Hunt Ann L, Sethi Kapil D
Department of Neurology, Beth Israel Medical Center, New York, New York 10003, USA.
Mov Disord. 2006 Jul;21(7):894-9. doi: 10.1002/mds.20925.
The pull test (PT) is used as a measure of postural instability in Parkinson's disease (PD) and other movement disorders. In 1987, it was incorporated into the Unified Parkinson's Disease Rating Scale (UPDRS), a scale used to measure the severity and treatment response in PD both in research studies and in clinical practice. However, the origins of the observation of postural instability in movement disorders and the attempt to quantify it are much older. Here, we trace the history of postural instability first described as a feature of PD by Romberg in 1853. Attempts to evaluate postural instability began with the first measurement by Charcot in the 1880s by pulling the clothes of patients and progressed to the push on the sternum by Hoehn and Yahr in the 1960s. Eventually, this evolved into the formal PT proposed by Fahn in the 1980s. Despite the widespread use of the PT as part of the UPDRS, variability exists in its execution. Recommendations have been made for training of examiners in clinical trials to improve its accuracy in assessing postural instability. We agree with improving PT technique for clinical trials and advocate for its routine use in clinical practice when diagnosing and treating movement disorders. Further, we propose the name "Fahn pull test" for the maneuver based on his significant contribution to its development.
拉拽试验（PT）被用作衡量帕金森病（PD）及其他运动障碍中姿势不稳的一项指标。1987年，它被纳入统一帕金森病评定量表（UPDRS），该量表在研究和临床实践中均用于衡量PD的严重程度及治疗反应。然而，运动障碍中姿势不稳的观察起源以及对其进行量化的尝试要早得多。在此，我们追溯姿势不稳的历史，它于1853年被Romberg首次描述为PD的一个特征。评估姿势不稳的尝试始于19世纪80年代Charcot通过拉拽患者衣物进行的首次测量，并在20世纪60年代发展为Hoehn和Yahr通过按压胸骨进行的测量。最终，这演变成了20世纪80年代Fahn提出的正式的拉拽试验。尽管拉拽试验作为UPDRS的一部分被广泛使用，但其执行过程中仍存在变异性。已有人建议在临床试验中对检查者进行培训，以提高其评估姿势不稳的准确性。我们赞同在临床试验中改进拉拽试验技术，并提倡在诊断和治疗运动障碍的临床实践中常规使用该试验。此外，基于Fahn对其发展的重大贡献，我们提议将该操作命名为“Fahn拉拽试验”。
