Parkinson disease
Upper limb
Introduction
❗ The problems of PD can change in the future.
→ New problems will be things not learned from young age.
Diminished arm-hand function affects:
Self-care: e.g. dressing,…
Daily-life activities: e.g. household activities
Recreational activities: e.g. sports.
Social and personal life.
→ Embarrassment: e.g. eating in company.
→ Use of modern technologies: e.g. smartphones, tablets ...
Professional activities: e.g. computer use.
Dexterity:
1. Writing.
❗ Most known difficulty.
→ Micrographia = smaller.
→ Disgraphia = drifting of the line, freezing, fluency ...
2. Fine-tuning of control of force (precision grip).
3. Ability to move the fingers selectively.
4. Finger coordination (synchronize and desynchronize).
5. Motor sequence performance - diminishing of movement.
Parkinson disease 1
, Assessment
MDS-UPDRS:
Hierin komen upper limb items voor:
Manual ability measure (MAM-16).
Asking which particular things you can do.
Questionnaire is not specific for PD, but these are:
→ Button shirt, open medication bottle, taking out of portefeuille & writing.
DEXTQ-24.
Specific for PD.
Most affected: shaving/make-up, buttoning, putting on socks, tying shoe
laces, writing, cutting and opening a jar.
Tests based on flipping or rotation of coins:
1. 10 euro neuro test: turning them as fast as possible.
Looking at duration and accuracy.
2. Coin rotation test: rotate between thumb, index and middle finger.
Counting half turns and coin drops.
Purdue pegboard test:
Test of manual dexterity and bimanual coordination.
→ Gross motor function of fingers, hands and arms.
→ Fine finger tip dexterity.
4 parts:
1. Preferred hands.
2. Non-preferred hand.
Parkinson disease 2
, 3. Both hands.
4. Assembly.
There are alternatives, but these are less specific.
Systematic screening of handwriting (SOS):
❗ recently validated for PD.
Copying a text during 5 minutes on a blank sheet of paper.
→ Write as neat and fast as possible.
Testing parameters:
❗ Also looking at forgotten words and crossed words or letters which
shows the cognition.
1. Writing speed.
→ Nr. of letters/5 minutes.
2. Mean writing size.
→ Straight blocks and where the most letters/words fit in is the mean
writing size.
3. Quality of the handwriting.
→ Fluency.
→ Connections between letters.
→ Regularity of letter size.
→ Space between words.
→ Straightness of sentence.
Scoring criteria:
Parkinson disease 3
Upper limb
Introduction
❗ The problems of PD can change in the future.
→ New problems will be things not learned from young age.
Diminished arm-hand function affects:
Self-care: e.g. dressing,…
Daily-life activities: e.g. household activities
Recreational activities: e.g. sports.
Social and personal life.
→ Embarrassment: e.g. eating in company.
→ Use of modern technologies: e.g. smartphones, tablets ...
Professional activities: e.g. computer use.
Dexterity:
1. Writing.
❗ Most known difficulty.
→ Micrographia = smaller.
→ Disgraphia = drifting of the line, freezing, fluency ...
2. Fine-tuning of control of force (precision grip).
3. Ability to move the fingers selectively.
4. Finger coordination (synchronize and desynchronize).
5. Motor sequence performance - diminishing of movement.
Parkinson disease 1
, Assessment
MDS-UPDRS:
Hierin komen upper limb items voor:
Manual ability measure (MAM-16).
Asking which particular things you can do.
Questionnaire is not specific for PD, but these are:
→ Button shirt, open medication bottle, taking out of portefeuille & writing.
DEXTQ-24.
Specific for PD.
Most affected: shaving/make-up, buttoning, putting on socks, tying shoe
laces, writing, cutting and opening a jar.
Tests based on flipping or rotation of coins:
1. 10 euro neuro test: turning them as fast as possible.
Looking at duration and accuracy.
2. Coin rotation test: rotate between thumb, index and middle finger.
Counting half turns and coin drops.
Purdue pegboard test:
Test of manual dexterity and bimanual coordination.
→ Gross motor function of fingers, hands and arms.
→ Fine finger tip dexterity.
4 parts:
1. Preferred hands.
2. Non-preferred hand.
Parkinson disease 2
, 3. Both hands.
4. Assembly.
There are alternatives, but these are less specific.
Systematic screening of handwriting (SOS):
❗ recently validated for PD.
Copying a text during 5 minutes on a blank sheet of paper.
→ Write as neat and fast as possible.
Testing parameters:
❗ Also looking at forgotten words and crossed words or letters which
shows the cognition.
1. Writing speed.
→ Nr. of letters/5 minutes.
2. Mean writing size.
→ Straight blocks and where the most letters/words fit in is the mean
writing size.
3. Quality of the handwriting.
→ Fluency.
→ Connections between letters.
→ Regularity of letter size.
→ Space between words.
→ Straightness of sentence.
Scoring criteria:
Parkinson disease 3
