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Upper-extremity motor co-ordination of healthy elderly people

Age and Ageing, March, 1995 by Johanne Desrosiers, Rejean Hebert, Gina Bravo, Elisabeth Dutil

Introduction

Motor co-ordination is essential to adequate upper-extremity performance. Co-ordination can be defined as the ability to produce a controlled, accurate and rapid movement [1]. Co-ordination results from the muscles working harmoniously together in the execution of movements [2]. Bourbonnais et al. [3] integrated these elements in their definition: 'the ability of a given subject to activate the appropriate muscles for the execution of a purposeful movement in an accurate and effective manner'. Good co-ordination depends not only on muscular work but also on sensory information and body scheme [1, 4]. Co-ordination is mainly under cerebellar control but it can be affected by many other components of the central nervous system, such as the pyramidal and extra-pyramidal systems [5]. According to Poirier [6], co-ordination is a prerequisite to good manual dexterity.

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Several methods of measuring motor co-ordination have been developed using sophisticated laboratory instruments [5], but few of them are used in clinical rehabilitation settings. Clinical quantitative methods used to evaluate motor co-ordination are mainly tapping tasks [7-9] and tracking tasks [10]. Usually, upper-extremity motor co-ordination is evaluated by observing patient performance during the execution of accurate, fast and repeated movements of the arm. The Finger-Nose Test is an example of such a test [5, 11]. Two main variations of the Finger-Nose Test are used in clinical settings. One consists of the subject repetitively touching his/her nose as fast as possible and fully extending the arm in front of him/herself. The second variation of this test consists of the subject alternately touching his/her nose and another target such as the examiner's finger.

In clinical co-ordination assessment, the two main criteria considered are the speed and the quality of movements (presence of tremor and dysmetria). Swaine and Sullivan [12] studied the reliability of the Finger-Nose Test in adults with traumatic brain injury. They concluded that therapists demonstrated poor reliability in assessing the presence of tremor and dysmetria. However, for the time of execution related to the speed of movements, intra-rater reliability was estimated at 0.97 for the right side and 0.99 for the left and inter-rater reliability at 0.92 and 0.91 respectively.

Swaine and Sullivan [13] explored the relationship between clinical and instrumental measures of motor coordination with traumatically brain-injured subjects. They concluded that, although meaningful correlations were observed, these two methods of testing do not measure the same dimensions but are complementary. However, in clinical settings, instrumental measures are less available and therefore rarely used by clinicians.

Some authors have reported that motor co-ordination is affected by age [7, 14-16]. Women are usually better co-ordinated than men [7, 15] or no difference is observed between the sexes [16]. In previous research, the dominant hand scored better [7, 15] except the male subjects of Potvin et al. [14] who obtained better scores in the non-dominant hand. The afore-mentioned studies involved different tests, methods and age groups which may. contribute to the observed differences. All used convenience samples which might not be representative of the normal elderly population.

With the ageing of the population, more and more elderly people are at risk of acquiring upper-extremity sensorimotor impairments such as inco-ordination. It is important to be familiar with normal ageing in order to identify pathological changes. However, an all too familiar problem in geriatrics is the absence of normative data. The main objective of the present study was to develop normative data on upper-extremity motor co-ordination of the elderly. Secondly, we wanted to analyse whether differences existed between the sexes and between the performance of the two upper limbs. Finally, we wanted to explore potential relationships between good motor co-ordination and some personal variables such as anthropometrics, prior occupational activity, current activity level and self-perceived health.

Methods

Subjects: A random sample of 360 subjects aged 60 and over, stratified for age (60-69, 70-79, 80 and over) and sex, was drawn from the electoral pool of the city of Sherbrooke (Quebec, Canada). Located 100 miles east of Montreal, Sherbrooke is a town of some 76 000 inhabitants, of whom nearly 17% are over 60. Each subject was first contacted by mail and then by telephone to verify eligibility criteria and the subject's willingness to participate in the study. The eligibility criteria were: lucidity, independence in activities of daily living, adequate eyesight and absence of impairment affecting upper-limb function. When a subject refused or was not eligible, another subject was selected until 60 subjects were enrolled per stratum. People who refused to participate in the study even though eligible were asked to reply to a general information telephone questionnaire in order to estimate refusal bias. Questions asked covered age, dominance, height, weight, current activity level and self-perceived health. Each subject was evaluated at the Upper Limb Functional Measurement Laboratory at the Centre de recherche en gerontologie et geriatrie of the Hopital D'Youville de Sherbrooke. Subjects' dominance was evaluated with the Edinburgh Handedness Inventory [17].

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Upper-extremity motor co-ordination of healthy elderly people

Age and Ageing, March, 1995 by Johanne Desrosiers, Rejean Hebert, Gina Bravo, Elisabeth Dutil

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