 2019). This method allows identifying the correlation between gait and stride length in different states.
Finally, the 10-m walk test is created for people with PD to assess their gait speed and the quality of walking. The main idea of this test is to measure the person’s gait speed at a single pace over a short distance with several minutes to complete (Duncan et al., 2017). Speed lower than 1.1 m/s says about the possibility of falls in PD patients because recommended speed for older adults is between 1.30 and 0.94 m/s (Lindholm et al., 2018). This tool is necessary for clinicians to observe patients and their understanding of safety measures in PD treatment.
In general, every tool in this research paper has a specific impact on measuring motor functions in PD patients. Depending on the area of evaluation, either upper or lower extremities, balance, posture, gait, or walking, medical employees should apply the required method. If hospitals do not have enough equipment or material to complete the test effectively, it is important to make the choice that meets their resources and corresponds to the patient’s condition.
References
Approach to the exam for Parkinson’s disease. (n.d.). Stanford Medicine 25. Web.
Araneda, R., Ebner-Karestinos, D., Paradis, J., Saussez, G., Friel, K. M., Gordon, A. M., & Bleyenheuft, Y. (2019). Reliability and responsiveness of the Jebsen-Taylor Test of Hand Function and the Box and Block Test for children with cerebral palsy. Developmental Medicine & Child Neurology, 61(10), 1182-1188.
Artilheiro, M. C., Fávero, F. M., Caromano, F. A., Oliveira, A. de S. B., Carvas, N., Voos, M. C., & de Sá, C. D. S. C. (2018). Reliability, validity and description of timed performance of the Jebsen–Taylor Test in patients with muscular dystrophies. Brazilian Journal of Physical Therapy, 22(3), 190–197.
Behrendt, F., & Schuster-Amft, C. (2018). Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: A usability and feasibility study protocol.BMJ Open, 8(7). Web.
Buckley, C., Alcock, L., McArdle, R., Rehman, R. Z. U., Del Din, S., Mazzà, C., Yarnall, A. J., & Rochester, L. (2019). The role of movement analysis in diagnosing and monitoring neurodegenerative conditions: Insights from gait and postural control.Brain Sciences, 9(2). Web.
Da Silva, B., Faria, C., Santos, M., & Swarowsky, A. (2017). Assessing timed up and go in Parkinson’s disease: Reliability and validity of timed up and go assessment of biomechanical strategies.Journal of Rehabilitation Medicine, 49(9), 723–731. Web.
Dandekar, S. P., & Ganvir, S. (2019). Action research arm test as a tool for assessment of motor recovery in patients with stroke: A critical review.International Journal of Research in Medical Sciences, 7(8), 3224-3229. Web.
Duncan, R. P., Combs-Miller, S. A., McNeely, M. E., Leddy, A. L., Cavanaugh, J. T., Dibble, L. E., Ellis, T. D., Ford, M. P., Foreman, K. B., & Earhart, G. M. (2017). Are the average gait speeds during the 10 meter and 6 minute walk tests redundant in Parkinson disease?Gait & Posture, 52, 178-182. Web.
Evers, L. J. W., Krijthe, J. H., Meinders, M. J., Bloem, B. R., & Heskes, T. M. (2019). Measuring Parkinson’s disease over time: The real‐world within‐subject reliability of the MDS‐UPDRS. Movement Disorders, 34(10), 1480-1487.
Feys, P., Lamers, I., Francis, G., Benedict, R., Phillips, G., LaRocca, N., Hudson, L. D., Rudick, R., & Multiple Sclerosis Outcome Assessments Consortium. (2017). The nine-hole peg test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis Journal, 23(5), 711-720.
Germanotta, M., Gower, V., Papadopoulou, D., Cruciani, A., Pecchioli, C., Mosca, R., Speranza, G., Falsini, C., Cecchi, F., Vannetti, F., Montesano, A., Galeri, S., Gramatica, F., & Aprile, I. (2020). Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke. Journal of Neuroengineering and rRehabilitation, 17(1).
Irie, K., Iseki, H., Okamoto, K., Nishimura, S., & Kagechika, K. (2020). Introduction of the purdue pegboard test for fine assessment of severity of cervical myelopathy before and after surgery. Journal of Physical Therapy Science, 32(3), 210–214.
Iruthayarajah, J., Mirkowski, M., Foley,N., Iliescu, A., Caughlin, S., Fragis, N., Alam, R., Harris, J., Dukelow, S., Chae, J., Knutson, J., Miller, T., & Teasell, R. (2019). Chapter 10: Upper extremity motor rehabilitation interventions. Heart & Stroke Foundation: Canadian Partnership for Stroke Recovery. Web.
Jeon, Y.-J., & Kim, G.-M. (2017). Comparison of the berg balance scale and fullerton advanced balance scale to predict falls in community-dwelling adults. Journal of Physical Therapy Science, 29(2), 232–234.
Johansson, G. M., & Häger, C. K. (2019). A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke. Journal of Neuroengineering and Rehabilitation, 16.
Kim, A., Lee, H. S., & Song, C. S. (2017). Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: A case study. Journal of Physical Therapy Science, 29(1), 168-171.
Krzysztoń, K., Stolarski, J., & Kochanowski, J. (2018). Evaluation of balance disorders in Parkinson’s disease using simple diagnostic tests – Not so simple to choose.Frontiers in Neurology, 9. Web.
Lee, S., Lee, Y.-S., & Kim, J. (2018). Automated evaluation of upper-limb motor function impairment using Fugl-Meyer assessment.IEEE Transactions on Neural Systems and Rehabilitation Engineering, 26(1), 125–134. Web.
Lindholm, B., Nilsson, M. H., Hansson, O., & Hagell, P. (2018). The clinical significance of 10-m walk test standardizations in Parkinson’s disease. Journal of Neurology, 265(8), 1829-1835.
Marsili, L., Rizzo, G., & Colosimo, C. (2018). Diagnostic criteria for Parkinson’s disease: From James Parkinson to the concept of prodromal disease. Frontiers in Neurology, 9.
Martinez, H. R., Garcia-Sarreon, A., Camara-Lemarroy, C., Salazar, F., & Guerrero-González, M. L. (2018). Accuracy of markerless 3D motion capture evaluation to differentiate between on/off status in Parkinson’s disease after deep brain stimulation.Parkinson’s Disease, 2018. Web.
Martinez-Martin, P., Skorvanek, M., Rojo-Abuin, J. M., Gregova, Z., Stebbins, G. T., & Goetz, C. G. (2018). Validation study of the hoehn and yahr scale included in the MDS-UPDRS. Movement Disorders, 33(4), 651–652.
McDonald, C., Gordon, G., Hand, A., Walker, R. W., & Fisher, J. M. (2018). 200 Years of Parkinson’s disease: What have we learnt from James Parkinson? Age and Ageing, 47(2), 209-214.
Modestino, E. J., Reinhofer, A., Blum, K., Amenechi, C., & O’Toole, P. (2018). Hoehn and Yahr staging of Parkinson’s disease in relation to neuropsychological measures.Front Biosci (Landmark Ed), 23, 1370-1379. Web.
Mollinedo, I., & Cancela, J. M. (2020). Evaluation of the psychometric properties and clinical applications of the timed up and go test in Parkinson disease: A systematic review.Journal of Exercise Rehabilitation, 16(4), 302-312. Web.
Opara, J. A., Małecki, A., Małecka, E., & Socha, T. (2017). Motor assessment in Parkinsons disease.Annals of Agricultural and Environmental Medicine, 24(3), 411-415. Web.
Parry, R., Macias Soria, S., Pradat-Diehl, P., Marchand-Pauvert, V., Jarrassé, N., & Roby-Brami, A. (2019). Effects of hand configuration on the grasping, holding, and placement of an instrumented object in patients with hemiparesis. Frontiers in Neurology, 10.
Proud, E. L., Miller, K. J., Bilney, B., Morris, M. E., & McGinley, J. L. (2019). Construct validity of the 9-hole peg test and Purdue pegboard test in people with mild to moderately severe Parkinson’s disease. Physiotherapy, 2020, 202-208.
Regnault, A., Boroojerdi, B., Meunier, J., Bani, M., Morel, T., & Cano, S. (2019). Does the MDS-UPDRS provide the precision to assess progression in early Parkinson’s disease? Learnings from the Parkinson’s progression marker initiative cohort.Journal of Neurology, 266(8), 1927-1936. Web.
Roalf, D. R., Rupert, P., Mechanic-Hamilton, D., Brennan, L., Duda, J. E., Weintraub, D., Trojanowksi, J. Q., Wolk, D., & Moberg, P. J. (2018). Quantitative assessment of finger tapping characteristics in mild cognitive impairment, Alzheimer’s disease, and Parkinson’s disease.Journal of Neurology, 265(6), 1365-1375. Web.
Simbaña, E. D. O., Baeza, P. S. H., Huete, A. J., & Balaguer, C. (2019). Review of automated systems for upper limbs functional assessment in neurorehabilitation. IEEE Access, 7, 32352-32367.
Walusinski, O. (2018). Jean-Martin Charcot and Parkinson’s disease: Teaching and teaching materials. Revue Neurologique, 174(7-8), 491-505.
Wolf motor function test. (2016). Shirley Ryan AbilityLab. Web.