Finger Tapping Test
The Finger Tapping Test is a measure of motor speed and is one of the components of the Halstead-Reitan Battery. It was originally developed by Halstead and improved by Reitan and Wolfson.72 This is probably the most widely used test of manual dexterity. It consists of tapping a key with a device that records the number of taps. The score for each hand is the average of five trials. Traumatic brain injury, if it produces motor slowing, often will have an adverse effect on finger-tapping rate. Lateralized lesions usually result in slowing of the tapping rate of the contralateral hand. There are norms for this test based on sex, age, and educational background.141
This test is sensitive to unilateral lesions, particularly in the posterior frontal lobes. However, it is sensitive to many conditions besides traumatic brain injury, including AIDS, Huntington's disease, Parkinson's disease, and other neurological or neurodegenerative disorders. It is also susceptible to false positives in severely depressed patients with psychomotor slowing or individuals on medications that produce motor slowing.
The Grip Strength Test is also called the hand dynamometer test. It is used to assess grip strength in each hand.72 It is a subtest within the Halstead-Reitan Battery. The test is based on the assumption that lateralized brain damage may affect strength of the contralateral hand. It is easily administered in approximately 5 min. However, this is a very effort-dependent test, and there is no method for determining validity. It can be consciously manipulated. Moreover, persons who have orthopedic injuries (e.g., cervical radiculopathy or carpal tunnel syndrome) or arthritis in the hands may perform poorly on this test. It is not a test used alone to detect brain injury or lateralized injury. It is performed with a dynamometer, and the force exerted in kilograms for each hand is averaged for two trials. One generally expects a 10% difference in strength between hands in normal persons, with the dominant hand showing the superior strength.
This test is a subtest within the Wisconsin Neuropsychological Test Battery. It was developed by Kl0ve in 1963.142 The test consists of a small board that contains a 5 ¥ 5 set of slotted holes. These function like keyholes, and each peg has a key ridge along one side that requires it to be rotated into position before it may be inserted. It is actually quite a complex test, which makes it very sensitive for measuring general slowing, whether it is due to medication, neurodegenerative disease, Parkinsonism, or other disorders. It can aid in identifying lateralized impairment. The method of scoring is based on the time to completion of the test. Generally, both hands are tested, but only one hand may be used if the examiner only wishes to know about motor speed. If measurements of lateralization of brain injury are required, both hands should be tested. Norms are available for both hands.3,207
Finger Localization and Fingertip Number Writing Test
This is a subtest of the Halstead-Reitan Battery and is part of the Sensory-Perceptual Examination. The finger localization portion of this test is a measure of finger agnosia. It is administered by blindfolding the patient and touching her fingers. There is a standardized format for touching fingers, and then the patient must report the name and number of each finger as it is touched. In the fingertip-writing portion, the examiner writes the numbers 3, 4, 5, or 6 in a standardized order, again with the patient blindfolded, until a total of 20 numbers have been written on the fingertips of each hand. The patient must identify which number the examiner has written. A significant number of errors is consistent with sensory impairment of either the peripheral nerves to the fingers or the contralateral parietal lobe. In the examination of a brain-injured patient, assuming peripheral nerve function is intact, this test will identify contralateral parietal lobe dysfunction.72,143
This test is a component of the Halstead-Reitan Test Battery.72 It contains a number of clinical tests to determine tactile stimulation and possible suppression, auditory stimulation and possible suppression, and the visual fields. In the tactile perception test, the patient's hands are placed on a table in front of the examiner with the palms down. The eyes are closed or blindfolded, and the examiner touches either the back of each hand or both hands lightly in a random sequence. After
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