Video 1
Unified Parkinson's Disease Rating Scale (UPDRS)24 Rapid, Repetitive Hand-Opening Task. Brief summary. Subject 1: Normal hand-opening/closure: thumb folds over fingers in all repetitions bilaterally, without thumb flexion. Subject 2: Recurrent thumb flexion is seen bilaterally, despite instructions to keep the thumb out (0’22”). Subject 3: Consistent thumb flexion is seen, despite instructions to keep the thumb out (0’45”). Subject 4: Progressive right thumb flexion and consistent left thumb flexion are seen. Subject 5: Consistent right thumb flexion and recurrent left thumb flexion are seen despite instructions to keep the thumb out (1’27”) and a repeat attempt with the right hand. Additional details. Subject 1: Normal hand-opening/closure: the thumb folds over fingers during hand-closure bilaterally on all repetitions, without thumb flexion. Subject 2: Subject opens and closes the right hand 19 times. Thumb flexion is seen in 17 of these repetitions. After instruction to maintain the thumb out, the subject performs two repetitions without thumb flexion; thumb flexion then recurs. The subject then flexes the left hand 11 times; thumb flexion is seen in 10 of these. (Instructions at 0’22”: “Yes, yes, good. And also get the thumb out.”) Subject 3: The subject opens and closes the right hand 16 times; thumb flexion is seen in all repetitions despite instructions to keep the thumb out. The subject then opens and closes the left hand 14 times; thumb flexion is seen in all repetitions. (Instructions at 0’45”: “And the thumb also out.”) Subject 4: The subject opens and closes the right hand 16 times. Thumb flexion is seen in all repetitions, initially folding over the fingers for four repetitions, then folding under them. The subject then opens and closes the left hand 15 times; thumb flexion is seen in all repetitions. Subject 5: The subject opens and closes the right hand 15 times; thumb flexion is seen in all repetitions. The subject then opens and closes the left hand 29 times; thumb flexion is seen in all but one repetition despite instructions to keep the thumb out. The subject is then asked to repeat the maneuver on the right, performed 13 times. Thumb flexion is seen in all repetitions. (Instructions at 1’24”: “Then the other side, all fingers out” and 1’27”: “The thumb, can you also get it out?”).
Table 1
Leading Diagnosis and Differential Diagnosis by Author (Diagnoses Deemed Excluded by an Author Are Not Included Here)
| Dr. Defazio | Dr. Greene | Dr. Jinnah | Dr. Tijssen | |
|---|---|---|---|---|
| Leading Diagnosis | ||||
| Dystonia | X | X | X | X |
| Differential Diagnosis | ||||
| Dystonic tic | X | |||
| Cortical thumb | X | X | ||
| Lower motor neuron injury | X | |||
| Culturally bound syndrome | X | X | ||
| Anatomical variant | X | |||