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Angelini L, Paparella G, Cannavacciuolo A, Costa D, Birreci D, De Riggi M, Passaretti M, Colella D, Guerra A, Berardelli A, Bologna M. Clinical and kinematic characterization of parkinsonian soft signs in essential tremor. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02784-0. [PMID: 38744708 DOI: 10.1007/s00702-024-02784-0] [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: 02/16/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Subtle parkinsonian signs, i.e., rest tremor and bradykinesia, are considered soft signs for defining essential tremor (ET) plus. OBJECTIVES Our study aimed to further characterize subtle parkinsonian signs in a relatively large sample of ET patients from a clinical and neurophysiological perspective. METHODS We employed clinical scales and kinematic techniques to assess a sample of 82 ET patients. Eighty healthy controls matched for gender and age were also included. The primary focus of our study was to conduct a comparative analysis of ET patients (without any soft signs) and ET-plus patients with rest tremor and/or bradykinesia. Additionally, we investigated the asymmetry and side concordance of these soft signs. RESULTS In ET-plus patients with parkinsonian soft signs (56.10% of the sample), rest tremor was clinically observed in 41.30% of cases, bradykinesia in 30.43%, and rest tremor plus bradykinesia in 28.26%. Patients with rest tremor had more severe and widespread action tremor than other patients. Furthermore, we observed a positive correlation between the amplitude of action and rest tremor. Most ET-plus patients had an asymmetry of rest tremor and bradykinesia. There was no side concordance between these soft signs, as confirmed through both clinical examination and kinematic evaluation. CONCLUSIONS Rest tremor and bradykinesia are frequently observed in ET and are often asymmetric but not concordant. Our findings provide a better insight into the phenomenology of ET and suggest that the parkinsonian soft signs (rest tremor and bradykinesia) in ET-plus may originate from distinct pathophysiological mechanisms.
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Affiliation(s)
- Luca Angelini
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Giulia Paparella
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | | | - Davide Costa
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy.
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Ali SM, Arjunan SP, Peter J, Perju-Dumbrava L, Ding C, Eller M, Raghav S, Kempster P, Motin MA, Radcliffe PJ, Kumar DK. Wearable Accelerometer and Gyroscope Sensors for Estimating the Severity of Essential Tremor. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:194-203. [PMID: 38196822 PMCID: PMC10776092 DOI: 10.1109/jtehm.2023.3329344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Several validated clinical scales measure the severity of essential tremor (ET). Their assessments are subjective and can depend on familiarity and training with scoring systems. METHOD We propose a multi-modal sensing using a wearable inertial measurement unit for estimating scores on the Fahn-Tolosa-Marin tremor rating scale (FTM) and determine the classification accuracy within the tremor type. 17 ET participants and 18 healthy controls were recruited for the study. Two movement disorder neurologists who were blinded to prior clinical information viewed video recordings and scored the FTM. Participants drew a guided Archimedes spiral while wearing an inertial measurement unit placed at the mid-point between the lateral epicondyle of the humerus and the anatomical snuff box. Acceleration and gyroscope recordings were analyzed. The ratio of the power spectral density between frequency bands 0.5-4 Hz and 4-12 Hz, and the sum of power spectrum density over the entire spectrum of 2-74 Hz, for both accelerometer and gyroscope data, were computed. FTM was estimated using regression model and classification using SVM was validated using the leave-one-out method. RESULTS Regression analysis showed a moderate to good correlation when individual features were used, while correlation was high ([Formula: see text] = 0.818) when suitable features of the gyro and accelerometer were combined. The accuracy for two-class classification of the combined features using SVM was 91.42% while for four-class it was 68.57%. CONCLUSION Potential applications of this novel wearable sensing method using a wearable Inertial Measurement Unit (IMU) include monitoring of ET and clinical trials of new treatments for the disorder.
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Affiliation(s)
- Sheik Mohammed Ali
- Department of Electrical and Biomedical EngineeringRMIT UniversityMelbourneVIC3000Australia
| | | | - James Peter
- Neurosciences DepartmentMonash HealthClaytonVIC3168Australia
| | | | - Catherine Ding
- Neurosciences DepartmentMonash HealthClaytonVIC3168Australia
| | - Michael Eller
- Neurosciences DepartmentMonash HealthClaytonVIC3168Australia
| | - Sanjay Raghav
- Department of Electrical and Biomedical EngineeringRMIT UniversityMelbourneVIC3000Australia
- Neurosciences DepartmentMonash HealthClaytonVIC3168Australia
| | - Peter Kempster
- Neurosciences DepartmentMonash HealthClaytonVIC3168Australia
- Department of MedicineSchool of Clinical SciencesMonash UniversityClaytonVIC3800Australia
| | - Mohammod Abdul Motin
- Department of Electrical and Biomedical EngineeringRMIT UniversityMelbourneVIC3000Australia
- Department of Electrical and Electronic EngineeringRajshahi University of Engineering and TechnologyRajshahi6204Bangladesh
| | - P. J. Radcliffe
- Department of Electrical and Biomedical EngineeringRMIT UniversityMelbourneVIC3000Australia
| | - Dinesh Kant Kumar
- Department of Electrical and Biomedical EngineeringRMIT UniversityMelbourneVIC3000Australia
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Kim CY, Luo L, Yu Q, Mirallave A, Saunders-Pullman R, Lipton RB, Louis ED, Pullman SL. Repeated Spiral Drawings in Essential Tremor: a Possible Limb-Based Measure of Motor Learning. THE CEREBELLUM 2019; 18:178-187. [PMID: 30206795 DOI: 10.1007/s12311-018-0974-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate changes in tremor severity over repeated spiral drawings to assess whether learning deficits can be evaluated directly in a limb in essential tremor (ET). A motor learning deficit in ET, possibly mediated by cerebellar pathways, has been established in eye-blink conditioning studies, but not paradigms measuring from an affected, tremulous limb. Computerized spiral analysis captures multiple characteristics of Archimedean spirals and quantifies performance through calculated indices. Sequential spiral drawing has recently been suggested to demonstrate improvement across trials among ET subjects. One hundred and sixty-one ET and 80 age-matched control subjects drew 10 consecutive spirals on a digitizing tablet. Degree of severity (DoS), a weighted, computational score of spiral execution that takes into account spiral shape and line smoothness, previously validated against a clinical rating scale, was calculated in both groups. Tremor amplitude (Ampl), an independent index of tremor size, measured in centimeters, was also calculated. Changes in DoS and Ampl across trials were assessed using linear regression with slope evaluations. Both groups demonstrated improvement in DoS across trials, but with less improvement in the ET group compared to controls. Ampl demonstrated a tendency to worsen across trials in ET subjects. ET subjects demonstrated less improvement than controls when drawing sequential spirals, suggesting a possible motor learning deficit in ET, here captured in an affected limb. DoS improved independently of Ampl, showing that DoS and Ampl are separable motor physiologic components in ET that may be independently mediated.
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Affiliation(s)
- Christine Y Kim
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Lan Luo
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Qiping Yu
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Ana Mirallave
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Seth L Pullman
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
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Herrnstadt G, McKeown MJ, Menon C. Controlling a motorized orthosis to follow elbow volitional movement: tests with individuals with pathological tremor. J Neuroeng Rehabil 2019; 16:23. [PMID: 30709409 PMCID: PMC6359763 DOI: 10.1186/s12984-019-0484-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for alternative treatment options for tremor patients who do not respond well to medications or surgery, either due to side effects or poor efficacy, or that are excluded from surgery. The study aims to evaluate feasibility of a voluntary-driven, speed-controlled tremor rejection approach with individuals with pathological tremor. The suppression approach was investigated using a robotic orthosis for suppression of elbow tremor. Importantly, the study emphasizes the performance in relation to the voluntary motion. METHODS Nine participants with either Essential Tremor (ET) or Parkinson's disease (PD) were recruited and tested off medication. The participants performed computerized pursuit tracking tasks following a sinusoid and a random target, both with and without the suppressive orthosis. The impact of the Tremor Suppression Orthosis (TSO) at the tremor and voluntary frequencies was determined by the relative power change calculated from the Power Spectral Density (PSD). Voluntary motion was, in addition, assessed by position and velocity tracking errors. RESULTS The suppressive orthosis resulted in a 94.4% mean power reduction of the tremor (p < 0.001) - a substantial improvement over reports in the literature. As for the impact to the voluntary motion, paired difference tests revealed no statistical effect of the TSO on the relative power change (p = 0.346) and velocity tracking error (p = 0.283). A marginal effect was observed for the position tracking error (p = 0.05). The interaction torque with the robotic orthosis was small (0.62 Nm) when compared to the maximum voluntary torque that can be exerted by adult individuals at the elbow joint. CONCLUSIONS Two key contributions of this work are first, a recently proposed approach is evaluated with individuals with tremor demonstrating high levels of tremor suppression; second, the impact of the approach to the voluntary motion is analyzed comprehensively, showing limited inhibition. This study also seeks to address a gap in studies with individuals with tremor where the impact of engineering solutions on voluntary motion is unreported. This study demonstrates feasibility of the wearable technology as an effective treatment that removes tremor with limited impediment to intentional motion. The goal for such wearable technology is to help individuals with pathological tremor regain independence in activities affected by the tremor condition. Further investigations are needed to validate the technology.
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Affiliation(s)
- Gil Herrnstadt
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Martin J McKeown
- Department of Medicine (Neurology) and Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Burnaby, Canada.
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Kutilek P, Volf P, Cerny R, Hejda J. The application of accelerometers to measure movements of upper limbs: Pilot study. ACTA GYMNICA 2017. [DOI: 10.5507/ag.2017.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND AND PURPOSE Tremor occurs in 10-85% of patients with focal dystonia as so-called dystonic tremor or tremor associated with dystonia. The aim of this study was to assess the incidence and to characterize parameters of tremor accompanying focal and segmental dystonia. MATERIAL AND METHODS One hundred and twenty-three patients with diagnosis of focal and segmental dystonia together with 51 healthy controls were included in the study. For each participant, clinical examination and objective assessment (accelerometer, electromyography, graphic tablet) of hand tremor was performed. Frequency and severity of tremor were assessed in three positions: at rest (rest tremor); with hands extended (postural tremor); during 'finger-to-nose' test and during Archimedes spiral drawing (kinetic tremor). Based on the mass load test, type of tremor was determined as essential tremor type or enhanced physiological type. RESULTS The incidence of tremor was significantly higher in dystonic patients as compared to controls (p = 0.0001). In clinical examination, tremor was found in 50% of dystonic patients, and in instrumental assessment in an additional 10-20%. The most frequent type of tremor was postural and kinetic tremor with 7 Hz frequency and featured essential tremor type. In the control group, tremor was detected in about 10% of subjects as 9-Hz postural tremor of enhanced physiological tremor type. No differences were found between patients with different types of dystonia with respect to the tremor incidence, type and parameters (frequency and severity). No correlations between tremor severity and dystonia severity were found either.
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Norman KE, Héroux ME. Measures of fine motor skills in people with tremor disorders: appraisal and interpretation. Front Neurol 2013; 4:50. [PMID: 23717299 PMCID: PMC3650669 DOI: 10.3389/fneur.2013.00050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
People with Parkinson's disease, essential tremor, or other movement disorders involving tremor have changes in fine motor skills that are among the hallmarks of these diseases. Numerous measurement tools have been created and other methods devised to measure such changes in fine motor skills. Measurement tools may focus on specific features - e.g., motor skills or dexterity, slowness in movement execution associated with parkinsonian bradykinesia, or magnitude of tremor. Less obviously, some tools may be better suited than others for specific goals such as detecting subtle dysfunction early in disease, revealing aspects of brain function affected by disease, or tracking changes expected from treatment or disease progression. The purpose of this review is to describe and appraise selected measurement tools of fine motor skills appropriate for people with tremor disorders. In this context, we consider the tools' content - i.e., what movement features they focus on. In addition, we consider how measurement tools of fine motor skills relate to measures of a person's disease state or a person's function. These considerations affect how one should select and interpret the results of these tools in laboratory and clinical contexts.
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Affiliation(s)
- Kathleen E. Norman
- School of Rehabilitation Therapy, Queen’s UniversityKingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s UniversityKingston, ON, Canada
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