The BRadykinesia Akinesia INcoordination (BRAIN) tap test: capturing the sequence effect

Abstract

BackgroundThe BRAIN tap test is an online keyboard tapping task that has been previously validated to assess upper limb motor function in Parkinsons disease (PD).\n\nObjectivesTo develop a new parameter which detects a sequence effect and to reliably distinguish between PD patients on and off medication. Alongside, we sought to validate a mobile version of the test for use on smartphones and tablet devices.\n\nMethodsBRAIN test scores in 61 patients with PD and 93 healthy controls were compared. A range of established parameters captured speed and accuracy of alternate taps. The new VS (Velocity Score) recorded the inter-tap speed. Decrement in the VS was used as a marker for the sequence effect. In the validation phase, 19 PD patients and 19 controls were tested using multiple types of hardware platforms including smart devices.\n\nResultsQuantified slopes from the VS demonstrated bradykinesia (sequence effect) in PD patients (slope cut-off -0.002) with sensitivity of 58% and specificity of 81% (discovery phase of the study) and sensitivity of 65% and specificity of 88% (validation phase). All BRAIN test parameters differentiated between on medication and off medication states in PD. Most BRAIN tap test parameters had high test-retest reliability values (ICC>0.75). Differentiation between PD patients and controls was possible on all hardware versions of the test.\n\nConclusionThe BRAIN tap test is a simple, user-friendly and free-to-use tool for assessment of upper limb motor dysfunction in PD, which now includes a measure of bradykinesia.