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Intention tremor rated according to different finger-to-nose test protocols: a survey
Peter G Feys1, Angela Davies-Smith, Rosemary Jones
1National Multiple Sclerosis Center, Melsbroek, Belgium. Peter.Feys@flok.kuleuven.ac.be
Objectives:
To investigate the dependence of intention tremor rating scores on different finger-to-nose test (FNT) protocols, varying in arm position and the time the finger has to be kept on the nose, and to examine their relevance to function.
Design:
Observational survey. Video recordings were made while patients performed the FNTs and functional tasks such as pouring water.
Setting:
Three European rehabilitation centers in Belgium, Finland, and England.
Participants:
Twenty-six multiple sclerosis patients with intention tremor (avg age, 44.1y).
Interventions:
Not applicable.
Main Outcome Measure:
Six examiners rated the degree of intention tremor by using the Fahn Tremor Rating Scale.
Results:
Interrater reliability for rating intention tremor during the FNTs was high (kappa=.65-.74). Both the required arm position and time constraints affected the magnitude of intention tremor rating scores (mean rank, 2.27-2.95) and their functional relevance (rho=.70-.84). Intention tremor was scored the highest when the arm was lifted to 90 degrees of abduction at the shoulder and the subject was required to stabilize the finger on the nose. However, its functional relevance was lower compared with a more "functionally" executed FNT.
Conclusions:
The rating of intention tremor during the FNT depends on test instructions. A standardized protocol is needed.