Oral Posters: Innovative Technologies

Presented by: A. Patel - View Audio/Video Presentation (Members Only)

Author(s):

T.J. Jenkins(1), B. Rosenthal(1), A. Ranade(2), W.K. Hsu(1), A.A. Patel(1)

(1) Northwestern University Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, IL, United States
(2) Rosalind Franklin University of Medicine and Science, Chicago, IL, United States

Abstract

Intro: Cervical myelopathy is the leading cause of spinal cord dysfunction in the adult population. Despite the prevalence and importance of the condition there is a paucity of objective and quantitative clinical measures for analysis of the disease process. The most common diagnostic tools available to the physician are non-quantitative physical exam findings (pathologic reflexes, gait disturbance) and subjective scoring systems (mJOA, Nurick scales). The lack of an easily-performed, objective, and quantitative diagnostic tool has hindered the diagnosis of these patients. In an effort to better classify myelopathy, provide earlier diagnosis, and improve clinical outcome measurements we developed a novel iPad application to test fine motor skills. A decline in these fine motor skills is an early hallmark of cervical myelopathy. We wrote a novel code for the iPad application with clinical application in mind and thus were able to fine tune the instrument making use efficient for clinicians and patients.

Methods: We recruited 71 healthy control patients and 8 myelopathic patients aged of at least 18 years and no neurologic or physical condition (i.e. Parkinson's, dementia, blindness, rheumatoid arthritis) that precluded fine motor testing. Myelopathic subjects were diagnosed by a fellowship trained spine surgeon based on clinical and radiographic evaluation. Enrolled patients completed the modified Japanese Orthopaedic Association scale (mJOA) for cervical myelopathy and our novel Fine Motor Skills (FiMS) iPad application. The FiMS iPad application consists of 4 unique challenges (Fig 1). All the challenges focus on the use of fine motor dexterity testing and increase in difficulty as the challenges progress. Challenge 1 involves accurately tapping a moving target on the screen. Challenge 2 necessitates dragging a target on the screen to a goal. Challenge 3 involves moving a target through a maze without touching the maze walls. Challenge 4 is similar to Challenge 2 but requires the use of both hands to drag 2 separate targets to a goal. The scores are recorded independently for each challenge and the mean scores were used for data analysis. A student t-test was used to determine significance with a p-value set at < 0.01.

Results: The average mJOA score (scale 0-18) for the myelopathic cohort was 11.4 with a score less than 12 being classified as severe myelopathy. The 71 control patients had a mean mJOA score of 17.4 with a score greater than 17 being inconsistent with myelopathy . Regression analysis of the healthy controls (n=71) showed that FiMS challenge scores decreased with age in all four challenges. When compared to age-matched healthy controls (n=44) the myelopathic cohort (n=12) had significantly lower FiMS scores for all challenges 1-4 (Table 1).

Conclusion: The novel Fine Motor Skills (FiMS) iPad application produced significantly lower scores in a myelopathic cohort when compared to an age-matched control cohort. This is true for all 4 challenges in the FiMA iPad application. In summary, the FiMS iPad application is a novel, easily administered, objectively quantifiable test for analyzing cervical myelopathy.

Figure 1

Table 1