Comparative analysis of diadochokinetic movements

Tests of diadochokinesia are an inherent part of a neurological examination. Various quantifying methods have been proposed to increase the objectivity, sensitivity, and reliability of such examinations. The methods used and analyses performed, however, differ substantially between tasks. We used a three-dimensional, ultrasound-based recording device to continuously record joint angles during three diadochokinetic movements, avoiding any external constraints of the movements. Alternate pronation and supination of the forearm, tapping with the whole hand and with the index finger in isolation were analyzed in a sample of 63 healthy control subjects. The most sensitive measure for capturing effects of gender, sex, and active hand was frequency. The right hand was faster than the left in all tasks, tapping performance declined with increasing age, and male subjects were faster than females in forearm diadochokinesia. Other measures that characterize speed of movement such as maximum angular velocities and accelerations did not yield comparable sensitivity in detecting the same statistical effects. However, angular velocity achieved the highest test-retest reliability for forearm diadochokinesia, while frequency was reproduced in the tapping tasks. Additional measures characterizing symmetry of the angular velocity profiles and intraindividual variability were shown to be largely independent of movement speed. Examples in neurological patients showed that the data define a valuable standard against which pathological performance can be precisely evaluated. In addition, the different measures captured dissociable aspects of motor performance that may further help to characterize the deficit and adjust therapy.