Interobserver reliability of a new horizontal pointing manoeuvre: comparison with conventional tests.

Finger-to-nose test, fine finger movements, to maintain arms against gravit y, alternate movements of hands, Barany's test muscle tone evaluation, Stew art-Holmes test and handwriting are the conventional clinical tests most fr equently used in daily practice to evaluate voluntary movements of the uppe r limb. We describe a new clinical manoeuvre consisting of a horizontal poi nting movement of one upper limb (the moving limb) towards the contralatera l motionless limb. We have analyzed the reliability of our new test and of the conventional tests between a observers using kappa statistics in a grou p of 34 right-handed neurological patients. Agreement is very good for our test since k has a value of 0.63 for left upper limb and a value of 0.64 fo r right upper limb. The only conventional test characterized by a higher in terobserver reliability is handwriting. Furthermore, our manoeuvre is origi nal, as attested by partial association coefficients analysis between our t est and conventional tests. This might be due to the fact that our manoeuvr e is the sole test investigating rapid proximal movements towards a fixed a rea in space. In conclusion, our horizontal pointing manoeuvre has a very g ood reliability between 2 observers and appears original.