The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

The overall goal of this procedure is to assess neurological and neuropsychological performance using an innovative iPad-based application, the multiple Sclerosis Performance Test, orm SPT. This is accomplished by first instructing the subject in and then having them perform the following tests, the walking speed test, a 25 foot timed walk the balance test a measure of how the subject integrates sensory information to maintain postural stability. The manual dexterity test to measure arm function, the low contrast letter acuity test that measures visual function.

And finally, the processing speed test that assesses information processing speed. Ultimately, neurological and neuropsychological performance is quantified and compared with reference populations to determine type and severity of disability in each particular subject and to compare change over time. The multiple sclerosis performance test MSPT is an innovative and improved way to measure disability in people with multiple sclerosis.

Our validation studies show that MSPT performs favorably to traditional technician based testing. We believe the MSPT has the potential to have a major impact in patient care and research in multiple sclerosis. To prepare for the MSPT, make sure the subject understands each part of the testing and knows that the MSPT will be conducted in the following order.

Timed 25 foot walk test nine hole PEG test dish nine hole PEG test row, low contrast letter acuity test and processing speed test. Make sure the subject wears comfortable shoes and ask if an assistive device is needed to perform the timed 25 foot walk. Before starting the test, ensure the iPad volume is turned up.

The technician has a manual stopwatch and has encouraged the subject to use their usual assistive device for walking. Using a special iPad belt lace the tablet facing outwards on the subject’s lower back At the sacral level, ask the subject to stand just behind the start line. Inform the subject to start walking.

When the technician presses a start button on the iPad and gives the command to start, then activate the walking test by pressing the start button while walking along with the subject and using a stopwatch to manually time them. Observe the subject, walk 25 feet two and pass the finish line as quickly and safely as possible without slowing down. When the subject passes the finish line, hit the iPad stop button.

After the subject completes the task, enter the result directly into the iPad to carry out the balance test that examines the integration of sensory information in maintaining postural stability. Affix the tablet at approximately sacral level. Ensure the volume on the tablet is turned up and inform the subject that the test consists of two 32nd trials.

For the first trial, have the subject stand with their hands positioned on their hips and while keeping both feet together, balance with their eyes open for 30 seconds, refer to the text protocol on how to count errors. For the second trial, have the subject stand with hands positioned on their hips. Place both feet together, close their eyes and balance for 30 seconds.

To perform the nine hole dish test as a timed measure of dexterity, begin by placing pegs in the starting dish, beginning with the dominant hand and allowing the subject to study the peg board with the non-dominant hand. Have the subject pick up the pegs one at a time and place each peg into a hole in any order until the holes are filled. When all nine holes are filled without pausing, have the subject remove the pegs one at a time, returning them to the dish container.

When the subject completes the task, touch the tablet screen. Have the subject, repeat the test with the same hand before repeating it twice with the non-dominant hand. To carry out the nine hole row test, place the pegs in the starting home row.

Position 7.1 centimeters from the middle of the center insertion holes using only the dominant hand and steadying the peg board with the non-dominant hand. Have the subject pick up the pegs one at a time and put them into the holes located in the middle of the PEG board in any order until the holes are filled. Then without pausing, have the subject remove the pegs one at a time, returning them to the dish container.

When the subject finishes the task, touch the tablet screen. Have the subject, repeat the test with the same hand before repeating it twice with the non-dominant hand with the subject seated. Use a music stand and a measuring tool to place the iPad at eye level five feet away from the subject.

Inform the subject that one row of five letters will appear on the screen and instruct them to identify the letters in order from left to right. Score the subject based on the number of letters correctly identified out of the five presented for each subsequent trial. Present rows of letters that become progressively smaller and with lower contrast.

Continue with additional trials until the smallest letter size identifiable by the subject has been determined. Okay, so now we are moving on with your final testing, which measures your thinking scales in cognitive function. So once I press start, you will hear all the instructions what to do on this test.

For this test, you’ll see two lines of boxes at the top of the screen. Each box in the upper row has a symbol in it, and each box in the lower row has a number in it. This section of this screen is called the key and indicates which symbols go with which numbers.

Now look at the middle of the screen. Notice that the boxes on the top have symbols, but the boxes beneath are empty. Your job is to fill in each empty box with the number that goes with each symbol according to the way they’re paired in the key at the top of the screen.

To fill in the empty box with a number, you’ll use the keyboard located at the bottom of the screen. The keyboard has the numbers from one to nine. You can make a response by lightly touching one of the numbers.

For example, if you look at the first symbol in the middle of the screen and then look up at the key at the top of the screen, you can see that this symbol is paired with the number two. So you would select the number two using the keyboard. Now we will begin a practice test.

Please select the number that should go in each empty box according to the way that the symbols are paired in the key at the top of the screen. Please only use the index or pointing finger of your writing hand to select the numbers using the keyboard at the bottom of the screen, please press the begin practice button to begin. Now we are ready to begin the test.

You are asked to select the numbers just like you did in the practice test. Once you fill in all the numbers in the row, a new row of symbols will appear. Just keep selecting numbers until you are instructed to stop.

Unlike the practice test, you will not be given feedback indicating if you selected the correct number. If you do select the wrong number, simply go on to the next symbol. Since you cannot correct your answer, remember to work as quickly and accurately as you can.

When you’re ready to begin the test, press the begin test button 3 2 1 51. Multiple sclerosis patients and 49 healthy controls were tested using the SPT average disease duration in the MS patients. Defined as time from first MS symptom was 12.1 years average EDSS was 3.9 74.5%were using MS disease modifying drugs.

29.4%had progressive forms of MS, and 43%were employed. Full-time test three test reproducibility was analyzed by inspecting visual plots and by generating concordance correlation coefficients. This figure shows reproducibility data for the technician based testing and MSPT testing for the dimensions of walking, manual dexterity vision and cognitive processing speed.

Reproducibility was similar for MS patients and healthy controls. Concurrent validity was tested by comparing the technician and iPad tests using Pearson correlation coefficients. As shown here, correlation coefficient succeeded 0.8 and in some cases, 0.9 in all tests for both MS patients and healthy controls.

This table shows that each component of the SPT distinguished MS from healthy controls. The effect size, meaning the sensitivity and distinguishing MS from HC was quantified using Cohen’s D as shown here in the table, the MSPT compared favorably to the technician testing. The MSPT can help us move into the future in measuring the impact of multiple sclerosis.

First, it can be directly linked to a research or clinical database. Second, because the test is computer based, we can conduct various advanced types of analyses on the data. Third, we have the possibility of adapting this technology for in-home use, making it possible for patients to come to the clinic less often.

And lastly, this technology is potentially transformational. It’s an entirely new way to measure the clinical impact of multiple sclerosis.