The pull test: A history

• Published in: Movement disorders Vol. 21; no. 7; pp. 894 - 899
• Main Authors: Hunt, Ann L., Sethi, Kapil D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-07-2006; Wiley
• Subjects: Biological and medical sciences; Cerebrospinal fluid. Meninges. Spinal cord; Europe; History, 19th Century; History, 20th Century; Humans; Investigative techniques of ocular function and vision; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Nervous system (semeiology, syndromes); Neurology; Parkinson Disease - history; Parkinson's disease; Postural Balance; postural instability; pull test; Severity of Illness Index; Unified Parkinson's Disease Rating Scale; United States; United States; Europe; Nervous system diseases; pull test; Parkinson's disease; Evaluation scale; Central nervous system disease; Parkinson disease; Instability; Degenerative disease; postural instability; Cerebral disorder; Extrapyramidal syndrome; Unified Parkinson's Disease Rating Scale
• ISSN: 0885-3185; 1531-8257
• 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. © 2006 Movement Disorder Society