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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.
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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
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2
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Kaburagi M, Maki F, Hino S, Nakano M, Yamaguchi T, Takasaki M, Iwamuro H, Iijima K, Sasanuma J, Watanabe K, Hasegawa Y, Yamano Y. Video Motion Analysis as a Quantitative Evaluation Tool for Essential Tremor during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy. Neurol Int 2023; 15:1411-1422. [PMID: 38132970 PMCID: PMC10745303 DOI: 10.3390/neurolint15040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The Clinical Rating Scale for Tremor (CRST) is commonly used to evaluate essential tremor (ET) during focused ultrasound (FUS) thalamotomy. However, it faces challenges such as the ceiling effect and test-retest variability. This study explored the utility of videographic motion analysis as an evaluation index for ET. Forty-three patients with ET performed postural tremor and line-drawing tasks recorded on video, and the data were analyzed using motion analysis software. The test-retest and inter-rater reliability, correlations with the CRST and tremor scores, and pre/post-FUS treatment comparisons were analyzed. The video motion analysis showed excellent test-retest and inter-rater reliability. In the postural tremor tasks, video parameter amplitude significantly correlated with the CRST and tremor scores. Similarly, for the line-drawing task, video parameter amplitude showed significant correlations with CRST and tremor scores, effectively addressing the ceiling effect. Regarding post-FUS treatment improvements, changes in the CRST and tremor scores were significantly associated with changes in video parameter amplitude. In conclusion, quantitative analysis of the video motion of ET enables precise evaluation of kinematic characteristics and effectively resolves the ceiling effect and test-retest variability. The video motion analysis score accurately reflected the tremor severity and treatment effects, demonstrating its high clinical utility.
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Affiliation(s)
- Mayumi Kaburagi
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Futaba Maki
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Sakae Hino
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Masayuki Nakano
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Toshio Yamaguchi
- Research Institute for Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
- International Academia for Focused Ultrasound Therapy, Kanagawa 215-0023, Japan
| | - Masahito Takasaki
- Department of Anesthesiology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Hirokazu Iwamuro
- Department of Neurosurgery, Juntendo University, Tokyo 113-8421, Japan
| | - Ken Iijima
- Department of Diagnostic Radiology, Saitama Sekishinkai Hospital, Saitama 350-1305, Japan
| | - Jinichi Sasanuma
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Kazuo Watanabe
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Yoshihisa Yamano
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
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Elble RJ, Ondo W. Tremor rating scales and laboratory tools for assessing tremor. J Neurol Sci 2022; 435:120202. [DOI: 10.1016/j.jns.2022.120202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/08/2021] [Accepted: 02/17/2022] [Indexed: 12/29/2022]
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4
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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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.
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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
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Hu J, Zhang J, Hu L, Yu H, Xu J. Art Therapy: A Complementary Treatment for Mental Disorders. Front Psychol 2021; 12:686005. [PMID: 34456801 PMCID: PMC8397377 DOI: 10.3389/fpsyg.2021.686005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/28/2021] [Indexed: 01/05/2023] Open
Abstract
Art therapy, as a non-pharmacological medical complementary and alternative therapy, has been used as one of medical interventions with good clinical effects on mental disorders. However, systematically reviewed in detail in clinical situations is lacking. Here, we searched on PubMed for art therapy in an attempt to explore its theoretical basis, clinical applications, and future perspectives to summary its global pictures. Since drawings and paintings have been historically recognized as a useful part of therapeutic processes in art therapy, we focused on studies of art therapy which mainly includes painting and drawing as media. As a result, a total of 413 literature were identified. After carefully reading full articles, we found that art therapy has been gradually and successfully used for patients with mental disorders with positive outcomes, mainly reducing suffering from mental symptoms. These disorders mainly include depression disorders and anxiety, cognitive impairment and dementias, Alzheimer's disease, schizophrenia, and autism. These findings suggest that art therapy can not only be served as an useful therapeutic method to assist patients to open up and share their feelings, views, and experiences, but also as an auxiliary treatment for diagnosing diseases to help medical specialists obtain complementary information different from conventional tests. We humbly believe that art therapy has great potential in clinical applications on mental disorders to be further explored.
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Affiliation(s)
- Jingxuan Hu
- College of Creative Design, Shenzhen Technology University, Shenzhen, China
| | - Jinhuan Zhang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.,Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Liyu Hu
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Haibo Yu
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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7
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Roth N, Braun-Benyamin O, Rosenblum S. Drawing Direction Effect on a Task's Performance Characteristics among People with Essential Tremor. SENSORS (BASEL, SWITZERLAND) 2021; 21:5814. [PMID: 34502703 PMCID: PMC8433857 DOI: 10.3390/s21175814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/26/2022]
Abstract
Essential tremor (ET) is a common movement disorder affecting the performance of various daily tasks, including drawing. While spiral-drawing task characteristics have been described among patients with ET, research about the significance of the drawing direction of both spiral and lines tasks on the performance process is scarce. This study mapped inter-group differences between people with ET and controls related to drawing directions and the intra-effect of the drawing directions on the tremor level among people with ET. Twenty participants with ET and eighteen without ET drew spirals and vertical and horizontal lines on a digitizer with an inking pen. Time-based outcome measures were gathered to address the effect of the drawing directions on tremor by analyzing various spiral sections and comparing vertical and horizontal lines. Significant group differences were found in deviation of the spiral radius from a filtered radius curve and in deviation of the distance curve from a filtered curve for both line types. Significant differences were found between defined horizontal and vertical spiral sections within each group and between both line types within the ET group. A significant correlation was found between spiral and vertical line deviations from filtered curve outcome measures. Achieving objective measures about the significance of drawing directions on actual performance may support the clinical evaluation of people with ET toward developing future intervention methods for improving their functional abilities.
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Affiliation(s)
- Navit Roth
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, University of Haifa, Haifa 3498838, Israel;
- Department of Mechanical Engineering, ORT Braude Academic College of Engineering, Karmiel 2161002, Israel;
| | - Orit Braun-Benyamin
- Department of Mechanical Engineering, ORT Braude Academic College of Engineering, Karmiel 2161002, Israel;
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, University of Haifa, Haifa 3498838, Israel;
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Schallert W, Fluet MC, Kesselring J, Kool J. Evaluation of upper limb function with digitizing tablet-based tests: reliability and discriminative validity in healthy persons and patients with neurological disorders. Disabil Rehabil 2020; 44:1465-1473. [PMID: 32757680 DOI: 10.1080/09638288.2020.1800838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate discriminative validity, relative reliability and absolute reliability of four tablet-based tests for the evaluation of upper limb motor function in healthy persons and patients with neurological disorders. METHODS Cross-sectional study in 54 participants: 29 patients with upper limb movement impairment due to a neurological condition recruited from an inpatient rehabilitation centre and 25 healthy persons. Accuracy, speed and path length were analysed for four tablet-based tests: "Spiral drawings," "Tapping," "Follow the dot" and "Trace a star." The area under the receiver operating characteristic curve (AUC) was used to evaluate discriminative validity. Relative reliability was analysed with the intra-class correlation coefficient (ICC), and absolute reliability by limits of agreement (LoA) and minimal detectable difference (MDD). RESULTS All four tests showed excellent discriminative validity for the parameter accuracy (AUC 0.93-0.98). Tapping was the best test for discriminating patients from healthy persons. Test-retest reliability was good for accuracy in all tests (ICC = 0.76-0.88), but poor to moderate for speed and path length (ICC = 0.20-0.69). The MDD varied between 14% and 38%. Performance on the four tablet-based tests was stable between sessions, indicating that there was no learning effect. CONCLUSION The parameter accuracy showed excellent discriminative validity and reliability in all four tablet-based tests. Discriminative validity was excellent for all three parameters in the Tapping test. In the other tasks speed showed good to poor reliability, while the reliability of path-length was poor in all tasks. Results were comparable for the dominant and non-dominant hand. Tablet-based tests have the advantage that patients can use them for self-monitoring of upper limb motor function.Implications for rehabilitationFour tablet-based tests for the assessment of upper limb motor function in patients with upper limb neurological dysfunction were evaluated: "Spiral drawings", "Tapping", "Follow the dot" and "Trace a star". The parameter accuracy in these four tests had excellent discriminative validity and good reliability.Patients can perform the tests independently at home for self-monitoring of progress. This may increase patients' motivation to exercise at home.The results can be sent to physicians, enabling the earlier detection of deterioration, which may require medical attention.
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Affiliation(s)
- Wolfgang Schallert
- Department of Rehabilitation Research, Rehabilitation Centre Valens, Valens, Switzerland.,Department of Physiotherapy, Berner Fachhochschule, Bern, Switzerland
| | - Marie-Christine Fluet
- Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.,ReHaptix GmbH, Rehabilitation Products, Zurich, Switzerland
| | - Juerg Kesselring
- Department of Rehabilitation Research, Rehabilitation Centre Valens, Valens, Switzerland
| | - Jan Kool
- Department of Rehabilitation Research, Rehabilitation Centre Valens, Valens, Switzerland
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9
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Spiral drawing: Quantitative analysis and artificial-intelligence-based diagnosis using a smartphone. J Neurol Sci 2020; 411:116723. [PMID: 32050132 DOI: 10.1016/j.jns.2020.116723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The evaluation of neurological examination in clinical practice still remains qualitative or semi-quantitative, and the results often vary depending on an examiner's skill level and are less objective. In this study, we developed a smartphone-based application to investigate quantifying neurological examinations using hand-drawn spirals and diagnose patients with tremor using artificial intelligence (AI). METHODS This study included 24 and 26 patients with essential tremor (ET) and cerebellar disease (CD), respectively, and 41 age-matched normal controls (NCs). We obtained 69, 46, and 56 hand-drawn spirals from the NC, ET, and CD groups, respectively, as image data captured by smartphones. The patients traced a printed reference spiral. The length of this spiral was compared with the reference spiral length (% of spiral length) and the total deviation area between these spirals was calculated. The server also estimates the diagnostic probability through AI. RESULTS The quantified spiral analysis (% of spiral length and deviation area) significantly correlated with disease severity in each disease group, and significant differences in the deviation area were observed among all groups. The AI diagnosis showed 79%, 70%, and 73% accuracies for the NC, ET, and CD groups, respectively. CONCLUSION This study indicates the possibility of using a smartphone as a medical examination tool and demonstrates the application of AI in neurological examinations.
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10
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Szumilas M, Lewenstein K, Ślubowska E, Szlufik S, Koziorowski D. A Multimodal Approach to the Quantification of Kinetic Tremor in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2019; 20:E184. [PMID: 31905697 PMCID: PMC6983132 DOI: 10.3390/s20010184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Abstract
Parkinson's disease results in motor impairment that deteriorates patients' quality of life. One of the symptoms negatively interfering with daily activities is kinetic tremor which should be measured to monitor the outcome of therapy. A new instrumented method of quantification of the kinetic tremor is proposed, based on the analysis of circles drawn on a digitizing tablet by a patient. The aim of this approach is to obtain a tremor scoring equivalent to that performed by trained clinicians. Models are trained with the least absolute shrinkage and selection operator (LASSO) method to predict the tremor scores on the basis of the parameters computed from the patients' drawings. Signal parametrization is derived from both expert knowledge and the response of an artificial neural network to the raw data, thus the approach was named multimodal. The fitted models are eventually combined into model ensembles that provide aggregated scores of the kinetic tremor captured in the drawings. The method was verified with a set of clinical data acquired from 64 Parkinson's disease patients. Automated and objective quantification of the kinetic tremor with the presented approach yielded promising results, as the Pearson's correlations between the visual ratings of tremor and the model predictions ranged from 0.839 to 0.890 in the best-performing models.
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Affiliation(s)
- Mateusz Szumilas
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, A. Boboli 8 St., 02-525 Warsaw, Poland
| | - Krzysztof Lewenstein
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, A. Boboli 8 St., 02-525 Warsaw, Poland
| | - Elżbieta Ślubowska
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, A. Boboli 8 St., 02-525 Warsaw, Poland
| | - Stanisław Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Żwirki i Wigury 61 St., 02-091 Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Żwirki i Wigury 61 St., 02-091 Warsaw, Poland
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11
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Pupo DA, Kakareka JW, Krynitsky J, Leggio L, Pohida T, Studenski S, Harvey BK. Reliability of a Novel Video-Based Method for Assessing Age-Related Changes in Upper Limb Kinematics. Front Aging Neurosci 2018; 10:281. [PMID: 30319392 PMCID: PMC6166023 DOI: 10.3389/fnagi.2018.00281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022] Open
Abstract
Monitoring age-related changes in motor function can be used to identify deviations that represent underlying diseases for which early diagnosis is often paramount for efficacious, interventional therapies. Currently, the availability of cost-effective and reliable diagnostic tools capable of routine monitoring is limited. Adequate diagnostic systems are needed to identify, monitor and distinguish early subclinical symptoms of neurological diseases from normal aging-associated changes. Herein, we describe the development, initial validation and reliability of the Hand-Arm Movement Monitoring System (HAMMS), a video-based data acquisition system built using a programmable, versatile platform for acquiring temporal and spatial metrics of hand and arm movements. A healthy aging population of 111 adults were used to evaluate the HAMMS via a repetitive motion test of changing target size. The test required participants to move a fiducial on their hand between two targets presented on a video monitor. The test-retest reliability based on Intraclass Correlation Coefficient (ICCs) for the system ranged from 0.56 to 0.87 and the Linear Correlation Coefficients (LCCs) ranged from 0.58 to 0.87. Average speed, average acceleration, speed error and center offset all demonstrated a positive correlation with age. Using an intertarget path of hand motion, we observed an age-dependent increase in the average number of points outside the most direct motion path, indicating a reduction in hand-arm movement control with age. The reliability, flexibility and programmability of the HAMMS makes this low cost, video-based platform an effective tool for evaluating longitudinal changes in hand-arm related movements and a potential diagnostic device for neurological diseases where hand-arm movements are affected.
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Affiliation(s)
- Daniel A Pupo
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - John W Kakareka
- Signal Processing and Instrumentation Section, Office of Intramural Research, Center for Information Technology (CIT), National Institutes of Health, Bethesda, MD, United States
| | - Jonathan Krynitsky
- Signal Processing and Instrumentation Section, Office of Intramural Research, Center for Information Technology (CIT), National Institutes of Health, Bethesda, MD, United States
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States.,Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Tom Pohida
- Signal Processing and Instrumentation Section, Office of Intramural Research, Center for Information Technology (CIT), National Institutes of Health, Bethesda, MD, United States
| | - Stephanie Studenski
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Brandon K Harvey
- Optogenetics and Transgenic Technology Core, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
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12
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Lopez-de-Ipina K, Solé-Casals J, Faúndez-Zanuy M, Calvo PM, Sesa E, Roure J, Martinez-de-Lizarduy U, Beitia B, Fernández E, Iradi J, Garcia-Melero J, Bergareche A. Automatic Analysis of Archimedes' Spiral for Characterization of Genetic Essential Tremor Based on Shannon's Entropy and Fractal Dimension. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E531. [PMID: 33265620 PMCID: PMC7513055 DOI: 10.3390/e20070531] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 02/06/2023]
Abstract
Among neural disorders related to movement, essential tremor has the highest prevalence; in fact, it is twenty times more common than Parkinson's disease. The drawing of the Archimedes' spiral is the gold standard test to distinguish between both pathologies. The aim of this paper is to select non-linear biomarkers based on the analysis of digital drawings. It belongs to a larger cross study for early diagnosis of essential tremor that also includes genetic information. The proposed automatic analysis system consists in a hybrid solution: Machine Learning paradigms and automatic selection of features based on statistical tests using medical criteria. Moreover, the selected biomarkers comprise not only commonly used linear features (static and dynamic), but also other non-linear ones: Shannon entropy and Fractal Dimension. The results are hopeful, and the developed tool can easily be adapted to users; and taking into account social and economic points of view, it could be very helpful in real complex environments.
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Affiliation(s)
- Karmele Lopez-de-Ipina
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Jordi Solé-Casals
- Data and Signal Processing Research Group, University of Vic—Central University of Catalonia, 08500 Barcelona, Spain
| | - Marcos Faúndez-Zanuy
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Pilar M. Calvo
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Enric Sesa
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Josep Roure
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Unai Martinez-de-Lizarduy
- Department of Electronic Technology, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Blanca Beitia
- Department of Mathematics, EleKin Research Group, University of the Basque Country UPV/EHU, 1006 Gasteiz, Spain
| | - Elsa Fernández
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Jon Iradi
- Department of Enterprises Organization, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Joseba Garcia-Melero
- Department of Mechanical Engineering, EleKin Research Group, University of the Basque Country UPV/EHU, 1006 Gasteiz, Spain
| | - Alberto Bergareche
- Department of Neuroscience, BioDonostia Health Institute, 20014 Donostia, Spain
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Lin PC, Chen KH, Yang BS, Chen YJ. A digital assessment system for evaluating kinetic tremor in essential tremor and Parkinson's disease. BMC Neurol 2018. [PMID: 29523097 PMCID: PMC5845296 DOI: 10.1186/s12883-018-1027-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Spiral drawing on papers is a common tremor evaluation tool for diagnosing patients with essential tremor (ET) or Parkinson’s disease (PD). No standard drawing methods and parameters that use graphic tablets are yet available for objective evaluation. Methods This study established a tremor assessment system for tremor severity by using graphic tablets. Twelve patients with ET and twelve patients with PD were tested to establish system algorithms, and six additional patients were tested with the developed system to evaluate its performance. The patients also performed spiral drawing with three guiding paradigms on a graphic tablet: traced along a given spiral (S1), performed freehand drawing (S2), and traced along a guiding point (S3). Three parameters were calculated to quantify tremor severity: the means of radial difference per radian (|dr/dθ|), the means of radial difference per second (|dr/dt|), and the area under curve (AUC) of the frequency spectrum of the velocity. Each patient’s drawing was also evaluated using a visual rating scale (VRS) by experienced physicians. The interrater reliability was examined to identify the most consistent test paradigm. Results The parameter |dr/dθ| and AUC correlated well with the VRS (R > 0.8) in S1, S2 and S3 tests. The S1 test presented the best interrater reliability (Weighted Kappa coefficient, k = 0.80) among three tests. The Weighted Kappa coefficients are 0.67 and 0.71 in S2 and S3 tests, respectively. Conclusions We developed three different guiding paradigms for spiral drawing on a digital graphic tablet for clinical tests. Three parameters were calculated to represent the tremor severity in spiral drawing and used to quantify temporal and spatial characteristics of tremor, and provided good correlation with current clinical assessments. The test “traced along a given spiral” is recommended due to its good interrater reliability. Electronic supplementary material The online version of this article (10.1186/s12883-018-1027-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Po-Chieh Lin
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan
| | - Kai-Hsiang Chen
- Neurology Division, National Taiwan University Hospital, Hsinchu Branch, Hsinchu City, 300, Taiwan
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan. .,Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu City, 300, Taiwan.
| | - Yu-Jung Chen
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan
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