Learning More from Finger Tapping in Parkinson's Disease: Up and Down from Dyskinesia to Bradykinesia

Abstract

Abstract:The finger tapping test evaluates bradykinesia, focusing on decrement in rate, amplitude, or both with repetitive action. Vertical positioning of the hands during this task may also be clinically relevant. We developed a "TAP score," measuring the vertical level above the lap where the patient performs the finger tapping ranging from 1 (task performed with the hand close to the lap) to 4 (above the head). In this pilot study, we retrospectively applied the TAP score in addition to usual motor scales during acute levodopa challenge in 123 PD patients (of whom 88 presented L-dopa-induced dyskinesia [LID]). TAP ON was higher than TAP OFF. Patients with LID presented higher TAP ON. TAP ON was related to LID severity, whereas TAP OFF was inversely related to the OFF motor symptoms. The TAP score may be a measure of proximal movement amplitude representing an easy method to evaluate defective or excessive motor output in patients with advanced disease.Bradykinesia is defined as the progressive reduction in speed, amplitude, or both of repetitive actions and is an important diagnostic feature of Parkinson's disease (PD). The aim of the present pilot study was to explore the clinical meaning of a specific aspect of performance of the finger tapping item of the UPDRS-III. 2 We have observed that patients with PD tend to perform the finger tapping in the off condition with their arm and hand lower and closer in approximation to their lap, whereas they raise their arm at least to head level in the on condition with dyskinesia. We sought to use this phenomenon in developing a simple and easily administrated scale to score off/on/on with dyskinesia state in patients with PD. To this aim, we developed a "TAP score" evaluating the vertical level where the patient performs the finger tapping. By retrospectively applying the TAP score to videos of PD patients undergoing a L-dopa challenge, we tested the following hypotheses: (1) TAP score during the on phases (TAP ON) is higher than the score during the off phases (TAP OFF); (2) TAP ON is positively correlated with the severity of LID in the whole body and specifically in the upper limbs; and (3) TAP OFF is negatively correlated with the severity of bradykinesia in the whole body and specifically in the upper limbs.

A Mathematical Model of Levodopa Medication Effect on Basal Ganglia in Parkinson's Disease: An Application to the Alternate Finger Tapping Task

“…Several rating scales are currently used to assess the clinical severity of PD, which include also behavioral tasks where the patient performs repetitive movements. Among the others, the finger tapping task (Picillo et al, 2016 ) is one of the simplest, being able to provide information about the severity of bradykinesia. In particular, frequency of alternate finger tapping on two separate keys has been shown to correlate strongly with part III of the Unified Parkinson's Disease rating scale (UPDRS III; Fahn and Elton, 1987 ), namely with the bradykinesia subscore (Homann et al, 2000 ; Taylor Tavares et al, 2005 ) and to have the highest sensitivity to discriminate PD patients from the general population (Pal et al, 2001 ).…”

Investigating the efficacy and importance of mobile-based assessments for Parkinson's disease: uncovering the potential of novel digital tests

“…The tapping frequency declining slope from start to end was calculated to indicate the change of frequency in finger movement. A decreasing tapping frequency may be an indicative sign of bradykinesia 26 .…”

Cortical Activation During Finger Tapping Task Performance in Parkinson's Disease Is Influenced by Priming Conditions: An ALE Meta-Analysis

“…PD patients usually have reduced movement, speed, and amplitude and have difficulties in autonomous movement (Sethi, 2008 ). The finger tapping task (FTT, also known as a tapping speed assessment) has been one of the most commonly paradigms that used to assess muscle control and motor ability since the nineteenth century (Golden et al, 2002 ; Picillo et al, 2016 ). The original FTT paradigm required participants to place their palms flat on a surface and continuously tap with their index finger in blocks of 10–30 s. The number of strokes by a participant was recorded.…”