1
|
Paredes-Acuna N, Utpadel-Fischler D, Ding K, Thakor NV, Cheng G. Upper limb intention tremor assessment: opportunities and challenges in wearable technology. J Neuroeng Rehabil 2024; 21:8. [PMID: 38218890 PMCID: PMC10787996 DOI: 10.1186/s12984-023-01302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Tremors are involuntary rhythmic movements commonly present in neurological diseases such as Parkinson's disease, essential tremor, and multiple sclerosis. Intention tremor is a subtype associated with lesions in the cerebellum and its connected pathways, and it is a common symptom in diseases associated with cerebellar pathology. While clinicians traditionally use tests to identify tremor type and severity, recent advancements in wearable technology have provided quantifiable ways to measure movement and tremor using motion capture systems, app-based tasks and tools, and physiology-based measurements. However, quantifying intention tremor remains challenging due to its changing nature. METHODOLOGY & RESULTS This review examines the current state of upper limb tremor assessment technology and discusses potential directions to further develop new and existing algorithms and sensors to better quantify tremor, specifically intention tremor. A comprehensive search using PubMed and Scopus was performed using keywords related to technologies for tremor assessment. Afterward, screened results were filtered for relevance and eligibility and further classified into technology type. A total of 243 publications were selected for this review and classified according to their type: body function level: movement-based, activity level: task and tool-based, and physiology-based. Furthermore, each publication's methods, purpose, and technology are summarized in the appendix table. CONCLUSIONS Our survey suggests a need for more targeted tasks to evaluate intention tremors, including digitized tasks related to intentional movements, neurological and physiological measurements targeting the cerebellum and its pathways, and signal processing techniques that differentiate voluntary from involuntary movement in motion capture systems.
Collapse
Affiliation(s)
- Natalia Paredes-Acuna
- Institute for Cognitive Systems, Technical University of Munich, Arcisstraße 21, 80333, Munich, Germany.
| | - Daniel Utpadel-Fischler
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Keqin Ding
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gordon Cheng
- Institute for Cognitive Systems, Technical University of Munich, Arcisstraße 21, 80333, Munich, Germany
| |
Collapse
|
2
|
Chandrabhatla AS, Pomeraniec IJ, Ksendzovsky A. Co-evolution of machine learning and digital technologies to improve monitoring of Parkinson's disease motor symptoms. NPJ Digit Med 2022; 5:32. [PMID: 35304579 PMCID: PMC8933519 DOI: 10.1038/s41746-022-00568-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor impairments such as tremor, bradykinesia, dyskinesia, and gait abnormalities. Current protocols assess PD symptoms during clinic visits and can be subjective. Patient diaries can help clinicians evaluate at-home symptoms, but can be incomplete or inaccurate. Therefore, researchers have developed in-home automated methods to monitor PD symptoms to enable data-driven PD diagnosis and management. We queried the US National Library of Medicine PubMed database to analyze the progression of the technologies and computational/machine learning methods used to monitor common motor PD symptoms. A sub-set of roughly 12,000 papers was reviewed that best characterized the machine learning and technology timelines that manifested from reviewing the literature. The technology used to monitor PD motor symptoms has advanced significantly in the past five decades. Early monitoring began with in-lab devices such as needle-based EMG, transitioned to in-lab accelerometers/gyroscopes, then to wearable accelerometers/gyroscopes, and finally to phone and mobile & web application-based in-home monitoring. Significant progress has also been made with respect to the use of machine learning algorithms to classify PD patients. Using data from different devices (e.g., video cameras, phone-based accelerometers), researchers have designed neural network and non-neural network-based machine learning algorithms to categorize PD patients across tremor, gait, bradykinesia, and dyskinesia. The five-decade co-evolution of technology and computational techniques used to monitor PD motor symptoms has driven significant progress that is enabling the shift from in-lab/clinic to in-home monitoring of PD symptoms.
Collapse
Affiliation(s)
- Anirudha S Chandrabhatla
- School of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, 22903, USA
| | - I Jonathan Pomeraniec
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA. .,Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, 22903, USA.
| | - Alexander Ksendzovsky
- Department of Neurosurgery, University of Maryland Medical System, Baltimore, MD, 21201, USA
| |
Collapse
|
3
|
Increased Speed Elicited More Automatized but Less Predictable Control in Cyclical Arm and Leg Movements. Motor Control 2021; 26:15-35. [PMID: 34768239 DOI: 10.1123/mc.2021-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022]
Abstract
The present study explores variations in the degree of automaticity and predictability of cyclical arm and leg movements. Twenty healthy adults were asked to walk on a treadmill at a lower-than-preferred speed, their preferred speed, and at a higher-than-preferred speed. In a separate, repetitive punching task, the three walking frequencies were used to cue the target pace of the cyclical arm movements. Movements of the arms, legs, and trunk were digitized with inertial sensors. Whereas absolute slope values (|β|) of the linear fit to the power spectrum of the digitized movements (p < .001, η2 = .676) were systematically smaller in treadmill walking than in repetitive punching, sample entropy measures (p < .001, η2 = .570) were larger reflecting the former task being more automated but also less predictable than the latter task. In both tasks, increased speeds enhanced automatized control (p < .001, η2 = .475) but reduced movement predictability (p = .008, η2 = .225). The latter findings are potentially relevant when evaluating effects of task demand changes in clinical contexts.
Collapse
|
4
|
KWON YURI, EOM GWANGMOON, KO JUNGHYUK, KIM JIWON. QUANTITATIVE ANALYSIS OF ESSENTIAL TREMOR DURING CLINICAL SPIRAL DRAWING TASK USING GYRO SENSORS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The spiral drawing task is a representative clinical test used to assess essential tremor. Many clinicians have used spirography to assess through visual rating of the drawings. We quantitatively investigated the clinical characteristics of action tremors during spiral drawing tasks using 3-axis gyro sensors. Eighteen essential tremor patients with sensors attached to their forefinger, dorsum of the hand, and forearm participated in a spiral drawing test. As quantitative variables, the average speed, maximum frequency and maximum power were derived from the gyro sensor signals. The average speed and maximum power were also logarithmically transformed. Two-way repeated measures analysis of variance (ANOVA) with tremor direction and joint (attachment location) as independent factors was performed to evaluate the main and interactive effects of direction and joint. Also, Spearman’s correlation analysis was performed to evaluate the relationship between the quantitative variables and visual rating scores. The average speed showed a significant main effect of direction ([Formula: see text]). Logarithmic variables showed interactive effects ([Formula: see text]) as well as main effects ([Formula: see text]). The interactive effects were attributed to no significant difference among the joints particularly in the roll direction ([Formula: see text]). The logarithmic variables of roll direction were significantly greater than that of the other directions ([Formula: see text]). Also, the quantitative variables were moderately correlated with visual rating scores ([Formula: see text], [Formula: see text]). These results indicate that kinetic tremor during spiral drawing mainly appears in the roll direction and may contribute to the determination of sensor location and direction for continuous monitoring of patients with essential tremor.
Collapse
Affiliation(s)
- YU-RI KWON
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - GWANG-MOON EOM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- Department of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - JUNGHYUK KO
- Division of Mechanical Engineering, College of Engineering, Korea Maritime and Ocean University, Busan, Republic of Korea
| | - JI-WON KIM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- Department of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| |
Collapse
|
5
|
Abtahi M, Bahram Borgheai S, Jafari R, Constant N, Diouf R, Shahriari Y, Mankodiya K. Merging fNIRS-EEG Brain Monitoring and Body Motion Capture to Distinguish Parkinsons Disease. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1246-1253. [DOI: 10.1109/tnsre.2020.2987888] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
6
|
Kwon DY, Kwon YR, Choi YH, Eom GM, Ko J, Kim JW. Quantitative measures of postural tremor at the upper limb joints in patients with essential tremor. Technol Health Care 2020; 28:499-507. [PMID: 32364182 PMCID: PMC7369080 DOI: 10.3233/thc-209050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is important to quantitatively assess tremor for accurate diagnosis and evaluation of the response to interventions in patients with essential tremor (ET). OBJECTIVE The purpose of this study was to investigate the relationship between quantitative measures of postural tremor and clinical rating scale in patients with ET. METHODS 18 ET patients performed a postural tremor task that required them to hold their arms outstretched parallel to the floor while wearing a gyro sensor based measurement system. The time domain variables were derived from the sensor signals. Additionally, the frequency domain variables were derived from the power spectrum of the angular velocity signal. Spearman correlation analysis was employed in the relationship between the variables and clinical score. RESULTS The RMS angular velocity of roll and yaw directions at the hand joint were strongly correlated with the clinical rating scale (r= 0.7, p< 0.01). Similarly, the peak power of roll and yaw directions at the hand joint were moderately correlated with the clinical rating scale (r= 0.61 and r= 0.67, p< 0.01). In contrast, no significant correlation coefficients were observed in the peak frequency (p> 0.05). CONCLUSION These results indicate that hand tremor of roll and yaw directions are more associated with assessment of severity of ET compared to other joints. This study suggests that quantitative measurements of postural tremor should be considered as tremor directionality as well as attachment location.
Collapse
Affiliation(s)
- Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Yu-Ri Kwon
- School of Biomedical Engineering, Konkuk University, Chungju, Korea.,BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Korea
| | - Yoon-Hyeok Choi
- School of Biomedical Engineering, Konkuk University, Chungju, Korea
| | - Gwang-Moon Eom
- School of Biomedical Engineering, Konkuk University, Chungju, Korea.,BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Korea
| | - Junghyuk Ko
- Division of Mechanical Engineering, College of Engineering, Korea Maritime and Ocean University, Busan, Korea
| | - Ji-Won Kim
- School of Biomedical Engineering, Konkuk University, Chungju, Korea.,BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Korea
| |
Collapse
|
7
|
Liang X, Kapetanios E, Woll B, Angelopoulou A. Real Time Hand Movement Trajectory Tracking for Enhancing Dementia Screening in Ageing Deaf Signers of British Sign Language. IFIP ADVANCES IN INFORMATION AND COMMUNICATION TECHNOLOGY 2019; 3:377-394. [PMID: 32066992 PMCID: PMC7025874 DOI: 10.1007/978-3-030-29726-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Real time hand movement trajectory tracking based on machine learning approaches may assist the early identification of dementia in ageing Deaf individuals who are users of British Sign Language (BSL), since there are few clinicians with appropriate communication skills, and a shortage of sign language interpreters. Unlike other computer vision systems used in dementia stage assessment such as RGBD video with the aid of depth camera, activities of daily living (ADL) monitored by information and communication technologies (ICT) facilities, or X-Ray, computed tomography (CT), and magnetic resonance imaging (MRI) images fed to machine learning algorithms, the system developed here focuses on analysing the sign language space envelope (sign trajectories/depth/speed) and facial expression of deaf individuals, using normal 2D videos. In this work, we are interested in providing a more accurate segmentation of objects of interest in relation to the background, so that accurate real-time hand trajectories (path of the trajectory and speed) can be achieved. The paper presents and evaluates two types of hand movement trajectory models. In the first model, the hand sign trajectory is tracked by implementing skin colour segmentation. In the second model, the hand sign trajectory is tracked using Part Affinity Fields based on the OpenPose Skeleton Model [1, 2]. Comparisons of results between the two different models demonstrate that the second model provides enhanced improvements in terms of tracking accuracy and robustness of tracking. The pattern differences in facial and trajectory motion data achieved from the presented models will be beneficial not only for screening of deaf individuals for dementia, but also for assessment of other acquired neurological impairments associated with motor changes, for example, stroke and Parkinson's disease.
Collapse
Affiliation(s)
- Xing Liang
- Cognitive Computing Research Lab, University of Westminster, London, UK
| | | | - Bencie Woll
- Deafness Cognition and Language Research Centre, University College London, London, UK
| | | |
Collapse
|
8
|
Perera T, Lee WL, Yohanandan SAC, Nguyen AL, Cruse B, Boonstra FMC, Noffs G, Vogel AP, Kolbe SC, Butzkueven H, Evans A, van der Walt A. Validation of a precision tremor measurement system for multiple sclerosis. J Neurosci Methods 2019; 311:377-384. [PMID: 30243994 DOI: 10.1016/j.jneumeth.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tremor is a debilitating symptom of Multiple Sclerosis (MS). Little is known about its pathophysiology and treatments are limited. Clinical trials investigating new interventions often rely on subjective clinical rating scales to provide supporting evidence of efficacy. NEW METHOD We present a novel instrument (TREMBAL) which uses electromagnetic motion capture technology to quantify MS tremor. We aim to validate TREMBAL by comparison to clinical ratings using regression modelling with 310 samples of tremor captured from 13 MS participants who performed five different hand exercises during several follow-up visits. Minimum detectable change (MDC) and test-retest reliability were calculated and comparisons were made between MS tremor and data from 12 healthy volunteers. RESULTS Velocity of the index finger was most congruent with clinical observation. Regression modelling combining different features, sensor configurations, and labelling exercises did not improve results. TREMBAL MDC was 84% of its initial measurement compared to 91% for the clinical rating. Intra-class correlations for test-retest reliability were 0.781 for TREMBAL and 0.703 for clinical ratings. Tremor was lower (p = 0.002) in healthy subjects. COMPARISON WITH EXISTING METHODS Subjective scales have low sensitivity, suffer from ceiling effects, and mitigation against inter-rater variability is challenging. Inertial sensors are ubiquitous, however, their output is nonlinearly related to tremor frequency, compensation is required for gravitational artefacts, and their raw data cannot be intuitively comprehended. CONCLUSIONS TREMBAL, compared with clinical ratings, gave measures in agreement with clinical observation, had marginally lower MDC, and similar test-retest reliability.
Collapse
Affiliation(s)
- Thushara Perera
- The Bionics Institute, East Melbourne, Australia; Department of Medical Bionics, University of Melbourne, Australia.
| | - Wee-Lih Lee
- The Bionics Institute, East Melbourne, Australia
| | - Shivanthan A C Yohanandan
- The Bionics Institute, East Melbourne, Australia; Department of Computer Science and Information Technology, Royal Melbourne Institute of Technology, Victoria, Australia
| | - Ai-Lan Nguyen
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - Belinda Cruse
- Department of Neurology, Royal Melbourne Hospital, Australia
| | | | - Gustavo Noffs
- Department of Neurology, Royal Melbourne Hospital, Australia; Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
| | - Adam P Vogel
- The Bionics Institute, East Melbourne, Australia; Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia; Redenlab, Victoria, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Scott C Kolbe
- Department of Medicine and Radiology, University of Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Victoria, Australia
| | - Andrew Evans
- The Bionics Institute, East Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia
| | - Anneke van der Walt
- The Bionics Institute, East Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Victoria, Australia
| |
Collapse
|
9
|
Kim HB, Lee WW, Kim A, Lee HJ, Park HY, Jeon HS, Kim SK, Jeon B, Park KS. Wrist sensor-based tremor severity quantification in Parkinson's disease using convolutional neural network. Comput Biol Med 2018; 95:140-146. [DOI: 10.1016/j.compbiomed.2018.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/17/2023]
|
10
|
López-Blanco R, Velasco MA, Méndez-Guerrero A, Romero JP, Del Castillo MD, Serrano JI, Benito-León J, Bermejo-Pareja F, Rocon E. Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study. J Neurosci Methods 2018; 303:95-102. [PMID: 29481820 DOI: 10.1016/j.jneumeth.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. NEW METHOD The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. RESULTS Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. COMPARISON WITH EXISTING METHOD(S) This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. CONCLUSIONS The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.
Collapse
Affiliation(s)
- Roberto López-Blanco
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares Madrid, Spain.
| | | | | | - Juan Pablo Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | | | | | - Julián Benito-León
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Center of Biomedical Network Research on Neurodegenerative Dseases (CIBERNED), Spain; Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain
| | - Félix Bermejo-Pareja
- Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain; Clinical Research Unit, University Hospital, "12 de Octubre", Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
| |
Collapse
|
11
|
Chan PY, Ripin ZM, Halim SA, Tharakan J, Muzaimi M, Ng KS, Kamarudin MI, Eow GB, Hor JY, Tan K, Cheah CF, Soong N, Then L, Yahya AS. An In-Laboratory Validity and Reliability Tested System for Quantifying Hand-Arm Tremor in Motions. IEEE Trans Neural Syst Rehabil Eng 2018; 26:460-467. [PMID: 29432113 DOI: 10.1109/tnsre.2017.2782361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite the advancement of the tremor assessment systems, the current technology still lacks a method that can objectively characterize tremors in relative segmental movements. This paper presents a measurement system, which quantifies multi-degrees-of-freedom coupled relative motions of hand-arm tremor, in terms of joint angular displacement. In-laboratory validity and reliability tests of the system algorithm to provide joint angular displacement was carried out by using the two-degrees-of-freedom tremor simulator with incremental rotary encoder systems installed. The statistical analyses show that the developed system has high validity results and comparable reliability performances using the rotary encoder system as the reference. In the clinical trials, the system was tested on 38 Parkinson's disease patients. The system readings were correlated with the observational tremor ratings of six trained medical doctors. The moderate to very high clinical correlations of the system readings in measuring rest, postural and task-specific tremors add merits to the degree of readiness of the developed tremor measurement system in a routine clinical setting and/or intervention trial for tremor amelioration.
Collapse
|
12
|
Lalvay L, Lara M, Mora A, Alarcón F, Fraga M, Pancorbo J, Marina JL, Mena MÁ, Lopez Sendón JL, García de Yébenes J. Quantitative Measurement of Akinesia in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:316-322. [PMID: 30363442 PMCID: PMC6174408 DOI: 10.1002/mdc3.12410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is great interest in developing simple, user-friendly, and inexpensive tools for the quantification and elucidation of motor deficits in patients with Parkinson's disease (PD). These systems could help to monitor the clinical status of patients with PD, to develop better treatments, and to identify individuals who have subtle motor signs that might pass unnoticed in the conventional neurological examination. METHODS Mememtum, a smartphone application that allows for the quantification of several parameters of movement, such as regularity, rhythm, and changes in the number of taps while taping with a single finger and with alternating fingers, was developed and then tested in a pilot study in Madrid and in an extensive study in Quito, Ecuador. RESULTS Almost all patients could successfully perform single-finger tapping, but approximately 10% of patients with severe parkinsonism had problems taping with alternating fingers. The results revealed changes in the regularity of the pressure applied while tapping and a reduction in the number of taps on the device screen when alternating tapping among patients who had idiopathic PD and vascular parkinsonism compared with controls and individuals who had prediagnostic motor abnormalities of PD. CONCLUSION Applications available in smartphones could be used for investigation and treatment of patients with PD, but much research is needed to optimize the ideal parameters to be investigated and the potential usefulness of this technique for patients with PD in different stages of the disease.
Collapse
Affiliation(s)
| | - Miguel Lara
- Servicio de NeurologíaHospital Eugenio EspejoQuitoEcuador
| | - Andrea Mora
- Servicio de NeurologíaHospital Eugenio EspejoQuitoEcuador
| | | | | | | | | | - María Ángeles Mena
- Fundación para Investigaciones NeurológicasMadridSpain
- Centro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | | | - Justo García de Yébenes
- Servicio de NeurologíaHospital Eugenio EspejoQuitoEcuador
- Fundación para Investigaciones NeurológicasMadridSpain
- Centro de Investigación Biomedica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| |
Collapse
|
13
|
An IoT approach for integration of computational intelligence and wearable sensors for Parkinson’s disease diagnosis and monitoring. HEALTH AND TECHNOLOGY 2016. [DOI: 10.1007/s12553-016-0148-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
San Luciano M, Wang C, Ortega RA, Yu Q, Boschung S, Soto-Valencia J, Bressman SB, Lipton RB, Pullman S, Saunders-Pullman R. Digitized Spiral Drawing: A Possible Biomarker for Early Parkinson's Disease. PLoS One 2016; 11:e0162799. [PMID: 27732597 PMCID: PMC5061372 DOI: 10.1371/journal.pone.0162799] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/28/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pre-clinical markers of Parkinson's Disease (PD) are needed, and to be relevant in pre-clinical disease, they should be quantifiably abnormal in early disease as well. Handwriting is impaired early in PD and can be evaluated using computerized analysis of drawn spirals, capturing kinematic, dynamic, and spatial abnormalities and calculating indices that quantify motor performance and disability. Digitized spiral drawing correlates with motor scores and may be more sensitive in detecting early changes than subjective ratings. However, whether changes in spiral drawing are abnormal compared with controls and whether changes are detected in early PD are unknown. METHODS 138 PD subjects (50 with early PD) and 150 controls drew spirals on a digitizing tablet, generating x, y, z (pressure) data-coordinates and time. Derived indices corresponded to overall spiral execution (severity), shape and kinematic irregularity (second order smoothness, first order zero-crossing), tightness, mean speed and variability of spiral width. Linear mixed effect adjusted models comparing these indices and cross-validation were performed. Receiver operating characteristic analysis was applied to examine discriminative validity of combined indices. RESULTS All indices were significantly different between PD cases and controls, except for zero-crossing. A model using all indices had high discriminative validity (sensitivity = 0.86, specificity = 0.81). Discriminative validity was maintained in patients with early PD. CONCLUSION Spiral analysis accurately discriminates subjects with PD and early PD from controls supporting a role as a promising quantitative biomarker. Further assessment is needed to determine whether spiral changes are PD specific compared with other disorders and if present in pre-clinical PD.
Collapse
Affiliation(s)
- Marta San Luciano
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine Bronx, New York, New York, United States of America
| | - Roberto A. Ortega
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
| | - Qiping Yu
- Department of Neurology, Columbia University, New York, New York, United States of America
| | - Sarah Boschung
- Department of Neurology, Columbia University, New York, New York, United States of America
| | - Jeannie Soto-Valencia
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
| | - Susan B. Bressman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
- Department of Neurology, Albert Einstein College of Medicine Bronx, New York, New York, United States of America
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine Bronx, New York, New York, United States of America
| | - Seth Pullman
- Department of Neurology, Columbia University, New York, New York, United States of America
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
- Department of Neurology, Albert Einstein College of Medicine Bronx, New York, New York, United States of America
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| |
Collapse
|
15
|
Perera T, Yohanandan SAC, Thevathasan W, Jones M, Peppard R, Evans AH, Tan JL, McKay CM, McDermott HJ. Clinical validation of a precision electromagnetic tremor measurement system in participants receiving deep brain stimulation for essential tremor. Physiol Meas 2016; 37:1516-27. [PMID: 27511464 DOI: 10.1088/0967-3334/37/9/1516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tremor is characterized commonly through subjective clinical rating scales. Accelerometer-based techniques for objective tremor measurement have been developed in the past, yet these measures are usually presented as an unintuitive dimensionless index without measurement units. Here we have developed a tool (TREMBAL) to provide quantifiable and objective measures of tremor severity using electromagnetic motion tracking. We aimed to compare TREMBAL's objective measures with clinical tremor ratings and determine the test-retest reliability of our technique. Eight participants with ET receiving deep brain stimulation (DBS) therapy were consented. Tremor was simultaneously recorded using TREMBAL and video during DBS adjustment. After each adjustment, participants performed a hands-outstretched task (for postural tremor) and a finger-nose task (for kinetic tremor). Video recordings were de-identified, randomized, and shown to a panel of movement disorder specialists to obtain their ratings. Regression analysis and Pearson's correlations were used to determine agreement between datasets. Subsets of the trial were repeated to assess test-retest reliability. Tremor amplitude and velocity measures were in close agreement with mean clinical ratings (r > 0.90) for both postural and kinetic tremors. Test-retest reliability for both translational and rotational components of tremor showed intra-class correlations >0.80. TREMBAL assessments showed that tremor gradually improved with increasing DBS therapy-this was also supported by clinical observation. TREMBAL measurements are a sensitive, objective and reliable assessment of tremor severity. This tool may have application in clinical trials and in aiding automated optimization of deep brain stimulation.
Collapse
Affiliation(s)
- Thushara Perera
- The Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria 3002, Australia. Medical Bionics Department, The University of Melbourne, Parkville, Victoria 3010, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Lee HJ, Kim SK, Park H, Kim HB, Jeon HS, Jung YJ, Oh E, Kim HJ, Yun JY, Jeon BS, Park KS. Clinicians' Tendencies to Under-Rate Parkinsonian Tremors in the Less Affected Hand. PLoS One 2015; 10:e0131703. [PMID: 26110768 PMCID: PMC4482425 DOI: 10.1371/journal.pone.0131703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022] Open
Abstract
The standard assessment method for tremor severity in Parkinson’s disease is visual observation by neurologists using clinical rating scales. This is, therefore, a subjective rating that is dependent on clinical expertise. The objective of this study was to report clinicians’ tendencies to under-rate Parkinsonian tremors in the less affected hand. This was observed through objective tremor measurement with accelerometers. Tremor amplitudes were measured objectively using tri-axis-accelerometers for both hands simultaneously in 53 patients with Parkinson’s disease during resting and postural tremors. The videotaped tremor was rated by neurologists using clinical rating scales. The tremor measured by accelerometer was compared with clinical ratings. Neurologists tended to under-rate the less affected hand in resting tremor when the contralateral hand had severe tremor in Session I. The participating neurologists corrected this tendency in Session II after being informed of it. The under-rating tendency was then repeated by other uninformed neurologists in Session III. Kappa statistics showed high inter-rater agreements and high agreements between estimated scores derived from the accelerometer signals and the mean Clinical Tremor Rating Scale evaluated in every session. Therefore, clinicians need to be aware of this under-rating tendency in visual inspection of the less affected hand in order to make accurate tremor severity assessments.
Collapse
Affiliation(s)
- Hong Ji Lee
- The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Sang Kyong Kim
- The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Hyeyoung Park
- The Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Byul Kim
- The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Hyo Seon Jeon
- The Interdisciplinary Program for Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Yu Jin Jung
- The Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Eungseok Oh
- The Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hee Jin Kim
- The Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea
| | - Ji Young Yun
- The Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Beom S. Jeon
- The Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang Suk Park
- The Department of Biomedical Engineering, Seoul National University, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
17
|
Perera T, Yohanandan SAC, McDermott HJ. A simple and inexpensive test-rig for evaluating the performance of motion sensors used in movement disorders research. Med Biol Eng Comput 2015; 54:333-9. [DOI: 10.1007/s11517-015-1314-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
|
18
|
PERFORM: a system for monitoring, assessment and management of patients with Parkinson's disease. SENSORS 2014; 14:21329-57. [PMID: 25393786 PMCID: PMC4279536 DOI: 10.3390/s141121329] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/25/2014] [Accepted: 10/20/2014] [Indexed: 01/20/2023]
Abstract
In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson's disease (PD) patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes) is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG)) as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID)). Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed—always under medical supervision—and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients' physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a precise, long-term and objective view of patient's motor status and drug/food intake. Thus, with the PERFORM system the clinician can remotely receive precise information for the PD patient's status on previous days and define the optimal therapeutical treatment.
Collapse
|
19
|
Experimental support that ocular tremor in Parkinson's disease does not originate from head movement. Parkinsonism Relat Disord 2014; 20:743-7. [DOI: 10.1016/j.parkreldis.2014.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/17/2014] [Accepted: 03/30/2014] [Indexed: 11/23/2022]
|
20
|
Pedrosa DJ, Auth M, Eggers C, Timmermann L. Effects of low-frequency thalamic deep brain stimulation in essential tremor patients. Exp Neurol 2013; 248:205-12. [PMID: 23778146 DOI: 10.1016/j.expneurol.2013.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Essential tremor (ET) patients may present with postural and/or intentional tremor. But despite high-frequency thalamic deep brain stimulation (DBS) effectively suppressing both, the emergence of intentional tremor has been attributed to a higher extent to cerebellar dysfunction. Therefore, we hypothesized thalamic 10 Hz-stimulation, which is known to worsen motor functions, having more impact on intentional tremor than on postural tremor. METHODS In sixteen ET-patients with bilateral thalamic-DBS, tremor rating scale (TRS) and ultrasound-based tremor-amplitude measurements were analyzed by sequentially applying three DBS-settings in a randomized order: i) low-frequency stimulation (LFS), ii) DBS being turned off (DBS-OFF) and iii) high-frequency stimulation (HFS). Repeated measures analyses of variance for TRS and for the quotients of tremor-amplitudes during DBS-OFF and LFS for intentional (q(int)) and postural tasks (q(post)) were calculated. Finally, electrode localization and the abovementioned quotients were put into relation by Pearson's correlation coefficient. RESULTS HFS reduced TRS significantly compared to DBS-OFF and LFS (ps<.001), while the latter two also differed significantly with TRS being the worst during LFS (p<.05). Additionally, intentional tremor-amplitude appeared to be strongly influenced by LFS than postural tremor-amplitude (p<.05). Furthermore, a lower placement of the electrodes caused worse intentional tremor-amplitude during LFS (r=.517, p>.05), while postural tremor-amplitude was unrelated to electrode localization (ps<.05). CONCLUSIONS During LFS in ET-patients, there is a more severe exacerbation of intentional tremor compared to postural tremor. Possibly, there are two different mechanisms responsible for both tremor entities, making more refined stimulation regimes feasible in the future.
Collapse
Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
| | | | | | | |
Collapse
|
21
|
Kaski D, Saifee TA, Buckwell D, Bronstein AM. Reply to letter--Eye oscillations in Parkinson's disease relate to the vestibulo-ocular reflex. Mov Disord 2013; 28:845-6. [PMID: 23653416 DOI: 10.1002/mds.25465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/10/2013] [Indexed: 11/07/2022] Open
|
22
|
Daneault JF, Carignan B, Codère CÉ, Sadikot AF, Duval C. Using a smart phone as a standalone platform for detection and monitoring of pathological tremors. Front Hum Neurosci 2013; 6:357. [PMID: 23346053 PMCID: PMC3548411 DOI: 10.3389/fnhum.2012.00357] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/25/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction: Smart phones are becoming ubiquitous and their computing capabilities are ever increasing. Consequently, more attention is geared toward their potential use in research and medical settings. For instance, their built-in hardware can provide quantitative data for different movements. Therefore, the goal of the current study was to evaluate the capabilities of a standalone smart phone platform to characterize tremor. Results: Algorithms for tremor recording and online analysis can be implemented within a smart phone. The smart phone provides reliable time- and frequency-domain tremor characteristics. The smart phone can also provide medically relevant tremor assessments. Discussion: Smart phones have the potential to provide researchers and clinicians with quantitative short- and long-term tremor assessments that are currently not easily available. Methods: A smart phone application for tremor quantification and online analysis was developed. Then, smart phone results were compared to those obtained simultaneously with a laboratory accelerometer. Finally, results from the smart phone were compared to clinical tremor assessments.
Collapse
Affiliation(s)
- Jean-François Daneault
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Montreal, QC, Canada ; Centre de Recherche de l'Institut, Universitaire de Gériatrie de Montréal Montréal, QC, Canada
| | | | | | | | | |
Collapse
|
23
|
Rigas G, Tzallas AT, Tsipouras MG, Bougia P, Tripoliti EE, Baga D, Fotiadis DI, Tsouli SG, Konitsiotis S. Assessment of tremor activity in the Parkinson's disease using a set of wearable sensors. ACTA ACUST UNITED AC 2012; 16:478-87. [PMID: 22231198 DOI: 10.1109/titb.2011.2182616] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tremor is the most common motor disorder of Parkinson's disease (PD) and consequently its detection plays a crucial role in the management and treatment of PD patients. The current diagnosis procedure is based on subject-dependent clinical assessment, which has a difficulty in capturing subtle tremor features. In this paper, an automated method for both resting and action/postural tremor assessment is proposed using a set of accelerometers mounted on different patient's body segments. The estimation of tremor type (resting/action postural) and severity is based on features extracted from the acquired signals and hidden Markov models. The method is evaluated using data collected from 23 subjects (18 PD patients and 5 control subjects). The obtained results verified that the proposed method successfully: 1) quantifies tremor severity with 87 % accuracy, 2) discriminates resting from postural tremor, and 3) discriminates tremor from other Parkinsonian motor symptoms during daily activities.
Collapse
Affiliation(s)
- George Rigas
- Department of Material Sciences and Engineering, University of Ioannina, Ioannina, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Blumrosen G, Uziel M, Rubinsky B, Porrat D. Noncontact tremor characterization using low-power wideband radar technology. IEEE Trans Biomed Eng 2011; 59:674-86. [PMID: 22155937 DOI: 10.1109/tbme.2011.2177977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous monitoring and analysis of tremor is important for the diagnosis and establishment of treatments in many neurological disorders. This paper describes noncontact assessment of tremor characteristics obtained by an experimental new ultrawideband (UWB) system. The system is based on transmission of a wideband electromagnetic signal with extremely low power, and analysis of the received signal, which is composed of many propagation paths reflected from the patient and its surroundings. A description of the physical principles behind the technology, a criterion, and efficient algorithms to assess tremor characteristics from the bulk UWB measurements are given. A feasibility test for the technology was conducted using a UWB system prototype, an arm model that mimics tremor, and a reference video system. The set of UWB system frequencies and amplitudes estimations were highly correlated with the video system estimations with an average error in the scale of 0.1 Hz and 1 mm for the frequency and amplitude estimations, respectively. The new UWB-based system does not require attaching active markers or inertial sensors to the body, can give displacement information and kinematic features from multiple body parts, is not limited by the range captured by the optical lens, has high indoor volume coverage as it can penetrate through walls, and does not require calibration to obtain amplitude estimations.
Collapse
Affiliation(s)
- Gaddi Blumrosen
- School of Computer Science and Engineering, Hebrew University of Jerusalem, Jerusalem 91904, Israel.
| | | | | | | |
Collapse
|
25
|
Uhríková Z, Šprdlík O, Hoskovcová M, Komárek A, Ulmanová O, Hlaváč V, Nugent CD, Růžička E. Validation of a new tool for automatic assessment of tremor frequency from video recordings. J Neurosci Methods 2011; 198:110-3. [DOI: 10.1016/j.jneumeth.2011.02.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/29/2022]
|
26
|
Joundi RA, Brittain JS, Jenkinson N, Green AL, Aziz T. Rapid tremor frequency assessment with the iPhone accelerometer. Parkinsonism Relat Disord 2011; 17:288-90. [PMID: 21300563 DOI: 10.1016/j.parkreldis.2011.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 11/26/2010] [Accepted: 01/05/2011] [Indexed: 11/17/2022]
Abstract
The physician is often seeking more efficient ways of performing patient assessments. Currently, measuring tremor frequency requires expensive and bulky equipment. We propose the use of the in-built accelerometer of the iPhone via the iSeismo application for rapid measurement of tremor frequency. We use this device in a series of 7 different tremor cases, and show that the frequency measurements on the iSeismo graph closely match the more sophisticated EMG analysis during tremor. This is a preliminary confirmation of the usefulness of this device in the clinical setting for quick assessment of the dominant frequency component in a variety of tremors.
Collapse
Affiliation(s)
- Raed A Joundi
- Department of Physiology, Anatomy, and Genetics, Oxford University, UK.
| | | | | | | | | |
Collapse
|
27
|
Mostile G, Giuffrida JP, Adam OR, Davidson A, Jankovic J. Correlation between Kinesia system assessments and clinical tremor scores in patients with essential tremor. Mov Disord 2010; 25:1938-43. [PMID: 20623687 DOI: 10.1002/mds.23201] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The primary aim of this study was to determine whether scores on The Essential Tremor Rating Assessment Scale (TETRAS) correlate with quantitative assessments using the Kinesia™ (CleveMed) system in patients with essential tremor (ET). Patients sequentially evaluated and diagnosed with ET at the Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine were enrolled in the study. The Kinesia portable device was attached to the wrist and subjects were instructed to hold their arms in an outstretched position and then touch their nose while data were wirelessly transmitted to a computer. Subjects were rated on the arm where the system was placed using specific TETRAS items. A linear regression model was constructed for each task using the logarithmic values of both clinical scores and objective motion data parameters to compute a Kinesia score. Twenty subjects underwent complete clinical TETRAS and Kinesia quantitative assessments. TETRAS clinical scores significantly correlated with predicted Kinesia quantitative variables for postural (r = 0.738; P < 0.001) and kinetic (r = 0.57; P = 0.009) tremor. We conclude that the Kinesia system may, therefore, have a utility in quantitative assessments of ET when combined with standard clinical assessment.
Collapse
Affiliation(s)
- Giovanni Mostile
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|
28
|
Giuffrida JP, Riley DE, Maddux BN, Heldman DA. Clinically deployable Kinesia technology for automated tremor assessment. Mov Disord 2009; 24:723-30. [PMID: 19133661 DOI: 10.1002/mds.22445] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The objective was to design, build, and assess Kinesia, a wireless system for automated assessment of Parkinson's disease (PD) tremor. The current standard in evaluating PD is the Unified Parkinson's Disease Rating Scale (UPDRS), a qualitative ranking system typically completed during an office visit. Kinesia integrates accelerometers and gyroscopes in a compact patient-worn unit to capture kinematic movement disorder features. Objectively quantifying PD manifestations with increased time resolution should aid in evaluating efficacy of treatment protocols and improve patient management. In this study, PD subjects performed the tremor subset of the UPDRS motor section while wearing Kinesia. Quantitative kinematic features were processed and highly correlated to clinician scores for rest tremor (r(2) = 0.89), postural tremor (r(2) = 0.90), and kinetic tremor (r(2) = 0.69). The quantitative features were used to develop a mathematical model that predicted tremor severity scores for new data with low errors. Finally, PD subjects indicated high clinical acceptance.
Collapse
Affiliation(s)
- Joseph P Giuffrida
- Division of Movement Disorders, Cleveland Medical Devices Inc., Cleveland, Ohio 44103, USA.
| | | | | | | |
Collapse
|
29
|
Espay AJ, Beaton DE, Morgante F, Gunraj CA, Lang AE, Chen R. Impairments of speed and amplitude of movement in Parkinson's disease: A pilot study. Mov Disord 2009; 24:1001-8. [DOI: 10.1002/mds.22480] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
30
|
Grimaldi G, Lammertse P, Van Den Braber N, Meuleman J, Manto M. Effects of inertia and wrist oscillations on contralateral neurological postural tremor using the wristalyzer, a new myohaptic device. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2008; 2:269-279. [PMID: 23853130 DOI: 10.1109/tbcas.2008.926726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Upper limb postural tremor consists of mechanical-reflex and central-neurogenic oscillations, superimposed upon a background of irregular fluctuations in muscle force. Muscle spindles play key-roles in the information flow to supra-spinal and spinal generators. Oscillations were delivered using a new generation portable myohaptic device, called ldquowristalyzer,rdquo taking into account the ergonomy of upper limbs and allowing a fine adjustment to each configuration of upper limb segments. The nominal torque of the first generation device is 4 Nm, with a maximal rotation velocity of 300 degrees/s and a range of motion of plusmn45 degrees. Reliability was assessed in basal condition and during loading conditions. We assessed the effects of the addition of inertia on postural tremor of the finger in a group of 26 neurological patients and the effects of wrist oscillations upon contralateral postural tremor in 6 control subjects and in 7 neurological patients exhibiting a postural tremor. Patients showed two different behaviors in response to inertia and exhibited an increased variability of postural tremor during fast oscillations (13.3 Hz). One patient with overactivity of the olivocerebellar pathways exhibited a drop in the peak frequency of more than 20%. The relative power of the 8-12 Hz subband was significantly higher in controls both in basal condition and during oscillations (p = 0.028 and p = 0.015, respectively). The second generation wristalyzer allows to investigate the effects of mechanical oscillations up to frequency of 50 Hz. This mechatronic device can assess the responsiveness of tremor generators to stimulation of muscle spindles and biomechanical loading. Potential applications are the monitoring of dysmetria under various inertial or damping conditions, the assessment of rigidity in Parkinson's disease and the characterization of voluntary muscle force.
Collapse
|
31
|
Rozman J, Bartolić A, Ribaric S. A new method for selective measurement of joint movement in hand tremor in Parkinson's disease patients. J Med Eng Technol 2007; 31:305-11. [PMID: 17566934 DOI: 10.1080/03091900600992064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system with tremor being one of its four main clinical features. Currently used methods can directly evaluate tremor amplitude and frequency but not joint movement in the affected limb. Measurement of joint movement facilitates the location of muscle groups that participate in PD tremor and this is important for treatment with local botulinum toxin injections. We developed and tested a method that measured tremor amplitude and frequency in a specific joint of the hand in PD patients. The tremor analysis method was based on force transducers adapted to record rest tremor of the wrist and metacarpophalangeal joints in two degrees of freedom for each joint. Direct measurements of joint movement in the hand can evaluate tremor amplitude and frequency and also locate the muscle groups that are most active in tremor movement, thus enabling their local treatment.
Collapse
Affiliation(s)
- J Rozman
- ITIS d.o.o. Ljubljana, Center for Implantable Technology and Sensors, Ljubljana, Slovenia
| | | | | |
Collapse
|
32
|
Legros A, Cif L, Sygiel M, Coubes P, Beuter A. [Kinematic evaluation of dystonic syndromes in patients treated with deep brain stimulation]. Rev Neurol (Paris) 2005; 160:793-804. [PMID: 15454865 DOI: 10.1016/s0035-3787(04)71033-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Quantification of motor functions of patients with dystonic syndromes treated by chronic high frequency stimulation of the internal globulus pallidus is a challenge. OBJECTIVE Through a series of clinical examples this paper shows that kinematic analysis of movements in dystonic syndromes treated by deep brain stimulation (DBS) is a complement to clinical evaluation. In addition, it provides valuable information for early detection of improvement or impairment of movements associated with modifications of stimulation parameters. METHOD Thirteen dystonic patients and eleven reference subjects completed three tests (i.e., rest: lying supine; posture: standing with arms held in front (at shoulder height); and alternative movements: bimanual finger-to-nose test). These tests were recorded with an electromagnetic system quantifying movement kinematics (position) in three-dimensional space. RESULTS From the recorded data, several indices were developed and provided a quantitative evaluation of movements during each test. In addition, a clinical evaluation (BMFDRS) was also completed. No correlation between clinical and kinematic evaluations was found. CONCLUSION It is shown that kinematic analysis is a useful complement of clinical evaluation and can assist clinicians in monitoring the evolution of movements in dystonic patients treated by DBS in a simple, reliable and valid fashion.
Collapse
Affiliation(s)
- A Legros
- Equipe d'Accueil 2991: Efficience et Déficience Motrices, Montpellier
| | | | | | | | | |
Collapse
|
33
|
Beuter A, Legros A, Cif L, Coubes P. Quantifying motion in dystonic syndromes: the bare essentials. J Clin Neurophysiol 2004; 21:209-14. [PMID: 15375350 DOI: 10.1097/00004691-200405000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Quantifying movement disorders is becoming crucially important in neurosurgery units to evaluate the efficacy of new therapeutic interventions such as deep brain stimulation. Kinematic analysis, available for more than a century, may represent an adequate solution to this problem. However, quantifying movement disorders poses a number of technical problems. To help clinicians quantify movement disorders, the authors present data recorded in patients with dystonic syndromes and explore the question of movement "normality" in these patients when they receive deep brain stimulation of the internal globus pallidus. In particular, they show that when one control group (n = 11) and a group of dystonic patients (n = 11) are compared, it is possible to detect subtle changes in the performance of a double-handed finger to nose test. These differences persist in the absence of differences in the clinical evaluation of these patients. Suggestions regarding the compromises to make and pitfalls to avoid when quantifying movement disorders are discussed.
Collapse
Affiliation(s)
- Anne Beuter
- Movement Disorder Research Unit, Hòpital Gui de Chauliac, Université de Montpellier I, Montpellier, France.
| | | | | | | |
Collapse
|
34
|
Mancini ML, Bartolini M, Tambasco N, Gallai V. Assessment of tremor: a new computerised tool for clinical practice. J Clin Neurosci 2004; 11:364-7. [PMID: 15080947 DOI: 10.1016/j.jocn.2002.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2002] [Accepted: 05/16/2002] [Indexed: 11/25/2022]
Abstract
The quantitative assessment of tremor represents the main difficulty in clinical evaluation. We developed a software package - T-Lab - for the biomechanical analysis of hyperkinetic movement disorders. This software can receive and elaborate data from an electronic device interfaced with a personal computer. The aim of our study was to verify the validity of the PC-aided method proposed in the routine assessment of tremor. We did this by a correlation (regression) analysis between the scores obtained by Webster's Amplitude Clinical Scale and the amplitude data by T-Lab and between EMG data and frequency measures of T-Lab. Forty-seven patients presenting with upper limb tremor were enrolled. Four series of data were obtained: two series for frequency and two for amplitude. A significant correlation between all sets of data compared was found. T-Lab represents a valid, objective and useful device of quantifying tremors in clinical practice.
Collapse
Affiliation(s)
- M L Mancini
- Department of Neuroscience, University of Perugia, Perugia, Italy.
| | | | | | | |
Collapse
|
35
|
Abstract
Head injury can cause extrapyramidal movement disorders such as tremors, parkinsonism, dystonia, chorea, myoclonus, and tics. Pure adventitious movements are rare, but combinations with paresis, spasticity, apraxia, or ataxia occur in approximately 20% of cases of severe head injury, in many cases appearing or evolving in the months following the injury. Tremors may improve in time but many of the other syndromes tend to persist. Reversible causes such as medications or metabolic derangements are occasionally identifiable. Some of these adventitious movements can be improved using neuroactive drugs, botulinum toxin injections, or stereotactic brain surgery.
Collapse
Affiliation(s)
- Padraig O'Suilleabhain
- Department of Neurology, University of Texas Southwestern Medical School, Dallas, 75390, USA.
| | | |
Collapse
|
36
|
O'Suilleabhain P, Dewey RB. Randomized trial comparing primidone initiation schedules for treating essential tremor. Mov Disord 2002; 17:382-6. [PMID: 11921128 DOI: 10.1002/mds.10083] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Early side effects are common when primidone is used to treat essential tremor, with as many as one-third of patients failing to tolerate the tablets. Lower doses can be prescribed initially using a suspension formulation. We suspected suspension initiation would result in fewer early side effects, allow better acclimatization, and improve compliance. Forty patients with essential tremor were randomized to begin primidone treatment using either 2.5 mg doses in the suspension form or 25 mg doses in the tablet form. Doses gradually increased over 3 weeks to 150 mg/day. This was a double-blind, double-dummy trial. Medication cessation due to side effects was designated the primary end-point. Four patients in the suspension group and two in the tablet group dropped out due to early side effects, resulting in a relative risk of 1.9 (95% confidence interval 0.4 to 9.2). Side effects in the first 48 hours of treatment were equally common, affecting seven subjects in each group. Treatment benefits were the same in both groups. We concluded that use of a very low initial dose and a graduated titration schedule in suspension formulation did not appear to improve primidone tolerability. If anything, compliance tended to be worse when compared with the tablet formulation, though the study was under-powered to reject the null hypothesis of equivalence.
Collapse
Affiliation(s)
- Padraig O'Suilleabhain
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | | |
Collapse
|