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An objective pronator drift test application (iPronator) using handheld device.

Shin S, Park E, Lee DH, Lee KJ, Heo JH, Nam HS - PLoS ONE (2012)

Bottom Line: The degrees of average and maximum in pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7-40.3 vs. 3.8° (IQR 0.3-7.5), p<0.001], in maximum, 33.0° (IQR 24.0-52.1) vs. 6.2° (IQR 1.4-9.4), p<0.001].In drift, the degrees of average, maximum, and oscillation were greater in the patient group.In stroke patients, a follow-up study at one week revealed improvements in the degrees of pronation and drift compared with baseline parameters.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Yonsei University College of Medicine, Seodaemoon-gu, Seoul, Korea.

ABSTRACT

Background: The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients.

Methods: The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later.

Results: There was a strong correlation between the average degree of pronation and drift measured by the iPronator (r = 0.741, p<0.001). The degrees of average and maximum in pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7-40.3 vs. 3.8° (IQR 0.3-7.5), p<0.001], in maximum, 33.0° (IQR 24.0-52.1) vs. 6.2° (IQR 1.4-9.4), p<0.001]. The degree of oscillation in pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of pronation and drift compared with baseline parameters.

Conclusions: The iPronator can reliably detect mild arm weakness of stroke patients and was also useful in detecting functional recovery for one week in patients with acute stroke.

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Comparison of the degrees of pronation and drift between patients and controls.The parameters of average (A), maximum (B) in pronation and the parameters of average (D), maximum (E), and oscillation (F) of drift were significantly greater in patients than in healthy controls whereas, the degree of oscillation in pronation was not different (C).
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pone-0041544-g003: Comparison of the degrees of pronation and drift between patients and controls.The parameters of average (A), maximum (B) in pronation and the parameters of average (D), maximum (E), and oscillation (F) of drift were significantly greater in patients than in healthy controls whereas, the degree of oscillation in pronation was not different (C).

Mentions: A total of 10 patients (mean age 69.1±9.4 years, 6 of men) and 10 controls (mean age 40.1±10.0, 2 of men) were enrolled. All stroke patients had pronator drift in conventional pronator drift test measurements (4 on the right arm, 6 on the left arm). The total median NIHSS score in patient group was 4.0 (IQR 3.0–6.0), and the median NIHSS score of the affected arm was 1 (IQR 1–1.25). The forearm rolling test was positive in 8 out of 10 patients and the finger rolling test was positive in all patients (Table 1). Measurements from the iPronator demonstrated a strong correlation between the average degree of pronation and that of drift (r = 0.741, P<0.001) (Figure 2). Neither the NIHSS score nor the MRC grade was correlated with the degree of pronation or drift (data not shown). Moreover, 1 out of 10 patients showed normal muscle strength in the arm as measured by the NIHSS score or MRC grade. Baseline degrees of pronation and drift of the patient group were greater than those of the control group. The average degree of pronation in the patient group was 28.9° (IQR 18.7–40.3), which was greater than the control group [3.8° (IQR 0.3–7.5), P<0.001] (Figure 3A). The maximum pronation was also greater in the patient group [33.0° (IQR 24.0–52.1) vs. 6.2° (IQR 1.4–9.4), p<0.001] (Figure 3B) whereas, the oscillation of pronation was not different between the groups (Figure 3C). In regards to drift, all parameters were significantly greater in the patient group than the control group. The average degree of drift was greater in the patient group [26.8° (IQR 19.7–43.0)] than the control group [−1.7° (IQR −4.0–0.5)] (P<0.001) (Figure 3D). Both maximum (P<0.001) and oscillation of drift (P = 0.007) were also greater in the patient group than the control group (Figure 3E and F) (Table 2).


An objective pronator drift test application (iPronator) using handheld device.

Shin S, Park E, Lee DH, Lee KJ, Heo JH, Nam HS - PLoS ONE (2012)

Comparison of the degrees of pronation and drift between patients and controls.The parameters of average (A), maximum (B) in pronation and the parameters of average (D), maximum (E), and oscillation (F) of drift were significantly greater in patients than in healthy controls whereas, the degree of oscillation in pronation was not different (C).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3404034&req=5

pone-0041544-g003: Comparison of the degrees of pronation and drift between patients and controls.The parameters of average (A), maximum (B) in pronation and the parameters of average (D), maximum (E), and oscillation (F) of drift were significantly greater in patients than in healthy controls whereas, the degree of oscillation in pronation was not different (C).
Mentions: A total of 10 patients (mean age 69.1±9.4 years, 6 of men) and 10 controls (mean age 40.1±10.0, 2 of men) were enrolled. All stroke patients had pronator drift in conventional pronator drift test measurements (4 on the right arm, 6 on the left arm). The total median NIHSS score in patient group was 4.0 (IQR 3.0–6.0), and the median NIHSS score of the affected arm was 1 (IQR 1–1.25). The forearm rolling test was positive in 8 out of 10 patients and the finger rolling test was positive in all patients (Table 1). Measurements from the iPronator demonstrated a strong correlation between the average degree of pronation and that of drift (r = 0.741, P<0.001) (Figure 2). Neither the NIHSS score nor the MRC grade was correlated with the degree of pronation or drift (data not shown). Moreover, 1 out of 10 patients showed normal muscle strength in the arm as measured by the NIHSS score or MRC grade. Baseline degrees of pronation and drift of the patient group were greater than those of the control group. The average degree of pronation in the patient group was 28.9° (IQR 18.7–40.3), which was greater than the control group [3.8° (IQR 0.3–7.5), P<0.001] (Figure 3A). The maximum pronation was also greater in the patient group [33.0° (IQR 24.0–52.1) vs. 6.2° (IQR 1.4–9.4), p<0.001] (Figure 3B) whereas, the oscillation of pronation was not different between the groups (Figure 3C). In regards to drift, all parameters were significantly greater in the patient group than the control group. The average degree of drift was greater in the patient group [26.8° (IQR 19.7–43.0)] than the control group [−1.7° (IQR −4.0–0.5)] (P<0.001) (Figure 3D). Both maximum (P<0.001) and oscillation of drift (P = 0.007) were also greater in the patient group than the control group (Figure 3E and F) (Table 2).

Bottom Line: The degrees of average and maximum in pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7-40.3 vs. 3.8° (IQR 0.3-7.5), p<0.001], in maximum, 33.0° (IQR 24.0-52.1) vs. 6.2° (IQR 1.4-9.4), p<0.001].In drift, the degrees of average, maximum, and oscillation were greater in the patient group.In stroke patients, a follow-up study at one week revealed improvements in the degrees of pronation and drift compared with baseline parameters.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Yonsei University College of Medicine, Seodaemoon-gu, Seoul, Korea.

ABSTRACT

Background: The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients.

Methods: The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later.

Results: There was a strong correlation between the average degree of pronation and drift measured by the iPronator (r = 0.741, p<0.001). The degrees of average and maximum in pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7-40.3 vs. 3.8° (IQR 0.3-7.5), p<0.001], in maximum, 33.0° (IQR 24.0-52.1) vs. 6.2° (IQR 1.4-9.4), p<0.001]. The degree of oscillation in pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of pronation and drift compared with baseline parameters.

Conclusions: The iPronator can reliably detect mild arm weakness of stroke patients and was also useful in detecting functional recovery for one week in patients with acute stroke.

Show MeSH
Related in: MedlinePlus