An extended drawing test for the assessment of arm and hand function with a performance invariant for healthy subjects

Impaired hand motor function resulting from neurological, psychiatric or orthopaedic disorders affects patients of all ages. Existing hand function assessment methods, e.g. rating scales, accelerometers and electromyographical devices, are often time-consuming to administer, subjective in interpretation and/or expensive. Graphonomic tests are gaining popularity as a way of avoiding these drawbacks while relating directly to writing and drawing. Here we present a computerized Extended Drawing Test (EDT), which improves on an earlier Drawing Test for stroke patients in three ways. First, it assesses isolated proximal arm movement using a graphics pen in a puck-like pen holder, and in addition combined arm and finger dexterity in movements using a normal writing grip. Secondly, we calibrated our test against 186 healthy subjects (3-70 years), finding significant age- and handedness-related differences in both speed and accuracy of drawing. Thirdly, to simplify assessment we devised an overall performance measure using a variant of Fitts' Law combining speed and accuracy, which we found to be age-independent for healthy subjects above 3 years of age. This result enables us to provide age-independent performance norms using both hands, with and without the pen holder. These norms may assist quantification of specific arm dysfunction by comparing patient performance with the healthy norms, and also by comparing within-patient performance in the dominant and non-dominant hands with and without the pen holder. Using our freely available software, this new test will allow clinicians to rapidly assess arm and hand function across a wide range of patient categories and ages.