Original article
Skilled Hand Dexterity in Parkinson's Disease: Effects of Adding a Concurrent Task

Presented to the Australian Physiotherapy Association, October 4 2009, Sydney, Australia.
https://doi.org/10.1016/j.apmr.2010.01.008Get rights and content

Abstract

Proud EL, Morris ME. Skilled hand dexterity in Parkinson's disease: effects of adding a concurrent task.

Objective

To compare the performance of people with Parkinson's disease (PD) and unimpaired participants on a timed dexterity task and to examine the effects of adding a secondary task.

Design

A repeated measures analysis of performance for the 2 groups under unitask and dual-task conditions.

Setting

All tests were conducted in a human movement laboratory.

Participants

People with idiopathic PD (n=22) and age-matched and sex-matched comparisons (n=22) volunteered for the study.

Interventions

Not applicable, although a verbal-cognitive secondary task was used.

Main Outcome Measures

The number of pegs placed in the Purdue Pegboard in 30 seconds, the number of correct verbal responses for the secondary task, scores on the Manual Ability Measure-16 test of hand function and, for the group with PD, ratings on the Unified Parkinson's Disease Rating Scale.

Results

For the pegboard task, people with PD had reduced dexterity (t=−5.289; P<.001) compared with the unimpaired group. When the secondary task was added, both groups placed fewer pegs (F1,42=.652; P=.42). There were no differences between groups in scores for the subtraction task performed alone, but when this activity was carried out with the Purdue Pegboard Test, the number of correct responses declined only in the PD group (F1,42=4.90; P=.032).

Conclusions

Manual dexterity was compromised in this group of people with mild-moderate PD when compared with an unimpaired group. When the concurrent verbal-cognitive task was added, dual-task interference occurred in both groups but to a greater extent in people with PD.

Section snippets

Participants

Twenty-two people diagnosed with idiopathic PD and 22 age-matched and sex-matched unimpaired people were recruited for this study using written and verbal invitations and local advertising. Potential participants with PD were recruited by written invitation and with advertising placed at movement disorders clinics and in a support group newsletter. The unimpaired group was recruited by word-of-mouth invitation within social networks and with advertising in a staff newsletter. Those expressing

Participant Characteristics

Twenty-two people with idiopathic PD diagnosed by a neurologist participated. There were 11 men and 11 women with PD (median modified Hoehn and Yahr score=2). Their mean age ± SD was 63.95±9.78 years (range, 51–85), and they were matched for age and sex with a group of 22 comparisons (mean age ± SD, 63.64±10.00y; range, 50–86). Levodopa equivalent daily dosages were calculated for each of the participants with PD, as shown in table 1.

Purdue Pegboard Test (Unitask)

Tests for the nondominant hand were not conducted on 1

Discussion

People with PD performed more poorly on a test of manual dexterity than an unimpaired group that was matched for age and sex. Although the participants with PD were tested when taking their usual medication, they were unable to match the performance of the unimpaired group on this dexterity task. When the dexterity test was combined with a verbal-cognitive task, the effect of dual-task interference caused both groups to reduce their performance on the timed dexterity test. Both groups showed a

Conclusions

People with mild-moderate PD had poor performance on a skilled hand task compared with age-matched peers. When a concurrent task was added, both groups declined in performance on the dexterity task. There was greater dual-task interference in the PD group, who showed reduced ability to perform the secondary task. Participants with PD also reported more difficulty with everyday hand activities such as fastening buttons and taking money from a wallet.

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