title: Does the Finger-to-Nose Test measure upper limb coordination in chronic stroke?
abstract: BACKGROUND
  We aimed to kinematically validate that the time to perform the Finger-to-Nose Test (FNT) assesses coordination by determining its construct, convergent and discriminant validity.
  
  
  METHODS
  Experimental, criterion standard study. Both clinical and experimental evaluations were done at a research facility in a rehabilitation hospital. Forty individuals (20 individuals with chronic stroke and 20 healthy, age- and gender-matched individuals) participated.. Both groups performed two blocks of 10 to-and-fro pointing movements (non-dominant/affected arm) between a sagittal target and the nose (ReachIn, ReachOut) at a self-paced speed. Time to perform the test was the main outcome. Kinematics (Optotrak, 100Hz) and clinical impairment/activity levels were evaluated. Spatiotemporal coordination was assessed with slope (IJC) and cross-correlation (LAG) between elbow and shoulder movements.
  
  
  RESULTS
  Compared to controls, individuals with stroke (Fugl-Meyer Assessment, FMA-UE: 51.9 ± 13.2; Box & Blocks, BBT: 72.1 ± 26.9%) made more curved endpoint trajectories using less shoulder horizontal-abduction. For construct validity, shoulder range (β = 0.127), LAG (β = 0.855) and IJC (β = -0.191) explained 82% of FNT-time variance for ReachIn and LAG (β = 0.971) explained 94% for ReachOut in patients with stroke. In contrast, only LAG explained 62% (β = 0.790) and 79% (β = 0.889) of variance for ReachIn and ReachOut respectively in controls. For convergent validity, FNT-time correlated with FMA-UE (r = -0.67, p < 0.01), FMA-Arm (r = -0.60, p = 0.005), biceps spasticity (r = 0.39, p < 0.05) and BBT (r = -0.56, p < 0.01). A cut-off time of 10.6 s discriminated between mild and moderate-to-severe impairment (discriminant validity). Each additional second represented 42% odds increase of greater impairment.
  
  
  CONCLUSIONS
  For this version of the FNT, the time to perform the test showed construct, convergent and discriminant validity to measure UL coordination in stroke.
authors.affiliation: School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.|Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada.
authors.forename: Marcos R M
authors.initials: MR
authors.lastname: Rodrigues
authors.affiliation: Faculty of Medicine, McGill University, Montreal, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Slimovitch
authors.affiliation: School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.|Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada.
authors.forename: Gevorg
authors.initials: G
authors.lastname: Chilingaryan
authors.affiliation: School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. mindy.levin@mcgill.ca.|Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, site of Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada. mindy.levin@mcgill.ca.
authors.forename: Mindy F
authors.initials: MF
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology; D009460:Neurologic Examination / Q000379:methods*; D011597:Psychomotor Performance; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D034941:Upper Extremity
keywords: CVA (cerebrovascular accident); Motor skills disorders; Outcomes assessment; Upper extremity