Values for timed limb coordination tests
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© The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society.
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Values for timed limb coordination tests
in a sample of healthy older adults
DESIREE JOY LANZINO, MEGAN N. CONNER, KELLI A. GOODMAN, KATHRYN H. KREMER, MAEGAN T. PETKUS,
JOHN H. HOLLMAN
Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
Address correspondence to: D. J. Lanzino. Tel: (+1) 507-538-0239; Fax: (+1) 507-284-0656. Email: [email protected]
Abstract
Background: timed limb coordination tests are reliable measures of motor performance but many lack published reference
values.
Objective: to determine mean values for timed tests in an older cohort, examining associations with anthropometric characteristics, handedness, gender and age.
Design: cross-sectional.
Setting: community.
Subjects: sixty-nine healthy adults divided into three groups: 60–69, 70–79 and 80+ years.
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D. J. Lanzino et al.
Methods: height, weight and time to complete ﬁve repetitions of ﬁnger-to-nose, pronation–supination, mass grasp, opposition and heel-on-shin were recorded. Performances were statistically compared with anthropometric characteristics, handedness and across age groups and gender.
Results: for all tests, height negatively correlated with speed (r = −0.26 to −0.41). Weight negatively correlated with performance of two tests (r = −0.25 to −0.35). When covariates were controlled, men performed heel-on-shin faster than
women. The youngest group completed upper extremity tests faster than the oldest. Adults in their 70 s completed ﬁngerto-nose and pronation–supination faster than persons aged 80+ years.
Conclusions: we report mean values for ﬁve clinical tests of timed limb coordination that may aid in identifying mild deﬁcits in otherwise healthy older adults.
Keywords: coordination, psychomotor performance, neurological examination, older people
Methods
vTimed limb coordination tests are reliable measures of
motor performance [1, 2] that are clinically useful. They can
differentiate persons with Alzheimer’s disease [3] or
Parkinson’s disease [4] from age-matched controls. Increased
disease severity has been revealed by slower speed of performance in patients with pulmonary disease [5]. The effectiveness of botulinum toxin for spasticity and deep brain
stimulation for dyskinesias is reﬂected by changes in timed
performance [6, 7]. Coordination speed is even able to
predict social participation years after a stroke [8].
The drawback of timed coordination measures is their
lack of reported reference values [9]. Only two, ﬁnger
tapping and ﬁnger-to-nose, have published norms. The
number of ﬁnger taps in 10 s has been documented [10,
11], but a lever was used to record tapping strokes.
Instrumentation improves test reliability [12], but is inconvenient and impractical in some settings. Two studies
reported timed ﬁnger-to-nose (starting position: 90° shoulder ﬂexion, ﬁngers extended, no target) for persons in their
teens to mid-30 s [13, 14]. Average time to complete ﬁve
repetitions differed by one-half to 1 s between the reports,
possibly due to the use of athletes in the study with faster
results. Since timed performance decreases with age [15],
times recorded for younger subjects are not applicable to
older age groups. The only study to quantify the
ﬁnger-to-nose test in older persons counted the number of
repetitions completed in 20 s and had subjects alternately
touching their nose and a wall target [16]. Most investigators time ﬁve cycles and do not use a wall target [1, 13];
therefore, the published values are not reﬂective of usual
practice.
The purposes of this study were to determine mean
values for ﬁve timed limb coordination tests in a healthy
older cohort, and to determine whether timed performance
is associated with anthropometric characteristics [height,
weight, body mass index (BMI)], inﬂuenced by hand dominance or age, or differs between genders. Findings from
this study may provide references for clinicians to compare
patient performance on the examined tests to aid in identifying impaired limb function.
Participants
804
This study was approved by the Mayo Clinic Institutional
Review Board. Based on an a priori power analysis, a
minimum of 54 participants distributed across three age
groups (60–69, 70–79, 80+) and both genders was indicated
to detect effect sizes of 0.50 at α = 0.05 at a statistical power
(1 – β) of 0.90 to protect against Type II error. Recruitment
ﬂyers and word-of-mouth were used to recruit subjects
around Rochester, MN. Males and females were recruited in
equal numbers, since a gender difference has been reported
for timed coordination tests [15]. Figure 1 depicts the sampling process, inclusion criteria and age group assignments.
Interested subjects were screened for eligibility by phone and
re-veriﬁed on the day of testing. Sixty-nine participants were
eligible and provided written consent.
Data collection
Weight and height were recorded. Hand dominance was
determined by the hand used for writing. Five repetitions of
ﬁnger-to-nose, pronation–supination, mass grasp, ﬁnger opposition and heel-on-shin were timed using a stopwatch.
These ﬁve tests have reported high inter-rater reliability coefﬁcients even among persons of different levels of experience
and backgrounds (intra-class correlation coefﬁcients of
0.89–0.97) [17]. For test descriptions, see Supplementary
data available in Age and Ageing online, Appendix 1, and for
test choice justiﬁcation, see Supplementary data available in
Age and Ageing online, Appendix 2.
Participants were seated during upper extremity tests
and supine for heel-on-shin. Visual demonstration with
verbal instruction of each measure was provided. Two
timed trials were completed. The second was used for analysis, since a prior study found subjects performed faster
during a second but not a third trial of coordination testing
[14]. If the best effort was not given during the second
trial, a third was completed and the fastest used for analysis.
Participants performed each task until told to stop to
ensure full speed throughout the tests, but only the ﬁrst
ﬁve cycles were timed.
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Background and purpose
Values for timed limb coordination tests
Test performance and anthropometric
characteristics
Height negatively correlated with performance time for all
tests (r = −0.26 to −0.41). Pronation–supination and mass
grasp timed performance negatively correlated with participants’ weight (r = −0.25 to −0.35). There was no effect of
weight on performing the remaining tests, or of BMI on
any test (for correlation coefﬁcients and P-values between
participant anthropometrics and timed coordination test
performance, see Supplementary data available in Age and
Ageing online, Appendix 3).
Handedness, gender and age effects
Figure 1. Flow diagram depicting the evolution of the sample,
inclusion criteria and participant group assignments.
Data analysis
Descriptive data stratiﬁed by age group, gender and hand
dominance were calculated. Relationships between test performance and participants’ anthropometrics were examined
with Pearson product-moment correlation coefﬁcients,
effects of hand dominance using paired t-tests and effects
of age and gender with 3×2 analyses of covariance and
Bonferroni adjustments. Anthropometric data that correlated with coordination performance were included as covariates. We used family wise α = 0.05 for all statistical tests.
Results
Sample characteristics
Descriptive data and mean times for test performances
across age groups and gender are presented in Table 1.
Mean height and weight, but not BMI, differed signiﬁcantly
across genders and age group. Men were taller and heavier
than women (P < 0.001). Persons in the youngest group
were taller (P = 0.013) and heavier (P = 0.023) than persons
in the oldest group.
Discussion
We report time-to-complete ﬁve repetitions of ﬁve
common limb coordination tests in a healthy cohort over
60 years of age. Patient performance times could be compared with these to identify possible deﬁcits or set goals.
Published values for objective measures are important,
since healthy older adults have variable performance that
subjective assessment may surmise as pathologic [18].
Of the tests examined, reference values are available
only for ﬁnger-to-nose. In a 2005 study [19], persons up
to age 63 years completed the test in 3.49–4.09 s. Their
fastest reported time is similar to persons in our 60–69
year group who averaged 3.5–3.7 s to complete ﬁve
repetitions.
We found height to be advantageous for moving faster.
Prior timed coordination studies have not reported such an
effect, unlike gait speed in which taller subjects walked
faster [20]. Increased body weight resulted in faster pronation–supination and mass grasp performance. Perhaps
increased soft tissue decreased total range of motion
needed to fully complete these tests, increasing the apparent
speed at which they can be performed. A 2010 study[13]
found BMI negatively affected time to complete
ﬁnger-to-nose, but BMI had no effect on limb speed in
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Handedness had no effect on timed performance (P =
0.086, 0.058, 0.071, 0.383 and 0.859 for the
ﬁnger-to-nose, pronation–supination, mass grasp, ﬁnger
opposition and heel-on-shin tests, respectively). Men performed faster than women during pronation–supination
(P = 0.005), mass grasp (P = 0.005) and heel-on-shin (P =
0.006) tests, but once height (all tests) and weight ( pronation–supination and mass grasp) were controlled, men
and women differed only in heel-on-shin performance
(Table 1). Performance times were slower in the 80+
group than the 60–69 group across all upper extremity
tests, and slower in the 80+ group than the 70–79 group
in the ﬁnger-to-nose and pronation–supination tests
(Table 1). Test performances between the 70–79 and 60–
69 groups did not differ.
D. J. Lanzino et al.
Table 1. Means and standard deviations (SD) for demographic and anthropometric characteristics of the study sample,
along with adjusted performance times for five timed tests of limb coordination
Parameter
Women
Men
60–69
n = 12
70–79
n = 12
80+
n = 12
60–69
n = 12
70–79
n = 12
80+
n=9
66.2 (2.7)
163.3 (4.4)
73.4 (10.2)
27.5 (3.3)
3.6 (0.9)
2.9 (0.6)
2.4 (0.7)
6.3 (1.7)
4.3 (0.9)
73.3 (2.0)
159.4 (6.3)
70.8 (10.5)
27.8 (3.4)
4.0 (1.0)
3.2 (0.6)
2.8 (0.8)
7.2 (1.9)
4.8 (1.1)
82.7 (2.8)
156.7 (4.4)
62.9 (11.9)
25.6 (4.9)
4.8 (1.2)
3.8 (0.7)
3.2 (0.9)
8.7 (2.1)
5.2 (1.2)
66.5 (2.6)
177.1 (6.0)
89.2 (9.5)
28.5 (3.3)
3.6 (1.1)
2.9 (0.7)
2.4 (0.9)
6.7(2.0)
4.0 (1.2)
73.1 (3.4)
174.9 (3.8)
88.1 (13.3)
28.8 (4.4)
3.8 (1.0)
2.9 (0.6)
2.4 (0.8)
7.2 (1.9)
3.7 (1.1)
84.2 (4.1)
174.0 (7.4)
81.8 (8.2)
27.1 (2.9)
4.4 (1.0)
3.1 (0.6)
2.8 (0.7)
7.8 (1.8)
4.1 (1.0)
....................................................................................
Age (years)
Height (cm)
Weight (kg)
BMI
Finger-to-nose*
Pronation–supination**
Mass grasp***
Finger opposition****
Heel-on-shin*****
our cohort, which was older (mean 22 versus 73.7 years)
with a larger average BMI (23.5 versus 27.7).
Performance did not vary signiﬁcantly according to
handedness, unlike previous studies [13, 14, 16]. While men
performed heel-on-shin faster than women, gender did not
play a role in upper limb performance once height and
weight were controlled. Prior investigators found men
faster than women in timed tasks [13, 16]. However, these
reports do not appear to have considered how height and
weight may have accounted for group differences. Analysis
for potential effects of height on timed performance warrants further study.
Over a lifetime, timed performance becomes fastest
during the teen years through the third decade of life [2,
13, 14]. Performance time begins to slow by 40–50 years of
age depending on task and gender [10, 15]. Ours and previous ﬁndings [16] suggest that slowing continues with age
and signiﬁcantly so after the age of 80 for many timed coordination tasks.
Key points
• We report mean values for ﬁve timed limb coordination
tests that may help identify mild deﬁcits in otherwise
healthy older adults.
• Taller subjects had faster limb coordination test times.
• Upper limb performance was signiﬁcantly slower after age 80.
Funding
This work was supported by the Physical Medicine and
Rehabilitation Department, Mayo Clinic, Rochester, MN.
The funding source played no role in the design, execution,
data analysis and interpretation or writing of the study.
Supplementary data
Limitations
Results are based on a small sample of healthy adults and may
not generalise to subjects in poor health, frail or institutionalised. Slower speed of performance from these groups may
not reﬂect neuromuscular impairment, therefore, validation
studies with larger samples across a variety of older adults are
needed. Finally, speed is just one aspect of coordination to
assess; it may not correlate with quality of movement.
806
Supplementary data mentioned in the text is available to
subscribers in Age and Ageing online.
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Times are reported in seconds. Since times between dominant and non-dominant extremities were not significantly different, adjusted performance times are
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WWW. Do not forget older people
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Received 28 October 2011; accepted in revised form
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Age and Ageing 2012; 41: 807–810
© The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society.
doi: 10.1093/ageing/afs083
All rights reserved. For Permissions, please email: [email protected]
Published electronically 16 August 2012
WWW. Do not forget older people
HEATHER MACFARLANE1, MARK T. KINIRONS2, MATTHEW F. BULTITUDE3
1
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London SE1 7EH, UK
3
Urology Centre, Guy’s and St Thomas’ Hospital, London, UK
2
Address correspondence to: M. F. Bultitude. Tel: (+44) 020 7 188 2519; Fax: (+44) 020 7 955 4465. Email: matthew.bultitude@
gstt.nhs.uk
Abstract
Background: internet use continues to grow. It is often assumed that most users are younger or middle aged. We set out
to establish how access to and use of the Internet varied with age.
Methods: we surveyed a sample of patients attending urology outpatient clinics in a one week period.
807
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