Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Behaviour and Cognition, Nijmegen, The Netherlands.
Eur J Neurol. 2022 Dec;29(12):3508-3512. doi: 10.1111/ene.15532. Epub 2022 Sep 8.
Clinical experience suggests that many patients with functional motor disorders (FMD), despite reporting severe balance problems, typically do not fall frequently. This discrepancy may hint towards a functional component. Here, we explored the role of the Shoulder-Touch test, which features a light touch on the patient's shoulders, to reveal a possible functional etiology of postural instability.
We enrolled consecutive outpatients with a definite diagnosis of FMD. Patients with Parkinson's disease (PD) or progressive supranuclear palsy (PSP) with postural instability served as controls. Each patient underwent a clinical evaluation including testing for postural instability using the retropulsion test. Patients with an abnormal retropulsion test (score ≥ 1) also received a light touch on their shoulders to explore the presence (S-Touch+) or absence (S-Touch-) of an incongruent, exaggerated postural response, defined as taking three or more steps to recover or a fall if not caught by the examiner.
From a total sample of 52 FMD patients, 48 patients were recruited. Twenty-five patients (52%) had an abnormal retropulsion test. Twelve of these 25 patients (48%) had an S-Touch+, either because of need to take two or more steps (n = 4) or a fall if not caught by the examiner (n = 8). None of the 23 PD/PSP patients manifested S-Touch+. The sensitivity of the S-Touch test was 48%, whereas its specificity was 100%.
The S-Touch test has a high specificity, albeit with a modest sensitivity, to reveal a functional etiology of postural instability in persons with FMD.
临床经验表明，许多功能性运动障碍（FMD）患者尽管报告严重的平衡问题，但通常不会经常摔倒。这种差异可能暗示存在功能性因素。在这里，我们探讨了肩部触碰测试的作用，该测试的特点是轻触患者的肩膀，以揭示姿势不稳定的可能功能性病因。
我们连续招募了明确诊断为 FMD 的门诊患者。帕金森病（PD）或进行性核上性麻痹（PSP）伴姿势不稳的患者作为对照组。每位患者接受临床评估，包括使用后退测试测试姿势不稳定。后退测试异常（得分≥1）的患者还接受肩部轻触，以探索是否存在（S-Touch+）或不存在（S-Touch-）不协调、夸大的姿势反应，定义为需要采取三步或更多步才能恢复，或如果未被检查者抓住则摔倒。
从总共 52 名 FMD 患者的样本中，招募了 48 名患者。25 名患者（52%）后退测试异常。这 25 名患者中有 12 名（48%）出现 S-Touch+，要么因为需要采取两步或更多步（n=4），要么因为如果未被检查者抓住则摔倒（n=8）。23 名 PD/PSP 患者均未出现 S-Touch+。S-Touch 测试的敏感性为 48%，特异性为 100%。
S-Touch 测试具有较高的特异性，尽管敏感性适中，可揭示 FMD 患者姿势不稳定的功能性病因。
