Tutorial for making the Composite Cerebellar Functional Score (CCFS) board

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Introduction

The Composite Cerebellar Functional Severity Score is a quantitative tool to measure cerebellar severity independently from age. It is an assessment in addition to a clinical examination and has demonstrated its usefulness in epidemiological studies, clinical trials, and patient follow-up. It was validated in adults and children. The CCFS is a combination of the time to perform 2 tasks, a 9-hole pegboard and a click test. Both tasks include a series of alternative movements: placing pegs and finger-pointing cycles, adjusted on age. A score is calculated and used as a follow-up measure of cerebellar signs. Pr Alexandra Durr and Dr Sophie Tezenas du Montcel have the pleasure to give you access to this online version that has been developed to facilitate administration and increase reliability and reproducibility. You can find all information, technical explanations and blueprints to build your own CCFS Board. Laser cutter machine is the only technical machine you would need to build your CCFS Board. You can find this kind of machine in your university or city’s FabLab.

Production stages

Parts Cutting

For this first step, you need a laser cuter access in your preferred FabLab. The laser cuter dimension has to be standard : 600*400mm. You need a pmma layer (400*400*3mm) (or other adapted raw).
1-    Download the file : Cutter Sheet With Numbers.pdf / Cutter sheet.dxf
2-    Follow the laser cuter instructions to cut parts of the CCFS board.

Set-up tutorial

The numbers of the parts are noted on the .pdf file « cutter sheet with numbers »

Step 1 : Buttons
parts needed: 8×2 – 9 – 10 – 11 – 12 – 16
– bond 2 copies of part 16 together, observe the correct fitting orientation, take the orientation in which the parts 16 are cut
– bond the part 11 under the part 16


– bond (or assemble with brackets and screws) the three sides of the button box (parts 8×2, 12)


– bond the button on the part 10 and weld two wires on the two pins of the button
– bond the part 10 on the three sides of the button box, in such a way that one side of the button box remains empty
– place the wires in the guide slot provided for this purpose
– close the button box by bonding part 9 on the empty side

Repeat these instructions by taking the same orientation for the bonding of the parts 16 to make the other button box.

Step 2 : The sides of the CCFS box
parts needed : 1 – 2 – 3 – 4 – 13 – 14 – 15×4
– bond (or assemble with brackets and screws) parts 2,3 and 4 to the part 1, observe the correct fitting orientation, take the orientation in which the part 1 is cut


– drag the parts 16 of the button boxes through the parts 3 and 4


– bond the parts 15 to the part 1
– bond the parts 13 and 14 over the parts 15, parts 13 are for the left button, parts 14 are for the right button

Step 3 : Close the CCFS box after putting all the electronic parts in it
parts needed : 5 – 6 – 7 ;
– bond the parts 5 and 7 to the parts 2,3 and 4
– screw the part 6 to the hinge screwed to part 1

Arduino board programming

At this step, upload the algorithm in the Arduino board:
1-    Download and set up the IDE Arduino software in your computer
2-    Download the file : CCFS Arduino.zip
3-    Open the file with Arduino Software
4-    Follow Arduino software process to upload the file in the Arduino board after wiring it to your computer

Optocoupler board

1-    Cut a 100mm x 100mm dimensioned electronic proto board with
2-    Weld the optocoupler on the board at the right distance (see cutter sheet)
3-    Weld the 200ohms resistor  on the board

4-    Wire the different electronic components

5-    Attach the board on the 9 holes box face

Front LED and buttons

1-    Cut a 40mm x 25mm dimensioned electronic proto board
2-    Weld the LED on the board with 12mm between each LED
3-    Weld the buttons on the board with 7mm between each buttons

4-    Weld the 300ohms resistor  on the board
5-    Wire the different electronic components

6-    Wire the LCD Screen (see electronic wiring).
7-    Attach the board and the LCD screen on the front face.

Electronic wiring

Download and see : CCFS_elec_CAD.pdf

Electronic parts in the box

1-    Place the Arduino board in the box
2-    Place the battery holder in the box

Final step

1-    Use glue to attach the last box face (9 holes) as pictured above

Inventory

QUANTITY REFERENCES
1 Arduino MEGA 2560
1 Platine SD Card Shield V4.0 for Arduino
1 Screen 2 x 16 characters
10 opto-switches
1 resistors 200 & 300
3 green led 3mm
3 mini switch
1 slide switch ON/OFF
2 buttons (30mm)
QUANTITY REFERENCES
Multiple colored wires
1 Bakelite board (15cm*9cm)
1 Bakelite board (5cm*7cm)
4 head supports for PCB
1 Sheet of pmma 3mm 600x600mm
Epoxy Glue
4 batteries AA
QUANTITY REFERENCES
1 holder 4 AA
1 Hinge
10 steel brackets

 

Instructions for CCFS Board use

First of all, be sure that the batteries are full and the SD card is available with free space.

–    Start the CCFS
Use the ON/OFF button on the side

–    File name
Name the file .csv which will be created to store the CCFS score. You can only use numbers from 0 to 9 to name the file. Use the « + » and « – » buttons to choose the set of numbers and press OK to implement the file’s name. When the name is correct, choose « V » on the screen to valid the name.
Press ok to continue.

–    Age
Enter the age of your participant. Use the « + » and « – » buttons to choose the correct age and press OK.

–    Nine-hole pegboard test (9hls)
The screen indicates the « nine-hole test », press OK when you and the participant are ready to start the test.
You should be seated face to face with the participant and the screen should be on your side.
The participant is seated and holds nine pegs  in the non dominant hand and places them randomly, one by one, as fast as possible, with the other hand (the dominant one) in the board with nine holes. If the participant drops a peg, he/she has to repeat the test.
To repeat the test, you need to place the pegs in the remaining empty holes. Then, remove all the pegs from the board before renewing the test. Press OK. The screen indicates “repeat the test ?”; you can choose yes or no with the “+” and “-“ buttons. Validate your choice, by pressing OK. The participant can then perform this test again. If the participant drops the peg again during the repeat test, you should consider that he/she is not able to perform the nine-hole peg test.
An intermediate score appears on the screen at the end of this test. Press OK to continue and remove the pegs.

–    Click test
To perform this test, you have to telescope the two arms supporting the buttons.
The screen indicates the « click test », press OK when you and the participant are ready to start the test.
The participant uses a dominant hand finger of his/her choice to press one button, alternately 10 times on each button, as fast as possible and strong enough in the middle of the buttons. The number of goes is indicated on the screen and you can stop the participant after 10 goes. PRESS OK.
The screen indicates “repeat the test ?” but you are not supposed to repeat this one except if the participant misunderstood the instructions.
To repeat the test, you can choose yes or no with the “+” and “-“ buttons. Validate your choice, by pressing OK.

NB:
•    After each test, you get the score of the performed one
•    During both tests, make sure the participant doesn’t take support on the table with his/her “working” arm.

–    Save the CCFS score
When both tests are passed, the screen displays the CCFS score. Press OK to save the score on the SD Card. The screen indicates”Exam successfully saved.

–    Repeat the tests with another participant or switch off the CCFS with the on/off button on the side.

Contact

Pierre Tissier – Email