I gusta this mucho. It seems like the rolling tests would also include some degree of cerebellar testing (e.g. for dysdiadochokinesia), due to the coordination and rapid cycling involved — which seems good for sensitivity although perhaps not for specificity. (But a positive cerebellar sign would perhaps present differently — rather than unilateral immobility, more of a general sluggishness or ataxia in the movement.) Things to ponder.
I do have some doubts as to ease of compliance… in the really elderly and comorbid patients, even the arm drift test can be a bit challenging to pull off. I suspect that getting them to do the cha-cha may require, let us say, a fairly low expectation of baseline performance.
I had the same thoughts in regards to cerebellar testing, and I wonder if having the patient close their eyes would increase the yield by really testing the patient’s proprioception.
You second point is also a valid one. I’ve been using this for maybe two years now with most patients I test being able to perform it well enough, but my experience is very skewed because there’s been a good deal of selection bias. I’ve purposely skip it on less cooperative patients because I wasn’t that interested in forcing the issue, but I think from here on out everyone getting a CPSS will also attempt an arm roll.
I’ve been surprised in a few cases when some unexpected patients were able to follow this even though they had fairly progressive dementia, and I think it might have something to do with the active participation required of the test. Tell them to hold their hands out, and they drift off for a nap within two seconds, but get them actively involved in moving their arms and they tend to stick with you for a little bit. Changing direction can require a couple of tries, and there’s a whole lot of patients whose attention you cannot keep for long enough to even get them to lift up their arms in the first place, but a select few may surprise you.
If you’ve had good luck with it, then I believe it. I wonder how necessary it is to try both directions. Doesn’t seem like the neuromotor pattern would be all that different.
The Conga Line Test is an easy and fun test to administer at home, in a skilled nursing facility, or in the back of your ambulance! We recommend playing some Buena Vista Social Club to really set the mood.
In all seriousness this is wonderful and I think it is far easier to administer than the standard arm drift. At 3am nobody likes to remember palms up versus palms down…
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