Hand Dexterity Impairment in Patients with Cervical Myelopathy: A New Quantitative Assessment Using a Natural Prehension Movement

Behavioural Neurology, Jul 2018

Cervical myelopathy (CM) caused by spinal cord compression can lead to reduced hand dexterity. However, except for the 10 sec grip-and-release test, there is no objective assessment system for hand dexterity in patients with CM. Therefore, we evaluated the hand dexterity impairment of patients with CM objectively by asking them to perform a natural prehension movement. Twenty-three patients with CM and 30 age-matched controls were asked to reach for and grasp a small object with their right thumb and index finger and to subsequently lift and hold it. To examine the effects of tactile afferents from the fingers, objects with surface materials of differing textures (silk, suede, and sandpaper) were used. All patients also underwent the Japanese Orthopedic Association (JOA) test. Preoperative patients showed significantly greater grip aperture during reach-to-grasp movements and weaker grip force than controls only while attempting to lift the most slippery object (silk). Patients, immediately after surgery, () tended to show improvements in the JOA score and in reaction time and movement time with respect to reaching movements. Multiple regression analysis demonstrated that some parameters of the prehension task could successfully predict subjective evaluations of dexterous hand movements based on JOA scores. These results suggest that quantitative assessments using prehension movements could be useful to objectively evaluate hand dexterity impairment in patients with CM.

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Hand Dexterity Impairment in Patients with Cervical Myelopathy: A New Quantitative Assessment Using a Natural Prehension Movement

Hand Dexterity Impairment in Patients with Cervical Myelopathy: A New Quantitative Assessment Using a Natural Prehension Movement Masao Omori,1 Satoshi Shibuya,2 Tsuyoshi Nakajima,2 Takashi Endoh,3 Shinya Suzuki,4 Shun Irie,2 Ryohei Ariyasu,2 Satoshi Unenaka,5 Hideto Sano,1 Kazutaka Igarashi,1 Shoichi Ichimura,1 and Yukari Ohki2 1Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan 2Department of Integrative Physiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan 3Faculty of Human Development and Education, Uekusa Gakuen University, 1639-3 Ogura-cho, Wakaba-ku, Chiba 264-0007, Japan 4Department of Physical Therapy, School of Rehabilitation, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsucho, Ishikari-gun, Hokkaido 061-0293, Japan 5Department of Sports Education, School of Lifelong Sport, Hokusho University, 23 Bunkyodai, Ebetsu, Hokkaido 069-0833, Japan Correspondence should be addressed to Masao Omori; pj.oc.liamtoh@oasam_iromo Received 28 March 2018; Revised 24 May 2018; Accepted 29 May 2018; Published 4 July 2018 Academic Editor: Norbert Kovács Copyright © 2018 Masao Omori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Cervical myelopathy (CM) caused by spinal cord compression can lead to reduced hand dexterity. However, except for the 10 sec grip-and-release test, there is no objective assessment system for hand dexterity in patients with CM. Therefore, we evaluated the hand dexterity impairment of patients with CM objectively by asking them to perform a natural prehension movement. Twenty-three patients with CM and 30 age-matched controls were asked to reach for and grasp a small object with their right thumb and index finger and to subsequently lift and hold it. To examine the effects of tactile afferents from the fingers, objects with surface materials of differing textures (silk, suede, and sandpaper) were used. All patients also underwent the Japanese Orthopedic Association (JOA) test. Preoperative patients showed significantly greater grip aperture during reach-to-grasp movements and weaker grip force than controls only while attempting to lift the most slippery object (silk). Patients, immediately after surgery, () tended to show improvements in the JOA score and in reaction time and movement time with respect to reaching movements. Multiple regression analysis demonstrated that some parameters of the prehension task could successfully predict subjective evaluations of dexterous hand movements based on JOA scores. These results suggest that quantitative assessments using prehension movements could be useful to objectively evaluate hand dexterity impairment in patients with CM. 1. Introduction Cervical myelopathy (CM) is a condition caused by spinal cord compression associated with disc herniation, cervical spondylosis, and congenital stenosis [1]. CM generally causes sensory disturbances of the upper and lower extremities (e.g., numbness or pain), reduced hand dexterity, gait disturbance, and urinary dysfunction. In severe cases, surgical treatment is applied to relieve compression of the spinal cord (i.e., decompressive surgery). Hence, appropriate functional outcome measures are necessary to determine the disease severity, progression of the disorder, and effectiveness of surgical treatment. Several subjective scales have been developed to assess clinical deficits in CM patients: the European Myelopathy Score [2], Nurick Score [3], Cooper Myelopathy Score [4], and the Japanese Orthopedic Association (JOA) score [5]. The JOA score has been widely used in Japan, and high degrees of inter- and intraobserver reliability have been confirmed [6]. Upper and lower extremity impairments caused by CM have also been evaluated objectively using several scales. For example, with respect to the lower extremity, the 30 m walking test [7], 10 sec step test [8], and triangle step test [9] have been developed. As a scale for the upper extremity, the 10 sec grip-and-release test is frequently used in Japan to evaluate hand function in myelopathy patients [10]. Recently, our group also proposed functional assessment of the proximal arm muscle in CM patients using target-reaching movements [11]. However, movements in the 10 sec grip-and-release test are quite different from the daily actions performed with the upper extremity. In fact, patients with CM have difficulty in manipulating relatively small objects (e.g., buttons or tableware) with their fingers during activities of daily living (i.e., reduced hand dexterity), in which fine motor control of the fingers via various sensory feedback mechanisms is necessary. Therefore, we assume that a natural prehension movement could be useful as an objective mea (...truncated)


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Masao Omori, Satoshi Shibuya, Tsuyoshi Nakajima, Takashi Endoh, Shinya Suzuki, Shun Irie, Ryohei Ariyasu, Satoshi Unenaka, Hideto Sano, Kazutaka Igarashi, Shoichi Ichimura, Yukari Ohki. Hand Dexterity Impairment in Patients with Cervical Myelopathy: A New Quantitative Assessment Using a Natural Prehension Movement, Behavioural Neurology, 2018, 2018, DOI: 10.1155/2018/5138234