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Finger and Hand Dexterity – development of a sensitive measurement tool

Neurological conditions like Motor Neuron Disease (MND), Multiple Sclerosis (MS) and Parkinsons Disease (PD) result in decreased functional ability in walking ability (gait) and hand function (dexterity). These changes occur from weakness, incoordination, spasticity and decreased sensation either alone or in combination. Drug development for these conditions relies on pre-clinical identification of therapeutic compounds, followed by clinical trials. The objective in trials is to measure the effect of a compound on functional ability, by determining whether it can slow down or stop the rate of neurological decline. But detection of meaningful change requires reliable quantitative outcome measurements, and the majority of scales used for clinical trials are semi-qualitative. This means they attribute a numerical value to a clinical assessment by an examiner. Because clinical examination can be very variable, conversion of the clinical findings to a rigid ordinal scale introduces problems with reliability and variance, which increases the risk of failure to identify a real effect of a new drug. Also, most scales do not provide a “clinical meaningfulness” measurement. We have no way of determining the real-life impact of a drug, because we cannot convert the numerical outcome measurement into how it functions in everyday life. My supervisor’s group is developing sensitive non-subjective tests to resolve the problems of variance in the outcome measure for MND (the ALSFRS-R). This project will develop a new device to measure hand dexterity. This could be used with the ALSFRS-R to improve reliability and to provide a measure of clinical meaningfulness.