The CAM test: a novel tool to quantify the decline in vertical upper limb pointing movements with ageing.

BACKGROUND AND AIM: Although upper limb movements in the vertical plane are very commonly used during the activities of daily life, there is still a lack of a reliable and easy standardized procedure to quantify them. In particular, ageing is associated with a decline in performances of coordinated movements, but a tool to quantify this decline is missing. METHODS: We created a novel portable test called counting arm movement test (CAM test). Participants were asked to perform fast and accurate successive pointing movements towards two fixed targets (mechanical counters) located in a vertical plane in the parasagittal axis during three different time periods (15, 30, 45 s). Each upper limb was assessed separately. The test was evaluated in a group of 63 healthy subjects (mean age ± SD 49.1 ± 19.8 years; F/M 33/30; range 18-87 years). RESULTS: Motor performances (number of clicks) significantly decreased as a function of age for both the dominant side (age effect; linear regression; p < 0.0001 for 15, 30 and 45 s) and the non-dominant side (linear regression; p < 0.0001 for 15, 30 and 45 s). Performances on the dominant and non-dominant side were linearly correlated with the time periods (p < 0.0001 on both sides). The symmetry index (ratio of performance on the dominant side divided by performance on the non-dominant side) was correlated linearly and positively with the duration of the test (y = 0.002x + 1.053; p = 0.0056). We also found a linear relationship between upper limb length and motor performance on the non-dominant side for 15 s (p = 0.023) and 45 s (p = 0.041). The test was characterized by a very high correlation between the results obtained by two investigators during two successive sessions in a subgroup of 7 subjects (Pearson product moment correlation: 0.989 for the dominant side and 0.988 for the non-dominant side). CONCLUSION: The CAM test appears as a robust and low cost tool to quantify upper limb pointing movements. In particular, the test strongly discriminates the effects of age upon motor performances in upper limbs. Future studies are now required to establish the sensitivity, specificity and reliability of this procedure in selected neuromuscular or skeletal diseases affecting the elderly.

The electronic counting arm movement test (eCAM test).

A novel transportable electronic platform aiming to characterize the performance of successive fast vertical visually guided pointing movements toward two fixed targets (eCAM test: electronic counting arm movement test) is described and one validation test is presented. This platform is based on an Arduino(®) micro-controller and a Processing(®) routine. It records both the pointing performance (number of clicks) and the elapsed time between two successive pointing movements. Using this novel platform, we studied the effects of functional electrical stimulation (FES) applied on the dominant upper limb in 15 healthy volunteers (mean age ± SD: 22.3 ± 4.3 years; 5 males/10 females). The following muscles were stimulated: flexor carpi radialis (FCR), extensor carpi radialis (ECR), biceps brachii (BB), and triceps brachii (TB). The intensities of the stimulation were 2 and 3 mA above the sensory threshold (ST). Movement times were lesser when performed against gravity and pointing performance improved with FES. We provide the first demonstration that low-intensity FES impacts on motor performances during successive vertical goal-directed pointing movements under visual guidance. The eCAM test is currently the sole electronic tool to assess quickly and easily the performances of successive vertical pointing movements. Future potential applications include, in particular, the follow-up of the effects of neurorehabilitation of neurological/neurosurgical disorders associated with hand-eye incoordination, the functional evaluation of upper limb prosthesis or orthosis, and the analysis of the effects of FES in central or peripheral nervous system disorders.