The Paper-Toss Test (PTT) is a simple bedside clinical assessment tool designed to detect unilateral ideomotor apraxia, a core feature of Corticobasal Syndrome (CBS)[@lueg2025]. This test was proposed in a 2025 video-based case series as a practical tool to facilitate earlier and more accurate diagnosis of CBS[@lueg2025].
Ideomotor apraxia is a hallmark feature of CBS, characterized by the inability to perform learned motor movements upon command, despite preserved motor strength and coordination[@lueg2025]. This deficit arises from disruption of the parietal-frontal praxis network, which is particularly vulnerable in CBS pathology.
The challenge with ideomotor apraxia in clinical practice:
A positive Paper-Toss Test indicates unilateral ideomotor apraxia when the patient exhibits:
| Finding | Description |
|---|---|
| Absent release | Failure to release the paper ball at the appropriate moment |
| Delayed release | Prolonged hesitation before releasing the paper ball |
| Interrupted throwing motion | Incomplete or stuttering throwing movement |
In the 2025 study by Lueg et al., four patients with different underlying CBS pathologies were evaluated[@lueg2025]:
| Patient | Underlying Pathology | PTT Result |
|---|---|---|
| 1 | Alzheimer's disease (AD) | Positive |
| 2 | Progressive Supranuclear Palsy (PSP) | Positive |
| 3 | Corticobasal Degeneration (CBD) | Positive |
| 4 | Corticobasal Degeneration (CBD) | Positive |
Key Finding: All four patients, regardless of their underlying pathology, exhibited a positive Paper-Toss Test, suggesting this test may be useful for detecting the clinical syndrome of CBS regardless of the specific neuropathology[@lueg2025].
The Paper-Toss Test complements other clinical assessments for CBS:
See also: Clinical Assessment of Corticobasal Syndrome