Purdue Pegboard: test-retest estimates

Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants' ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21-40 years), middle-aged (41-60 years), and older (61-88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.

Arthroscopy-Assisted Surgery for Trapeziometacarpal Osteoarthritis

Background: Functional outcomes of patients who underwent arthroscopy-assisted surgery for trapeziometacarpal osteoarthritis were reported. Methods: We included 24 consecutive patients (6 males and 18 females) who underwent surgery and postoperative hand therapy at our hospital between April 2012 and March 2018. For functional evaluation, we used the Purdue Pegboard Test (PPT), grip and pinch strength, range of motion of the thumb, visual analogue scale (VAS) for thumb pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Japanese version of the Patient-Rated Wrist Evaluation (PRWE-J) preoperatively and 3 months postoperatively. Results: The mean PPT rating improved from 12.3 to 13.3, the VAS score from 51 to 16, the QuickDASH score from 48 to 30 and the PRWE-J score from 55 to 29. All the improvements were statistically significant. There was a moderate positive correlation between the magnitude of improvement in PPT and QuickDASH scores. Conclusions: Arthroscopic intervention and associated hand therapy were effective in achieving early postoperative relief of thumb pain and in improving hand dexterity and activities of daily living. Level of Evidence: Level IV (Therapeutic).

The standardised Malay version of purdue pegboard test: Content validity and test-retest reliability testing

Introduction

Purdue Pegboard Test (PPT) is a valid and reliable instrument for measuring hand dexterity among individuals with or without medical conditions. In the Southeast Asia region where Malay is widely spoken, there is a need to have a Malay translation of Purdue Pegboard Test. This study aimed to translate the PPT into the Malay version (PPT-M) and to determine the content validity and test-retest reliability of this translated version.

Methods

This study involved: (1) four English teachers (translators) for forward and backward translation procedures; (2) 10 experts in the field of occupational therapy (expert reviewers) for content validity testing; and (3) 60 undergraduate students (participants) for test-retest reliability testing.

Results

PPT-M had excellent content validity with Item-Content Validity Index = 0.9-1.0, Scale-Content Validity Index/Average = 0.93-0.95, and a slightly lower Scale-Content Validity Index/Universal Agreement = 0.25-0.75. Test-retest reliability for 3-trial administration (n = 30; Intraclass Correlation Coefficients, ICCs = 0.76-0.85; good) was higher compared to 1-trial administration (n = 30; ICCs = 0.34-0.46; poor) for all subtests. Both trial administrations were mostly affected by systematic errors, especially practice effect as the retests gave higher scores. Random errors mostly affected Subtest 3 of 1-trial administration, evident by its Minimal Detectable Change Percent values = 30.84% that fell beyond the acceptable range.

Conclusion

PPT-M has the potential to be a valuable instrument for measuring hand dexterity among Malay speaking individuals especially when the 3-trial administration is used.

Determining a multimodal aging clock in a cohort of Chinese women

BACKGROUND

Translating aging rejuvenation strategies into clinical practice has the potential to address the unmet needs of the global aging population. However, to successfully do so requires precise quantification of aging and its reversal in a way that encompasses the complexity and variation of aging.

METHODS

Here, in a cohort of 113 healthy women, tiled in age from young to old, we identified a repertoire of known and previously unknown markers associated with age based on multimodal measurements, including transcripts, proteins, metabolites, microbes, and clinical laboratory values, based on which an integrative aging clock and a suite of customized aging clocks were developed.

FINDINGS

A unified analysis of aging-associated traits defined four aging modalities with distinct biological functions (chronic inflammation, lipid metabolism, hormone regulation, and tissue fitness), and depicted waves of changes in distinct biological pathways peak around the third and fifth decades of life. We also demonstrated that the developed aging clocks could measure biological age and assess partial aging deceleration by hormone replacement therapy, a prevalent treatment designed to correct hormonal imbalances.

CONCLUSIONS

We established aging metrics that capture systemic physiological dysregulation, a valuable framework for monitoring the aging process and informing clinical development of aging rejuvenation strategies.

FUNDING

This work was supported by the National Natural Science Foundation of China (32121001), the National Key Research and Development Program of China (2022YFA1103700 and 2020YFA0804000), the National Natural Science Foundation of China (81502304), and the Quzhou Technology Projects (2022K46).

Early- and late-onset of isolated rapid eye movement sleep behavior disorder: A retrospective cohort study

OBJECTIVE

Age at onset of neurodegenerative disease has significant implications in differentiating disease profiles. We aimed to determine whether age at onset could identify clinical and neurodegenerative profiles in patients with isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) - a prodromal stage of α-synucleinopathies.

METHODS

In this retrospective cohort study, the time of the first episode of dream-enactment behaviors that the patient/bed-partners recalled at the time of the patient's first visit to sleep clinic was collected. The distribution of age at onset was examined and patients were dichotomized into early- and late-onset groups based on the intersection point of underlying two Gaussian distributions of onset age.

RESULTS

A total of 241 patients were included. The intersection of underlying two Gaussian models of onset age was 64.6 years, yielding 168 early- (median onset age: 58.0 years, range: 38.0-64.0) and 73 late-onset patients (median onset age: 70.0 years, range: 65.0-82.0). Among them, 154 of early- and 68 late-onset patients were followed-up. Late-onset patients had milder RBD symptoms, but worse sleep, cognition, olfactory and motor functions, and a higher risk of phenoconversion (adjusted hazard ratio (aHR) = 2.2, 95% confidence interval (CI) = 1.2-3.9), especially to probable dementia with Lewy bodies (DLB) (aHR = 8.9, 95% CI = 3.0-26.2), than early-onset patients.

CONCLUSIONS

Late-onset iRBD was associated with a higher level of neurodegenerative markers and a quicker phenoconversion, especially to probable DLB. Age at onset of iRBD could help identify clinical features and predict prognosis of iRBD.

Alterations in dexterity and manual function in patients with focal hand dystonia

INTRODUCTION

Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia.

MATERIALS AND METHODS

We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF).

RESULTS

The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%).

CONCLUSIONS

Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Assessment of the modified O'Connor Tweezer Dexterity and Purdue Pegboard test for use among dental students

OBJECTIVES

The current study aimed to assess criteria validity and test-retest reliability of the modified O'Connor Tweezer Dexterity (O'Connor) and the Purdue Pegboard test (PPT) for use among dental students. Occupational therapists were asked to assess dentist-related skills due to the high percentage of students who failed the dental school exams that year. The O'Connor and the PPT are suitable for these purposes, they aim to evaluate fine motor skills requirements. The original tests were modified for use under indirect visualization conditions (through a mirror) to mimic the typical dentists' work environment.

MATERIALS AND METHODS

A total of 110 dentists were included in the present study (50 dentists for the O'Connor test and 60 for the PPT). Both tests were conducted twice. Initially, the original version of the tests was followed by the modified versions (through a mirror). For the test-retest reliability assessment, 21 participants (10 participants from the O'Connor group and 11 participants from the PPT group) repeated the evaluation within a 1-week interval using the same settings (original followed by modified versions).

RESULTS

Both versions of the O'Connor tests were significantly correlated (r = 0.54, p < 0.01), as were the two PPT versions (r = 0.640, p < 0.01). Significantly test-retest reliability was found for both tests. The interclass correlation ranged between 0.883 and 0.997, p < 0.000.

CONCLUSION

The results confirmed our hypothesis, demonstrating a criteria validity and test-retest reliability assessment of the modified O'Connor and the modified PPT for assessing dentists.

Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review

Although there are many assessment tools for upper extremity (UE) function, it is still difficult to select an appropriate outcome measurement for the rehabilitation process of individuals with stroke. This review aims to classify each tool within the International Classification of Functioning, Disability and Health (ICF) framework and provide an overview of UE assessments. Through a comprehensive understanding of assessments based on ICF, health care professionals will be able to choose suitable measurement tools for individuals, facilitating their rehabilitation.

The impact of cerebral anomalies on cognitive outcome in patients with spina bifida: A systematic review

BACKGROUND

Spina bifida is the most common congenital birth defect affecting the central nervous system. Given the frequent association of cerebral anomalies, spina bifida is not a single developmental abnormality of the central nervous system. Patients with spina bifida typically perform below average on cognitive tasks. It has been hypothesized that associated cerebral anomalies as well negatively affect cognition in spina bifida patients.

OBJECTIVE

This study aims to review the impact of cerebral anomalies on cognitive outcome in patients with spina bifida.

METHODS

A systematic search of multiple databases, including Pubmed, Embase, Web of Science and The Cochrane Central Register of Controlled Trials, was performed. All relevant primary research articles were included. All included articles were methodologically evaluated using a critical appraisal checklist.

RESULTS

In total 27 articles were included in this systematic review. A significant impact of different cerebral anomalies on cognition was found. More specifically, hydrocephalus, Chiari malformation type II and anomalies of the corpus callosum, central executive network, default mode network, cortical thickness and gyrification, fornix, grey matter volume and total brain volume were found to have a significant impact on cognitive outcome. The presence of a CSF shunt was also negatively associated with cognition. The results on Chiari malformation type II decompression and CSF shunt complications are inconsistent.

CONCLUSION

Associated cerebral anomalies have a significant impact on cognitive outcome in patients with spina bifida. The interrelatedness of the different cerebral anomalies makes it difficult to distinguish their individual impact on cognition.

Alterations in dexterity and manual function in patients with focal hand dystonia

INTRODUCTION

Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia.

MATERIALS AND METHODS

We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF).

RESULTS

The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%).

CONCLUSIONS

Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Measuring Hand Dexterity in People With Parkinson's Disease: Reliability of Pegboard Tests

IMPORTANCE

Knowledge regarding the reliability of pegboard tests when used to measure dexterity in people with Parkinson's disease (PD) is currently limited.

OBJECTIVE

To examine the test-retest and interrater reliability of the 9-Hole Peg Test (9HPT) and Purdue Pegboard Test (PPT) in people with PD.

DESIGN

Cross-sectional observational study. For test-retest reliability, tests were completed on 2 days, 1 wk apart, in the "on" phase and "end-of-dose" period of participants' medication cycle. For interrater reliability, occupational therapists and physical therapists rated prerecorded pegboard test performance of participants with PD.

SETTING

Test-retest reliability was determined in participants' homes or in a university department. Interrater reliability was determined in a university department or a hospital setting.

PARTICIPANTS

Test-retest reliability was determined with volunteers diagnosed with PD (N = 30). Interrater reliability was determined with a convenience sample of occupational and physical therapists (N = 11).

OUTCOMES AND MEASURES

The 9HPT and PPT are commonly used measures of manual dexterity.

RESULTS

PPT subtests showed higher test-retest reliability (intraclass correlation coefficients [ICCs] ≥ .90) in both phases of the medication cycle compared with the 9HPT (ICCs = .70-.81). Minimal detectable change scores indicated acceptable measurement error for both tools. Interrater reliability for recorded performance of each measure was very good (ICCs > .99), with no calculable measurement error.

CONCLUSIONS AND RELEVANCE

Although both tools showed adequate test-retest and interrater reliability, results suggest that the PPT may be a more reliable measure of dexterity loss in people with PD.

WHAT THIS ARTICLE ADDS

This study informs the clinical measurement of the loss of manual dexterity in people with PD, a frequent problem reported by people living with this disorder.

The effect of walnut rolling training on hand function and corticospinal tract

Background

We investigated the effect of the walnut rolling training for two weeks on the hand function and corticospinal tract (CST) in normal subjects.

Methods

Seventeen right-handed normal subjects performed walnut rolling training with their non-dominant (left) hand, with the right hand defined as the control side. The walnut rolling training was performed three times daily, for 30 minutes at a time, over two weeks. The Purdue Pegboard Test (PPT), tip pinch and grip strength (GS) were used evaluate the change of hand function, and diffusion tensor tractography (DTT) evaluated change of the CST and transcallosal fibers for the hand motor somatotopy.

Results

All of the clinical scores in terms of PPT, tip pinch and GS increased significantly in the post-training (PPT: 16.59±1.09, tip pinch: 5.03±2.18, GS: 40.61±10.99) in the left hand compared with pre-training (PPT: 14.94±1.36, tip pinch: 3.66±1.44, GS: 33.58±11.08) (P<0.05). By contrast, the clinical scores for the right hand did not differ significantly between pre- (PPT: 16.25±1.98, tip pinch: 5.75±2.26, GS: 37.58±14.61) and post-training (PPT: 16.97±1.67, tip pinch: 5.66±2.31, GS: 37.82±14.25). The fiber numbers (FN) of the right CST increased significantly in post-training DTT (2,123.05±529.07) compared with pre-training DTT (1,734.73±581.84) (P<0.05), whereas fractional anisotropy (FA) (pre-training: 0.50±0.02, post-training: 0.51±0.01) did not change significantly. Neither FA nor FN of the left CST and transcallosal fibers changed significantly from pre- (FA: 0.44±0.02, FN: 1,871.15±636.36) to post-training DTTs (FA: 0.45±0.03, FN: 1,823.84±701.14).

Conclusions

We demonstrated improvement of hand function and facilitation of the contralateral CST by walnut rolling training in normal subjects. Our results suggest that walnut rolling training can be used for improvement of hand function and facilitation of the contralateral CST.

Effect of Neuromuscular Electrical Stimulation Training on the Finger Extensor Muscles for the Contralateral Corticospinal Tract in Normal Subjects: A Diffusion Tensor Tractography Study

Objectives: Neuromuscular electrical stimulation (NMES) is a popular rehabilitative modality to improve motor function of the extremities and trunk. In this study, we investigated changes of hand function and the contralateral corticospinal tract (CST) with treatment by NMES on the finger extensor muscles for 2 weeks, using serial diffusion tensor tractography (DTT).

Methods: Thirteen right handed normal subjects were recruited. Treatment was applied to the left hand (the NMES side), and the right hand was the control side. NMES was applied for 30 min/day, 7 days per week, for 2 weeks. Hand motor function was evaluated twice at pre-NMES and post-NMES training using grip strength (GS), Purdue pegboard test (PPT) and tip pinch. The fractional anisotropy (FA), mean diffusivity (MD) and tract volume (TV) of the CST in both hemispheres were measured using DTT.

Results: On the control side, the clinical scores did not differ significantly between pre- and post-NMES training (p > 0.05). However, on the NMES side, PPT and tip pinch improved significantly (p < 0.05), although GS did not. TV of the right CST increased significantly at post-NMES training (p < 0.05) whereas FA and MD did not differ significantly (p > 0.05). By contrast, FA, MD and TV on the left CST did not change significantly (p > 0.05).

Conclusion: We demonstrated facilitation of the contralateral CST with improvement of fine motor activity by 2 weeks of NMES training of peripheral muscles in normal subjects. We think our results can be applied to the normal subjects and patients with brain injury to improve the fine motor function of the hand and facilitate the normal CST or healing of the injured CST.

Phenotypic Characterization of Paclitaxel-Induced Peripheral Neuropathy in Cancer Survivors

CONTEXT

Although paclitaxel is one of the most commonly used drugs to treat breast, ovarian, and lung cancers, little is known about the impact of paclitaxel-induced peripheral neuropathy (PIPN) on cancer survivors.

OBJECTIVES

The purposes of this study were to evaluate for differences in demographic and clinical characteristics as well as measures of sensation, balance, upper extremity function, perceived stress, symptom burden, and quality of life (QOL) between survivors who received paclitaxel and did (n = 153) and did not (n = 58) develop PIPN.

METHODS

Pain characteristics associated with PIPN are described in detail. Both subjective and objective measures were used to evaluate the impact of PIPN.

RESULTS

Survivors with PIPN were significantly older, had a higher body mass index, and a worse comorbidity profile. The duration of PIPN was almost four years, and pain scores were in the moderate range. Compared with survivors without PIPN, survivors with PIPN had a higher number of upper and lower extremity sites that had lost light touch, cold, and pain sensations. Survivors with PIPN had worse upper extremity function, more problems with balance, a higher symptom burden, and higher levels of perceived stress. In addition, survivors with PIPN had worse QOL scores particularly in the domain of physical functioning.

CONCLUSION

The findings from this large descriptive study are the first to document the impact of PIPN on survivors' symptom burden, functional status, and QOL.

Association of Neuronal Injury in the Genu and Body of Corpus Callosum After Cranial Irradiation in Children With Impaired Cognitive Control: A Prospective Study

PURPOSE

Brain radiation is associated with functional deficits in children. The purpose of this study was to examine white matter integrity as measured by diffusion tensor imaging and associations with region-specific radiation dose and neuropsychological functioning in children treated with cranial irradiation.

METHODS AND MATERIALS

A total of 20 patients and 55 age- and sex-matched controls were included in the present study. Diffusion tensor imaging and neuropsychological assessments were conducted at baseline and 6, 15, and 27 months after treatment. The neuropsychological assessment included motor dexterity, working memory, and processing speed. White matter regions were contoured, and the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were recorded for each participant. Linear mixed effects regression models were used to prospectively compare the associations among ADC, FA, radiation dose to contoured structures, and performance on the neuropsychological assessments over time.

RESULTS

The mean prescription dose was 44 Gy (range 12-54). Across visits, compared with the controls, the patients showed a significantly increased ADC across all selected regions and alterations in FA in the dorsal midbrain and corpus callosum (genu, splenium, body). An increased radiation dose to the genu and body of the corpus callosum was associated with alterations in ADC and FA and reduced neuropsychological performance, most notably motor speed and processing.

CONCLUSIONS

These prospective data suggest that subcortical white matter, especially the genu and body of the corpus callosum, could be regions with increased susceptibility to radiation-induced injury, with implications for cognitive function.

Effect of Subthalamic Deep Brain Stimulation on Upper Limb Dexterity in Patients with Parkinson Disease

OBJECTIVE

The efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on dexterity remains controversial despite its recognition as an effective strategy for Parkinson disease. The present study investigated the efficacy of STN-DBS for ameliorating bradykinesia and dexterity compared with dopaminergic medications.

METHODS

Part III of the Unified Parkinson's Disease Rating Scale was used for the evaluation of bradykinesia, whereas the Purdue Pegboard Test and the Box and Block test were selected for dexterity.

RESULTS

Our findings indicate that bradykinesia is significantly improved with both DBS and dopaminergic medication, whereas dexterity is improved only with DBS. Dopaminergic medication did not show a satisfactory efficacy on dexterity, and there was little synergistic effect of dopaminergic medication and STN-DBS for improving dexterity associated with Parkinson disease.

CONCLUSIONS

Our results suggest that DBS is potentially more effective than dopaminergic medications for improving dexterity. The disparities in efficacy for bradykinesia and dexterity between DBS and dopaminergic medication hint at the potential mechanisms of STN-DBS. We speculate that DBS follows at least 2 different mechanisms for improving parkinsonian symptoms: 1) the dopaminergic system, primarily for the improvement of bradykinesia and 2) the nondopaminergic system, for the improvement of dexterity. This hypothesis requires further verification and investigation.

Chemotherapy-Induced Neuropathy in Cancer Survivors

CONTEXT

Evidence suggests that chemotherapy-induced neuropathy (CIN) is a significant problem for cancer survivors. However, a detailed phenotypic characterization of CIN in cancer survivors is not available.

OBJECTIVES

To evaluate between-group differences in demographic and clinical characteristics, as well as in measures of sensation, function, and postural control, in a sample of cancer survivors who received a platinum and/or a taxane-based CTX regimen and did (n = 426) and did not (n = 197) develop CIN.

METHODS

Survivors completed self-report questionnaires and underwent objective testing (i.e., light touch, pain sensation, cold sensation, vibration, muscle strength, grip strength, Purdue Pegboard test, Timed Get Up and Go test, Fullerton Advanced Balance test). Parametric and nonparametric statistics were used to compare between-group differences in study outcomes.

RESULTS

Of the 426 survivors with CIN, 4.9% had CIN only in their upper extremities, 27.0% only in their lower extremities, and 68.1% in both their upper and lower extremities. Demographic and clinical characteristics associated with CIN included the following: older age, lower annual income, higher body mass index, a higher level of comorbidity, being born prematurely, receipt of a higher cumulative dose of chemotherapy, and a poorer functional status. Survivors with CIN had worse outcomes for all of the following objective measures: light touch, pain, temperature, vibration, upper and lower extremity function, and balance.

CONCLUSIONS

This study is the first to provide a detailed phenotypic characterization of CIN in cancer survivors who received a platinum and/or a taxane compound. These data can serve as a benchmark for future studies of CIN in cancer survivors.

Cognitive Processing Speed across the Lifespan: Beyond the Influence of Motor Speed

Traditional neuropsychological measurement of cognitive processing speed with tasks such as the Symbol Search and Coding subsets of the WAIS-IV, consistently show decline with advancing age. This is potentially problematic with populations where deficits in motor performance are expected, i.e., in aging or stroke populations. Thus, the aim of the current study was to explore the contribution of hand motor speed to traditional paper-and-pencil measures of processing speed and to a simple computer-customized non-motor perception decision task, the Inspection Time (IT) task. Participants were 67 young university students aged between 18 and 29 (59 females), and 40 older adults aged between 40 and 81 (31 females) primarily with a similar education profile. As expected, results indicated that age group differences were highly significant on the motor dexterity, Symbol Search and Coding tasks. However, no significant differences or correlations were seen between age groups and the simple visual perception IT task. Furthermore, controlling for motor dexterity did not remove significant age-group differences on the paper-and-pencil measures. This demonstrates that although much of past research into cognitive decline with age is confounded by use of motor reaction times as the operational measure, significant age differences in cognitive processing also exist on more complex tasks. The implications of the results are crucial in the realm of aging research, and caution against the use of traditional WAIS tasks with a clinical population where motor speed may be compromised, as in stroke.

An Examination of Practice and Laterality Effects on the Purdue Pegboard and Moving Beans with Tweezers

The purpose of this study was to examine the relation of practice or learning and laterality on the Purdue Pegboard and the Moving Beans with Tweezers test. The subjects were 30 right-handed, healthy young male adults (age: M = 21.1, SD= 1.9 yr.). The subjects performed both tests five times with each hand. A two-way analysis of variance (hand × trial) for scores on the Purdue Pegboard showed that Trial 1 had a significantly lower mean than Trials 4 and 5 with the dominant hand, and scores on Trials 1 and 3 were lower than that on Trial 5 for the nondominant hand. For the Moving Beans with Tweezers test, Trial 1 had a significantly lower score than Trial 5 with the nondominant hand. The dominant hand produced significantly higher values on all trials of both tests. Intraclass correlation coefficients of Trials 2 and 3 were high, and means were significantly higher for the dominant hand. A correlation between other tests was not high ( r = 37–.46) for both hands. All correlations among five trials on both tests were significant and high (Purdue Pegboard-Dominant: average r = .72, | r| = .60–.80, Purdue Pegboard-Nondominant: average r = .59, | r| = .43–.76), (Moving Beans-Dominant: average r = .74, | r| = .57–.81, Moving Beans-Nondominant: average r = .71, | r| = .55–.87). Correlations among five trials for the ratio of dominant:nondominant hand on both tests were significant and moderate (Moving Beans: average r =.28, | r| = .08–.57, Purdue Pegboard: average r = .41, | r| = .19– .56). Performance with the dominant hand is superior to that of the nondominant hand on both tests. Practice effects are found for both tests across five trials. The Moving Beans with Tweezers test also showed laterality of practice effects. The two tests may measure different abilities.

Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer

BACKGROUND

Vincristine is an integral treatment component of many childhood tumors with potentially dose-limiting sensory and/or motor neuropathy. Results from a pilot study on the incidence of vincristine-induced peripheral neuropathy (VIPN) as well as the efficacy and safety of glutamine in reducing signs and symptoms of VIPN in children with cancer are presented.

METHODS

Fifty-six patients between the ages of 5-21 with newly diagnosed leukemia, lymphoma, extracranial solid tumor or medulloblastoma and expected to receive a minimum cumulative dose of 6 mg/m² of vincristine over a 30-week period were eligible. Patients' neurological functioning was monitored every 3 weeks using clinical history, exam, and assessment of motor functioning. Upon identification of neuropathy, patients were randomized to either glutamine (6 g/m² per dose twice daily, maximum 10 g/dose) or placebo for a 3-week period followed by 3-week wash out period (Time 3).

RESULTS

Forty-nine patients were fully evaluable and 100 % developed neuropathy per study definitions. No significant differences in demographics or side effects were noted between the randomized groups. The distribution of sensory neuropathy scores between the two groups was statistically significant after the intervention (p = 0.022). Children receiving glutamine also rated their quality of life (QoL) as 8.42 points higher on the PedsQL total score than those receiving placebo (p = 0.031).

CONCLUSIONS

Glutamine supplementation is well tolerated and associated with improvements in sensory function and self-reported overall quality of life. Future studies are warranted to confirm the efficacy of glutamine for the treatment of vincristine-related sensory neuropathy in pediatric cancer patients.

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children

Background

Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience.

Methods

The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6–12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance.

Results

TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task.

Conclusions

These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures.

Human behavioral assessments in current research of Parkinson's disease

Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.

Effects of contralesional robot-assisted hand training in patients with unilateral spatial neglect following stroke: a case series study

Background

A reduction of hemispatial neglect due to stroke has been associated with activation of the contralesional hand in the contralesional hemispace. Robot-assisted upper limb training was found to effectively improve paretic arm function in stroke patients. To date no proof of concept of robot-assisted hemispatial neglect therapy has been reported in literature. This study aimed to determine whether robot-assisted left (contralesional) hand activation alone could lead to an improvement in hemispatial neglect following stroke.

Methods

Three stroke patients with right brain injury underwent a 2-week training program of robotic left hand activation with the Gloreha® hand rehabilitation glove, which provides repetitive, passive mobilization of the fingers. Outcomes were assessed using the Line Crossing test, the Bells test, the Sentence Reading test, the Saccadic Training, the Sustained Attention to Response Task, and the Purdue Pegboard test.

Results

Changes were observed after treatment as follows. Line Crossing test: all patients showed improved performance (6.7%, 89.5% and 80% increase in lines crossed) with two patients reaching normal performance levels. Bells test: one patient improved performance (50% increase), while one patient showed no change and one patient declined (−10.3% change); no patient reached normal performance levels. Sentence Reading test: all patients showed improved performance (800%, 57.1% and 42.9% increase in number of sentences read) with no patient reaching normal performance level. Saccadic Training: all patients showed improved performance (−62.8%, −15.5% and −9.7% change of the left hemifield reaction time). Sustained Attention to Response Task: all patients showed improved performance (−20.5%, −5.8% and −10% change of the reaction time) with two patients reducing incorrect responses (−42.9% and −73.3%) and one patient increasing them (9.1%). Purdue Pegboard test: all patients showed improved performance (100%, 27.3% and 75% change in the left + right + both hands sub-item score).

Conclusions

Some caution is warranted when interpreting our results, as the responses to the intervention were variable and might have been due to a placebo effect or fluctuating clinical conditions. However, robot-assisted hemispatial neglect therapy might be useful in stroke patients. Larger-scale investigations are needed to confirm our preliminary findings.

Electronic supplementary material

The online version of this article (doi:10.1186/1743-0003-11-160) contains supplementary material, which is available to authorized users.

Differential effects of facilitatory and inhibitory theta burst stimulation of the primary motor cortex on motor learning

OBJECTIVE

To evaluate the differential effects on motor learning of two types of theta burst stimulation (TBS), the excitatory intermittent TBS (iTBS) and inhibitory continuous TBS (cTBS), if TBS is applied in an early stage of learning process.

METHODS

Thirty right handed healthy people were randomly allocated into one of the three groups according to the intervention applied, iTBS, cTBS or placebo. The interventions and measurements targeted the non-dominant side. The reaction time task (RTT) and Purdue pegboard task (PPT) were used. Measurements and motor tasks were carried out at baseline (T0), immediately after the intervention (T1), and 30 min later (T2).

RESULTS

Compared to placebo, following cTBS M1 excitability went down and PPT learning was slowed. Following iTBS M1 excitability increased temporarily and PPT learning pattern changed, but learning was not improved. The MEP and PPT changes induced during the T0-T1 time interval correlated significantly.

CONCLUSIONS

The early consolidation of the learned material was much more influenced by the TBS induced promotion/suppression of the M1 functional plasticity reserves than by the absolute level of the M1 activation.

SIGNIFICANCE

The results may help to better define the use of TBS in promotion of motor learning in neurorehabilitation and cognitive enhancement.

Use of objective psychomotor tests in health professionals

Evaluation of psychomotor skills is undertaken in a number of broad contexts. This includes testing of health professional populations as a measure of innate ability, to evaluate skill acquisition, or to compare professions. However, the use of psychomotor tests is frequently confounded by a lack of understanding of a particular tool's psychometric properties, strengths, and weaknesses. To identify and appraise the most commonly used tests on health professional populations, 86 articles were reviewed and the top nine tests identified. Few tests have had sufficient validity or reliability testing on health professionals. Based on the evidence available, use of the Grooved Pegboard Test, the Purdue Pegboard Test, or the Finger Tapping Test is recommended for the evaluation of dexterity in a health professional population; however, this choice may be dependent on the task(s) to which findings are generalised. More rigorous evaluation of validity and other psychometric properties is required.

Predictors of cognitive impairment in an early stage Parkinson's disease cohort

The impact of Parkinson’s disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype.

Normative data for neuromuscular assessment of the hand-arm vibration syndrome and its retrospective applications in Korean male workers

PURPOSE

The purpose of this study was to describe normative data for the neuromuscular assessments of the hand-arm vibration syndrome (HAVS) in Korean.

METHODS

Data for the vibrotactile perception threshold (VPT) at three frequencies (31.5, 125, and 250 Hz), the hand grip strength (HGS), the finger pinch strength (FPS), the finger tapping test, and the Purdue pegboard tests were collected from 120 male office workers aged 30-59 years with no prior history of regular use of handheld vibrating tools. The collected data were compared with the results of a similar study of shipbuilding workers in order to investigate the diagnostic utility of clinical test for HAVS.

RESULTS

The mean VPT values indicate that no significant differences were observed between the dominant and non-dominant hands or between the index and little fingers. The age group of 30s was highly sensitive to vibration input with a peak in sensitivity at 125 Hz among all age groups. In neuromuscular performance, dominant hands are usually more accurate, dexterous, and functionally quicker than non-dominant hands. The index finger was superior to the little finger in the finger tapping counts (p < 0.05). Also, FPS was greater in the index finger than in the middle finger (p < 0.05). The HGS of dominant hands was significantly stronger than that of non-dominant hands (p < 0.05). When the normative data were compared with the data of shipyard workers exposed to vibration, there were statistically significant differences in VPT and neuromuscular functions.

CONCLUSIONS

The current data can be used to evaluate HAVS in Korean male workers. Age is an important factor for VPT.

Bilateral deficits in fine motor control ability and manual dexterity in women with fibromyalgia syndrome

The aim of the current study was to investigate fine motor control ability and manual dexterity women with fibromyalgia syndrome (FMS) without symptoms in the upper extremity compared to healthy women. Subtests of the Purdue Pegboard Test (one-hand, bilateral and assembly) and of the Jebsen-Taylor hand-function test (writing, turning cards, picking up small, light and large heavy objects, simulated feeding and stacking checkers) were evaluated bilaterally in 20 women with FMS (aged 35-55 years) without symptoms in the upper limb and 20 age- and hand dominance-matched healthy women. Differences between sides and groups were analysed with several analysis of variance (ANOVA). The ANOVA revealed significant differences between groups (P < 0.001) and sides (P = 0.007) for one-hand pin placement subtest: women with FMS showed bilateral worse scores than controls. Patients also exhibited significantly lower scores in bilateral pin placement and assembly subtests when compared to healthy controls (P < 0.001). The ANOVA also revealed significant differences between groups for writing, turning over cards, picking up small objects, stacking checkers, picking up large light objects and picking up large heavy objects (all, P < 0.001): women with FMS needed more time for these subtests than healthy women with both hands. No difference for simulated feeding was found between groups. Our findings revealed bilateral deficits in fine motor control ability and manual dexterity in patients with FMS without symptoms in the upper extremity. These deficits are not related to the clinical features of the symptoms supporting an underlying central mechanism of altered motor control.

Functional significance of atypical cortical organization in spina bifida myelomeningocele: relations of cortical thickness and gyrification with IQ and fine motor dexterity

The cortex in spina bifida myelomeningocele (SBM) is atypically organized, but it is not known how specific features of atypical cortical organization promote or disrupt cognitive and motor function. Relations of deviant cortical thickness and gyrification with IQ and fine motor dexterity were investigated in 64 individuals with SBM and 26 typically developing (TD) individuals, aged 8-28 years. Cortical thickness and 3D local gyrification index (LGI) were quantified from 33 cortical regions per hemisphere using FreeSurfer. Results replicated previous findings, showing regions of higher and lower cortical thickness and LGI in SBM relative to the TD comparison individuals. Cortical thickness and LGI were negatively associated in most cortical regions, though less consistently in the TD group. Whereas cortical thickness and LGI tended to be negatively associated with IQ and fine motor outcomes in regions that were thicker or more gyrified in SBM, associations tended to be positive in regions that were thinner or less gyrified in SBM. The more deviant the levels of cortical thickness and LGI-whether higher or lower relative to the TD group-the more impaired the IQ and fine motor outcomes, suggesting that these cortical atypicalities in SBM are functionally maladaptive, rather than adaptive.

Test-retest reliability of Purdue Pegboard performance in thermoneutral and cold ambient conditions

In the cold, Purdue Pegboard (PP) performance declines. The purpose of this study was to determine if this cold-induced impairment is consistent across days (i.e. test-retest reliability) in 5°C. In thermoneutral air (25°C), 14 men were familiarised to the dominant hand (PPa) and bimanual (PPb) PP tasks. They then experienced two 90-min cold exposures (Day 1, Day 2) while wearing ∼1 clo. Bare hands were maintained throughout. Performance on both tasks showed high reliability from day to day (intraclass correlations >0.700) in both thermoneutral and cold conditions. However for both tasks, room temperature performance did not predict performance in the cold (intraclass correlations <0.450). When screening applicants for manual labour in the cold, one must consider that room temperature dexterity does not correlate with dexterity in the cold. It is recommended that a 60-min period of cold exposure be employed to assess manual dexterity in these workers. STATEMENT OF RELEVANCE: This study shows that PP performance in room temperature does not predict performance in the cold but performance in the cold is consistent from day to day. When screening applicants for manual labour in the cold, it is recommended that dexterity tests be conducted in the same ambient conditions.

Neuropsychological differences among children with Asperger syndrome, nonverbal learning disabilities, attention deficit disorder, and controls

Confusion is present as to possible diagnostic differences between Asperger syndrome (AS) and Nonverbal learning disabilities (NLD) and the relation of these disorders to attentional difficulties. Three-hundred and forty-five children participated in this study in 5 groups; NLD, AS, attention deficit hyperactivity disorder (ADHD): Combined type, ADHD: Inattentive type, and controls. The NLD group showed particular difficulty on visual-spatial, visual-motor, and fluid reasoning measures compared to the other groups. There was also a significant verbal-performance IQ split in this group related to difficulty in social functioning. This study extends the findings from previous studies and extends these findings to differences between AS and NLD groups.

Verbal memory impairments in children after cerebellar tumor resection

This study was designed to investigate cerebellar lobular contributions to specific cognitive deficits observed after cerebellar tumor resection. Verbal working memory (VWM) tasks were administered to children following surgical resection of cerebellar pilocytic astrocytomas and age-matched controls. Anatomical MRI scans were used to quantify the extent of cerebellar lobular damage from each patient's resection. Patients exhibited significantly reduced digit span for auditory but not visual stimuli, relative to controls, and damage to left hemispheral lobule VIII was significantly correlated with this deficit. Patients also showed reduced effects of articulatory suppression and this was correlated with damage to the vermis and hemispheral lobule IV/V bilaterally. Phonological similarity and recency effects did not differ overall between patients and controls, but outlier patients with abnormal phonological similarity effects to either auditory or visual stimuli were found to have damage to hemispheral lobule VIII/VIIB on the left and right, respectively. We postulate that damage to left hemispheral lobule VIII may interfere with encoding of auditory stimuli into the phonological store. These data corroborate neuroimaging studies showing focal cerebellar activation during VWM paradigms, and thereby allow us to predict with greater accuracy which specific neurocognitive processes will be affected by a cerebellar tumor resection.

Prediction of hand function after occupational hand injury by evaluation of initial anatomical severity

PURPOSE

To examine the relationship between initial anatomic severity evaluated by the Hand Injury Severity Scoring (HISS) system and recovered hand function evaluated by the Purdue Pegboard after occupational hand injury.

METHOD

In the retrospective cohort study, 95 patients hospitalized between 1 January 2000 and 31 December 2003 for surgery due to occupational hand injury were recruited. The HISS scores were obtained by chart review by a surgeon. The Purdue Pegboard was performed at least 6 months after the injury by well-trained occupational therapists. The Purdue Pegboard scores were compared with the initial HISS scores by simple regression, multiple regression and logistic regression analysis.

RESULTS

The total HISS score was negatively correlated with scores of the Purdue Pegboard subtests, including injured-hand, both-hands, and assembly. The risk of having low injured-hand score (<13) was significantly increased in workers with initial major severity (HISS >or= 101), with OR 9.57 (95% CI 1.4-94.8). The risk of having low both-hands score (<10) was significantly increased in workers with initial severe and major severity (HISS of 51-100 and >or=101), with OR 4.5 (95% CI 1.1-21.8) and OR 25 (95% CI 3.5-263). The risk of having low assembly score (<25) was significantly increased in workers with initial major severity (HISS >or= 101), with OR 9.0 (95% CI 1.3-72.5).

CONCLUSION

The study showed that after occupational hand injury, initial anatomic severity evaluated by the HISS system could predict hand function after recovery.

A prospective cohort study of manipulative dexterity in vibration-exposed workers

OBJECTIVES

To investigate the relation between manipulative dexterity and vibration exposure, ergonomic risk factors, and upper limb disorders in a group of workers exposed to hand-transmitted vibration (HTV).

METHODS

Manipulative dexterity was investigated on 115 HTV workers (82 forestry workers and 33 stone workers) and 64 control men over 1-year follow-up period. The Purdue pegboard method was used to test manipulative dexterity which was scored for the dominant hand, non-dominant hand, and both hands. Information about individual, work and health history was obtained by means of a standardised questionnaire. Vibration exposure was assessed in terms of tool vibration magnitudes, daily and total exposure duration, and cumulative vibration dose.

RESULTS

On the cross-sectional investigation, Purdue pegboard scores were significantly lower in the HTV workers than in the controls (0.001 < P < 0.05). Over 1-year follow-up period, Purdue pegboard scores were found to be inversely related to age, smoking and use of vibratory tools (0.001 < P < 0.05). Moreover, deterioration of some measures of manipulative dexterity was significantly associated with sensorineural and vascular symptoms in the fingers of the HTV workers. Random-intercept linear regression analysis showed that Purdue pegboard scores decreased with the increase of vibration exposure. The reduction of assembly score (i.e. number of pins, collars, and washers assembled in a 60-s period) was significantly associated with the increase in vibration exposure and ergonomic stress (neck-upper arm posture, hand-intensive work, and total ergonomic score). Purdue pegboard scores tended to improve over the follow-up period in both the controls and the HTV workers, suggesting a possible learning effect over time.

CONCLUSION

The findings of this longitudinal study suggest an association between deterioration of manipulative dexterity and neurovascular symptoms in the fingers of HTV workers. There was evidence for a significant relation between loss of precise manipulation and exposures to hand-transmitted vibration and ergonomic risk factors.

The effect of microbiological containment systems on dexterity

Microbiology laboratories use containment equipment such as safety cabinets and isolators or respiratory protective equipment to protect workers against aerosol infection hazards. There is a perception among microbiologists that the use of containment equipment reduces dexterity to a point where the risks associated with using sharps are increased. Thus, in a situation where it is essential to use sharps, the use of respiratory protection is frequently the favored method of operator protection. Using three methods of manual dexterity testing, the effect of latex gloves, a positive pressure respirator, and three forms of containment equipment, (a Class II safety cabinet, a half suit, and a flexible film isolator) were tested against performance in these tests using bare hands in 10 subjects. The study was extended to additionally assess Class III cabinets using 20 subjects. With the exception of latex gloves, the personal protective equipment and containment equipment all had a statistically significant detrimental effect on manual dexterity compared with working solely with bare hands. The use of containment systems, especially barrier containment systems such as Class III cabinets and isolators, significantly reduces dexterity and may increase the chance of accidents. The use of positive pressure respirators with double gloves also affects dexterity but to a lesser extent. The use of sharps should be minimized within containment equipment. Risk assessment may be required to address the comparative risk of aerosol and needlestick infection with different agents to choose the most appropriate containment systems.

Living a normal life with the nondominant hemisphere: magnetic resonance imaging findings and clinical outcome for a patient with left-hemispheric hydranencephaly

In hemihydranencephaly, the human brain lacks 1 complete hemisphere. An occlusion of the carotid artery, affecting all supplied territories, is thought to be the underlying mechanism. This extremely rare disorder, of which only 7 cases have been reported to date, is thought to occur before the last trimester of gestation (20th to 27th week), after neural migration but before synaptogenesis. We report on a 36-year-old man born at term, with no complications, from nonconsanguineous healthy parents. Cranial computed tomography had been performed because of left-sided headaches. Because of the imaging findings, the patient presented at our institution for additional MRI and clinical testing (including the Motor Activity Log, Wolf motor function test, 2-point discrimination test, Purdue pegboard test, gross motor function test, Physician Rating Scale, and Aachener aphasia test, including patterns for spontaneous speech, repetition, naming, comprehension, written language, and the token test). The patient's disabilities were related to deficits in fine motor control and reduced precision. Therefore, the patient was unable to perform the Purdue pegboard test with his affected hand. According to the Aachener aphasia test, no aphasia could be demonstrated for this strongly left-handed patient. Strong mirror movements were found. Cortical reorganization is possible if damage occurs in very early childhood. Motor function and speech were controlled by the remaining, nonaffected hemisphere, with a remarkable outcome. Because the damage is thought to occur before synaptogenesis, existing or prepared cortical areas and pathways have the potential to execute the lacking functions of the destroyed hemisphere.