Effects of Aging on the Regularity of Physiological Tremor

A machine-learning method isolating changes in wrist kinematics that identify age-related changes in arm movement

Normal aging often results in an increase in physiological tremors and slowing of the movement of the hands, which can impair daily activities and quality of life. This study, using lightweight wearable non-invasive sensors, aimed to detect and identify age-related changes in wrist kinematics and response latency. Eighteen young (ages 18-20) and nine older (ages 49-57) adults performed two standard tasks with wearable inertial measurement units on their wrists. Frequency analysis revealed 5 kinematic variables distinguishing older from younger adults in a postural task, with best discrimination occurring in the 9-13 Hz range, agreeing with previously identified frequency range of age-related tremors, and achieving excellent classifier performance (0.86 AUROC score and 89% accuracy). In a second pronation-supination task, analysis of angular velocity in the roll axis identified a 71 ms delay in initiating arm movement in the older adults. This study demonstrates that an analysis of simple kinematic variables sampled at 100 Hz frequency with commercially available sensors is reliable, sensitive, and accurate at detecting age-related increases in physiological tremor and motor slowing. It remains to be seen if such sensitive methods may be accurate in distinguishing physiological tremors from tremors that occur in neurological diseases, such as Parkinson's Disease.

Hand and distal joint tremor are most coherent with the activity of elbow flexors and wrist extensors in persons with essential tremor

Essential tremor (ET) affects millions of people. Although frontline treatment options (medication, deep brain stimulation, and focused ultrasound ablation) have provided significant relief, many patients are unsatisfied with the outcomes. Peripheral suppression techniques, such as injections of botulinum toxin or sensory electrical stimulation of muscles, are gaining popularity, but could be optimized if the muscles most responsible for a patient's tremor were identified. The purpose of this study was to quantify the relationship between the activity in various upper limb muscles and the resulting tremor in patients with ET. Surface electromyogram (sEMG) from the 15 major superficial muscles of the upper limb and displacement of the hand and upper limb joints were recorded from 22 persons with ET while they performed kinetic and postural tasks representative of activities of daily living. We calculated the peak coherence (frequency-dependent correlation) in the tremor band (4-8 Hz) between the sEMG of each muscle and the displacement in each major degree of freedom (DOF). Averaged across subjects with ET, the highest coherence was found between elbow flexors (particularly biceps brachii and brachioradialis) and the distal DOF (forearm, wrist, and hand motion), and between wrist extensors (extensor carpi radialis and ulnaris) and the same distal DOF. These coherence values represent the upper bound on the proportion of the tremor caused by each muscle. We conclude that, without further information, elbow flexors and wrist extensors should be among the first muscles considered for peripheral suppression techniques in persons with ET.NEW & NOTEWORTHY We characterized the relationships between activity in upper limb muscles and tremor in persons with essential tremor using coherence, which provides an upper bound on the proportion of the tremor due to each muscle. Averaged across subjects and various tasks, tremor in the hand and distal joints was most coherent with elbow flexors and wrist extensors. We conclude that, without further information, these muscle groups should be among the first considered for peripheral suppression techniques.

The effect of standing posture on amplitude and variability of postural tremor in Parkinson’s disease

INTRODUCTION

This study examined whether altering body position (i.e., sitting or standing) affected the dynamics of physiological tremor for healthy older adults and persons with Parkinson's disease (PD). It was also of interest to determine how consistent the tremor was for both groups as determined by examining changes in within-subject variability of tremor amplitude, regularity and frequency.

METHODS

Ten Parkinsonian participants (65.1±3.2 yrs.) and twelve elderly persons (71.2±2.6 yrs.) participated in this study. Tremor was collected from the index finger and hand segments using lightweight accelerometers during the performance of a bilateral pointing task. Persons performed the pointing task in a standing or sitting position.

RESULTS

As expected, the tremor for the PD persons was greater in magnitude (mean RMS, peak power), more regular (lower SampEn), and more inconsistent from trial-to-trial (increased intra-individual variability, IIV) than the tremor recorded for the elderly. Further, when assessed during standing, the magnitude of the tremor for all individuals (elderly and PD) was greater, more variable, and less complex compared to the tremor when assessed during the sitting posture. The only measure which did not change within each group was the frequency of the major tremor peak which remained consistent, showing no significant change between limbs or as a function of the posture adopted.

CONCLUSION

The findings revealed that tremor increased in amplitude and decreased in regularity for all individuals was assessed when standing compared to sitting. It is likely that these increases were task-related, reflecting the increased physical demands of performing the task when standing rather than being driven by specific age- or disease-related changes in the mechanisms underlying tremorgenesis. Further, the tremor for the PD individuals tended to be more variable from trial-by-trial in terms of both amplitude and regularity as compared to the elderly persons. Interestingly, the only tremor metric which showed no change within each group was the frequency of the major tremor peak which was consistent within both groups irrespective of the posture adopted.

Diagnosis and Treatment of Tremor in Parkinson's Disease Using Mechanical Devices

BACKGROUND

Parkinsonian tremors are sometimes confused with essential tremors or other conditions. Recently, researchers conducted several studies on tremor evaluation using wearable sensors and devices, which may support accurate diagnosis. Mechanical devices are also commonly used to treat tremors and have been actively researched and developed. Here, we aimed to review recent progress and the efficacy of the devices related to Parkinsonian tremors.

METHODS

The PubMed and Scopus databases were searched for articles. We searched for "Parkinson disease" and "tremor" and "device".

RESULTS

Eighty-six articles were selected by our systematic approach. Many studies demonstrated that the diagnosis and evaluation of tremors in patients with PD can be done accurately by machine learning algorithms. Mechanical devices for tremor suppression include deep brain stimulation (DBS), electrical muscle stimulation, and orthosis. In recent years, adaptive DBS and optimization of stimulation parameters have been studied to further improve treatment efficacy.

CONCLUSIONS

Due to developments using state-of-the-art techniques, effectiveness in diagnosing and evaluating tremor and suppressing it using these devices is satisfactorily high in many studies. However, other than DBS, no devices are in practical use. To acquire high-level evidence, large-scale studies and randomized controlled trials are needed for these devices.

Relationship between physiological tremor and cognitive function in physically active older women

[Purpose]

This study aimed to compare the physiological tremor, grip strength, and cognitive function of sedentary and physically active older adults.

[Methods]

Twenty-four older adults aged ≥65 years participated in this study and were divided into the sedentary (76.5±4.4 years, n=12) and physically active (73.5±3.3 years, n=12) groups. Each group completed the Mini-Mental State Examination (MMSE) for cognitive function assessment. Physiological tremor was measured using an accelerometer for both hands at rest and the left/right hand with a 1,000 g dumbbell on the palm in neutral positions and the elbow flexed at 90°. Physical fitness was measured by grip strength and completion of the Short Physical Performance Battery (SPPB) and the 6-min walk test.

[Results]

The physically active group showed a significantly lower level of physiological tremor in both hands at rest and the left/right hand with a 1,000 g dumbbell on the palm (P<0.05) than that in the sedentary group. For cognitive function, the physically active group showed significantly higher scores than those in the sedentary group (P<0.001). No significant correlation was found between cognitive function and left/right grip strength (left: r = 0.117, P = 0.585; right: r = 0.230, P = 0.279), physiological tremor in both hands at rest (left: r = -0.524, P < 0.001; right: r = -0.508, P < 0.05), and the left/right hand with a 1,000 g dumbbell on the palm (left: r = -0.505, P < 0.05; right: r = -0.458, P < 0.05).

[Conclusion]

Physiological tremor of the hands has the potential to be a useful predictor of cognitive function in older adults.

Wearable sensors during drawing tasks to measure the severity of essential tremor

Commonly used methods to assess the severity of essential tremor (ET) are based on clinical observation and lack objectivity. This study proposes the use of wearable accelerometer sensors for the quantitative assessment of ET. Acceleration data was recorded by inertial measurement unit (IMU) sensors during sketching of Archimedes spirals in 17 ET participants and 18 healthy controls. IMUs were placed at three points (dorsum of hand, posterior forearm, posterior upper arm) of each participant's dominant arm. Movement disorder neurologists who were blinded to clinical information scored ET patients on the Fahn-Tolosa-Marin rating scale (FTM) and conducted phenotyping according to the recent Consensus Statement on the Classification of Tremors. The ratio of power spectral density of acceleration data in 4-12 Hz to 0.5-4 Hz bands and the total duration of the action were inputs to a support vector machine that was trained to classify the ET subtype. Regression analysis was performed to determine the relationship of acceleration and temporal data with the FTM scores. The results show that the sensor located on the forearm had the best classification and regression results, with accuracy of 85.71% for binary classification of ET versus control. There was a moderate to good correlation (r2 = 0.561) between FTM and a combination of power spectral density ratio and task time. However, the system could not accurately differentiate ET phenotypes according to the Consensus classification scheme. Potential applications of machine-based assessment of ET using wearable sensors include clinical trials and remote monitoring of patients.

Motion characteristics of subclinical tremors in Parkinson's disease and normal subjects

The characteristics of the Parkinson’s disease tremor reported previously are not applicable to the full spectrum of severity. The characteristics of high- and low-amplitude tremors differ in signal regularity and frequency dispersion, a phenomenon that indicates characterisation should be studied separately based on the severity. The subclinical tremor of Parkinson’s disease is close to physiological tremor in terms of amplitude and frequency, and their distinctive features are still undetermined. We aimed to determine joint motion characteristics that are unique to subclinical Parkinson’s disease tremors. The tremors were characterised by four hand–arm motions based on displacement and peak frequencies. The rest and postural tremors of 63 patients with Parkinson’s disease and 62 normal subjects were measured with inertial sensors. The baseline was established from normal tremors, and the joint motions were compared within and between the two subject groups. Displacement analysis showed that pronation–supination and wrist abduction–adduction are the most and least predominant tremor motions for both Parkinson’s disease and normal tremors, respectively. However, the subclinical Parkinson’s disease tremor has significant greater amplitude and peak frequency in specific predominant motions compared with the normal tremor. The flexion–extension of normal postural tremor increases in frequency from the proximal to distal segment, a phenomenon that is explainable by mechanical oscillation. This characteristic is also observed in patients with Parkinson’s disease but with amplification in wrist and elbow joints. The contributed distinctive characteristics of subclinical tremors provide clues on the physiological manifestation that is a result of the neuromuscular mechanism of Parkinson’s disease.

Physiological complexity: influence of ageing, disease and neuromuscular fatigue on muscle force and torque fluctuations

NEW FINDINGS

What is the topic of this review? Physiological complexity in muscle force and torque fluctuations, specifically the quantification of complexity, how neuromuscular complexityis altered by perturbations and the potential mechanism underlying changes in neuromuscular complexity. What advances does it highlight? The necessity to calculate both magnitude- and complexity-based measures for the thorough evaluation of force/torque fluctuations. Also the need for further research on neuromuscular complexity, particularly how it relates to the performance of functional activities (e.g. manual dexterity, balance, locomotion).

ABSTRACT

Physiological time series produce inherently complex fluctuations. In the last 30 years, methods have been developed to characterise these fluctuations, and have revealed that they contain information about the function of the system producing them. Two broad classes of metrics are used: (1) those which quantify the regularity of the signal (e.g. entropy metrics); and (2) those which quantify the fractal properties of the signal (e.g. detrended fluctuation analysis). Using these techniques, it has been demonstrated that ageing results in a loss of complexity in the time series of a multitude of signals, including heart rate, respiration, gait and, crucially, muscle force or torque output. This suggests that as the body ages, physiological systems become less adaptable (i.e. the systems' ability to respond rapidly to a changing external environment is diminished). More recently, it has been shown that neuromuscular fatigue causes a substantial loss of muscle torque complexity, a process that can be observed in a few minutes, rather than the decades it requires for the same system to degrade with ageing. The loss of torque complexity with neuromuscular fatigue appears to occur exclusively above the critical torque (at least for tasks lasting up to 30 min). The loss of torque complexity can be exacerbated with previous exercise of the same limb, and reduced by the administration of caffeine, suggesting both peripheral and central mechanisms contribute to this loss. The mechanisms underpinning the loss of complexity are not known but may be related to altered motor unit behaviour as the muscle fatigues.

Fatigue-induced changes in knee-extensor torque complexity and muscle metabolic rate are dependent on joint angle

Purpose

Joint angle is a significant determinant of neuromuscular and metabolic function. We tested the hypothesis that previously reported correlations between knee-extensor torque complexity and metabolic rate (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2) would be conserved at reduced joint angles (i.e. shorter muscle lengths).

Methods

Eleven participants performed intermittent isometric knee-extensor contractions at 50% maximum voluntary torque for 30 min or until task failure (whichever occurred sooner) at joint angles of 30º, 60º and 90º of flexion (0º = extension). Torque and surface EMG were sampled continuously. Complexity and fractal scaling of torque were quantified using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 was determined using near-infrared spectroscopy.

Results

Time to task failure/end increased as joint angle decreased (P < 0.001). Over time, complexity decreased at 90º and 60º (decreased ApEn, increased DFA α, both P < 0.001), but not 30º. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 increased at all joint angles (P < 0.001), though the magnitude of this increase was lower at 30º compared to 60º and 90º (both P < 0.01). There were significant correlations between torque complexity and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 at 90º (ApEn, r =  − 0.60, P = 0.049) and 60º (ApEn, r =  − 0.64, P = 0.035; DFA α, ρ = 0.68, P = 0.015).

Conclusion

The lack of correlation between \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 and complexity at 30º was likely due to low relative task demands, given the similar kinetics of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 and torque complexity. An inverse correlation between \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$\end{document}mV˙O2 and knee-extensor torque complexity occurs during high-intensity contractions at intermediate, but not short, muscle lengths.

Complexity of Knee Extensor Torque: Effect of Aging and Contraction Intensity

ABSTRACT

Fiogbé, E, Vassimon-Barroso, V, Catai, AM, de Melo, RC, Quitério, RJ, Porta, A, and Takahashi, ACdM. Complexity of knee extensor torque: effect of aging and contraction intensity. J Strength Cond Res 35(4): 1050-1057, 2021-Assessing the knee extensors' torque complexity in older adults is relevant because these muscles are among the most involved in functional daily activities. This study aimed to investigate the effects of aging and isometric contraction intensity on knee extensor torque complexity. Eight young (24 ± 2.8 years) and 13 old adults (63 ± 2.8 years) performed 3 maximal (maximum voluntary contraction [MVC], duration = 10 seconds) and submaximal isometric contractions (SICs, targeted at 15, 30, and 40% of MVC, respectively) of knee extensors. Torque signals were sampled continuously, and the metrics of variability and complexity were calculated basing on the SIC torque data. The coefficient of variation (CV) was used to quantify the torque variability. The torque complexity was determined by calculating the corrected approximate entropy (CApEn) and sample entropy (SampEn) and its normalized versions (NCApEn and NSampEn). Young subjects produced greater isometric torque than older adults, and the CV was similar between both groups except at the highest force level (40% MVC) where young subjects' value was higher. The major novel finding of this investigation was that although the knee extensor torque complexity is reduced in older adults, its relationship with contraction intensity is similar to young subjects. This means that despite the age-related decrease of the interactions between the components of the neuromuscular system, the organization of force control remains preserved in older adults, at least up to just below the force midrange.

A-WEAR Bracelet for Detection of Hand Tremor and Bradykinesia in Parkinson's Patients

Parkinson's disease patients face numerous motor symptoms that eventually make their life different from those of normal healthy controls. Out of these motor symptoms, tremor and bradykinesia, are relatively prevalent in all stages of this disease. The assessment of these symptoms is usually performed by traditional methods where the accuracy of results is still an open question. This research proposed a solution for an objective assessment of tremor and bradykinesia in subjects with PD (10 older adults aged greater than 60 years with tremor and 10 older adults aged greater than 60 years with bradykinesia) and 20 healthy older adults aged greater than 60 years. Physical movements were recorded by means of an AWEAR bracelet developed using inertial sensors, i.e., 3D accelerometer and gyroscope. Participants performed upper extremities motor activities as adopted by neurologists during the clinical assessment based on Unified Parkinson's Disease Rating Scale (UPDRS). For discriminating the patients from healthy controls, temporal and spectral features were extracted, out of which non-linear temporal and spectral features show greater difference. Both supervised and unsupervised machine learning classifiers provide good results. Out of 40 individuals, neural net clustering discriminated 34 individuals in correct classes, while the KNN approach discriminated 91.7% accurately. In a clinical environment, the doctor can use the device to comprehend the tremor and bradykinesia of patients quickly and with higher accuracy.

A Scale Mixture-Based Stochastic Model of Surface EMG Signals With Variable Variances

OBJECTIVE

Surface electromyogram (EMG) signals have typically been assumed to follow a Gaussian distribution. However, the presence of non-Gaussian signals associated with muscle activity has been reported in recent studies, and there is no general model of the distribution of EMG signals that can explain both non-Gaussian and Gaussian distributions within a unified scheme.

METHODS

In this paper, we describe the formulation of a non-Gaussian EMG model based on a scale mixture distribution. In the model, an EMG signal at a certain time follows a Gaussian distribution, and its variance is handled as a random variable that follows an inverse gamma distribution. Accordingly, the probability distribution of EMG signals is assumed to be a mixture of Gaussians with the same mean but different variances. The EMG variance distribution is estimated via marginal likelihood maximization.

RESULTS

Experiments involving nine participants revealed that the proposed model provides a better fit to recorded EMG signals than conventional EMG models. It was also shown that variance distribution parameters may reflect underlying motor unit activity.

CONCLUSION

This study proposed a scale mixture distribution-based stochastic EMG model capable of representing changes in non-Gaussianity associated with muscle activity. A series of experiments demonstrated the validity of the model and highlighted the relationship between the variance distribution and muscle force.

SIGNIFICANCE

The proposed model helps to clarify conventional wisdom regarding the probability distribution of surface EMG signals within a unified scheme.

Parameters of Surface Electromyogram Suggest That Dry Immersion Relieves Motor Symptoms in Patients With Parkinsonism

Dry immersion (DI) is acknowledged as a reliable space flight analog condition. At DI, subject is immersed in water being wrapped in a waterproof film to imitate microgravity (μG). Microgravity is known to decrease muscle tone due to deprivation of the sensory stimuli that activate the reflexes that keep up the muscle tone. In contrary, parkinsonian patients are characterized by elevated muscle tone, or rigidity, along with rest tremor and akinesia. We hypothesized that DI can diminish the elevated muscle tone and/or the tremor in parkinsonian patients. Fourteen patients with Parkinson's disease (PD, 10 males, 4 females, 47-73 years) and 5 patients with vascular parkinsonism (VP, 1 male, 4 females, 65-72 years) participated in the study. To evaluate the effect of DI on muscles' functioning, we compared parameters of surface electromyogram (sEMG) measured before and after a single 45-min long immersion session. The sEMG recordings were made from the biceps brachii muscle, bilaterally. Each recording was repeated with the following loading conditions: with arms hanging freely down, and with 0, 1, and 2 kg loading on each hand with elbows flexed to 90°. The sEMG parameters comprised of amplitude, median frequency, time of decay of mutual information, sample entropy, correlation dimension, recurrence rate, and determinism of sEMG. These parameters have earlier been proved to be sensitive to PD severity. We used the Wilcoxon test to decide which parameters were statistically significantly different before and after the dry immersion. Accepting the p < 0.05 significance level, amplitude, time of decay of mutual information, recurrence rate, and determinism tended to decrease, while median frequency and sample entropy of sEMG tended to increase after the DI. The most statistically significant change was for the determinism of sEMG from the left biceps with 1 kg loading, which decreased for 84% of the patients. The results suggest that DI can promptly relieve motor symptoms of parkinsonism. We conclude that DI has strong potential as a rehabilitation method for parkinsonian patients.

Effects of ipsilateral and contralateral fatigue and muscle blood flow occlusion on the complexity of knee-extensor torque output in humans

NEW FINDINGS

What is the central question of this study? We addressed the question "what role do central and peripheral fatigue mechanisms play in the fatigue-induced loss of isometric torque complexity?" What is the main finding and its importance? When the contralateral limb is fatigued, the complexity of isometric torque output is unaffected even if the blood flow to the contralateral limb is occluded, which suggests that neither central fatigue nor afferent feedback from ischaemic muscle influences the complexity of torque output in an otherwise fresh muscle.

ABSTRACT

Neuromuscular fatigue reduces the temporal structure, or complexity, of torque output during muscular contractions. To determine whether the fatigue-induced loss of torque complexity could be accounted for by central or peripheral factors, nine healthy participants performed four experimental trials involving intermittent isometric contractions of the knee extensors at 50% of the maximal voluntary contraction torque. These trials involved: (i) two bouts of contractions to failure using the right leg separated by 3 min recovery (IPS); (ii) the same protocol but with cuff occlusion during the 3 min recovery (IPS-OCC); (iii) contractions of the left leg to failure, followed 1 min later by contractions of the right leg to failure (CONT); and (iv) the same protocol but with cuff occlusion applied to the left leg throughout both the recovery period and right leg contractions (CONT-OCC). Supramaximal electrical stimulation during maximal voluntary contractions was used to determine the degree of central and peripheral fatigue, whilst complexity was determined using approximate entropy (ApEn) and detrended fluctuation analysis α exponent (DFA α). Neuromuscular fatigue was consistently associated with a loss of torque complexity in all conditions [e.g. IPS bout 1, ApEn from (mean ± SD) 0.46 ± 0.14 to 0.12 ± 0.06 (P < 0.001)]. In IPS-OCC, occlusion abolished the recovery from fatigue, and torque complexity remained at the values observed at task failure in the preceding bout (IPS-OCC bout 2, first minute 0.14 ± 0.03, P < 0.001). Prior contralateral contractions, with or without blood flow occlusion, had no effect on torque complexity.

Robotic finger perturbation training improves finger postural steadiness and hand dexterity

The purpose of the study was to understand the effect of robotic finger perturbation training on steadiness in finger posture and hand dexterity in healthy young adults. A mobile robotic finger training system was designed to have the functions of high-speed mechanical response, two degrees of freedom, and adjustable loading amplitude and direction. Healthy young adults were assigned to one of the three groups: random perturbation training (RPT), constant force training (CFT), and control. Subjects in RPT and CFT performed steady posture training with their index finger using the robot in different modes: random force in RPT and constant force in CFT. After the 2-week intervention period, fluctuations of the index finger posture decreased only in RPT during steady position-matching tasks with an inertial load. Purdue pegboard test score improved also in RPT only. The relative change in finger postural fluctuations was negatively correlated with the relative change in the number of completed pegs in the pegboard test in RPT. The results indicate that finger posture training with random mechanical perturbations of varying amplitudes and directions of force is effective in improving finger postural steadiness and hand dexterity in healthy young adults.

Automatic Classification of Tremor Severity in Parkinson's Disease Using a Wearable Device

Although there is clinical demand for new technology that can accurately measure Parkinsonian tremors, automatic scoring of Parkinsonian tremors using machine-learning approaches has not yet been employed. This study aims to fill this gap by proposing machine-learning algorithms as a way to predict the Unified Parkinson’s Disease Rating Scale (UPDRS), which are similar to how neurologists rate scores in actual clinical practice. In this study, the tremor signals of 85 patients with Parkinson’s disease (PD) were measured using a wrist-watch-type wearable device consisting of an accelerometer and a gyroscope. The displacement and angle signals were calculated from the measured acceleration and angular velocity, and the acceleration, angular velocity, displacement, and angle signals were used for analysis. Nineteen features were extracted from each signal, and the pairwise correlation strategy was used to reduce the number of feature dimensions. With the selected features, a decision tree (DT), support vector machine (SVM), discriminant analysis (DA), random forest (RF), and k-nearest-neighbor (kNN) algorithm were explored for automatic scoring of the Parkinsonian tremor severity. The performance of the employed classifiers was analyzed using accuracy, recall, and precision, and compared to other findings in similar studies. Finally, the limitations and plans for further study are discussed.

Wearable inertial sensors for human movement analysis

INTRODUCTION

The present review aims to provide an overview of the most common uses of wearable inertial sensors in the field of clinical human movement analysis.

AREAS COVERED

Six main areas of application are analysed: gait analysis, stabilometry, instrumented clinical tests, upper body mobility assessment, daily-life activity monitoring and tremor assessment. Each area is analyzed both from a methodological and applicative point of view. The focus on the methodological approaches is meant to provide an idea of the computational complexity behind a variable/parameter/index of interest so that the reader is aware of the reliability of the approach. The focus on the application is meant to provide a practical guide for advising clinicians on how inertial sensors can help them in their clinical practice. Expert commentary: Less expensive and more easy to use than other systems used in human movement analysis, wearable sensors have evolved to the point that they can be considered ready for being part of routine clinical routine.

Loss of knee extensor torque complexity during fatiguing isometric muscle contractions occurs exclusively above the critical torque

The complexity of knee extensor torque time series decreases during fatiguing isometric muscle contractions. We hypothesized that because of peripheral fatigue, this loss of torque complexity would occur exclusively during contractions above the critical torque (CT). Nine healthy participants performed isometric knee extension exercise (6 s of contraction, 4 s of rest) on six occasions for 30 min or to task failure, whichever occurred sooner. Four trials were performed above CT (trials S1–S4, S1 being the lowest intensity), and two were performed below CT (at 50% and 90% of CT). Global, central, and peripheral fatigue were quantified using maximal voluntary contractions (MVCs) with femoral nerve stimulation. The complexity of torque output was determined using approximate entropy (ApEn) and the detrended fluctuation analysis-α scaling exponent (DFA-α). The MVC torque was reduced in trials below CT [by 19 ± 4% (means ± SE) in 90%CT], but complexity did not decrease [ApEn for 90%CT: from 0.82 ± 0.03 to 0.75 ± 0.06, 95% paired-samples confidence intervals (CIs), 95% CI = −0.23, 0.10; DFA-α from 1.36 ± 0.01 to 1.32 ± 0.03, 95% CI −0.12, 0.04]. Above CT, substantial reductions in MVC torque occurred (of 49 ± 8% in S1), and torque complexity was reduced (ApEn for S1: from 0.67 ± 0.06 to 0.14 ± 0.01, 95% CI = −0.72, −0.33; DFA-α from 1.38 ± 0.03 to 1.58 ± 0.01, 95% CI 0.12, 0.29). Thus, in these experiments, the fatigue-induced loss of torque complexity occurred exclusively during contractions performed above the CT.

Visually guided targeting enhances bilateral force variability in healthy older adults

This study observed the effect of visual feedback on between-limb force variability relationships in young and older adults. Abduction force was examined in healthy young (n = 15, 25 ± 4 years) and older adults (n = 18, 71 ± 6 years) during simultaneous isometric contractions of both index fingers. Target forces ranged from 5% to 30% maximum voluntary contraction (MVC), where force variability and first dorsal interosseus activity were measured while (1) subjects viewed visual targets for both index fingers, (2) a visual target was provided for the dominant index finger only, and (3) visual targets were removed for both index fingers during bilateral isometric contractions. When subjects were provided with bilateral visual feedback during simultaneous contractions at low forces (5% and 10% MVC), older adults produced greater force variability than younger subjects (p = 0.002). However, when bilateral visual feedback was removed, age-related differences in variability were no longer present. Between-limb force variability differences existed at higher force outputs (20% and 30% MVC) when visual feedback was removed for the nondominant limb during bilateral isometric index finger abduction (p = 0.002). The control of bilateral force variability is compromised in older adults when visuomotor processes are engaged. However, age-related differences in force variability are abolished when no task-related visual feedback is available, and isometric contractions are based on internally guided feedback.

Effects of task and age on the magnitude and structure of force fluctuations: insights into underlying neuro-behavioral processes

BACKGROUND

The present study aimed at characterizing the effects of increasing (relative) force level and aging on isometric force control. To achieve this objective and to infer changes in the underlying control mechanisms, measures of information transmission, as well as magnitude and time-frequency structure of behavioral variability were applied to force-time-series.

RESULTS

Older adults were found to be weaker, more variable, and less efficient than young participants. As a function of force level, efficiency followed an inverted-U shape in both groups, suggesting a similar organization of the force control system. The time-frequency structure of force output fluctuations was only significantly affected by task conditions. Specifically, a narrower spectral distribution with more long-range correlations and an inverted-U pattern of complexity changes were observed with increasing force level. Although not significant older participants displayed on average a less complex behavior for low and intermediate force levels. The changes in force signal's regularity presented a strong dependence on time-scales, which significantly interacted with age and condition. An inverted-U profile was only observed for the time-scale relevant to the sensorimotor control process. However, in both groups the peak was not aligned with the optimum of efficiency.

CONCLUSION

Our results support the view that behavioral variability, in terms of magnitude and structure, has a functional meaning and affords non-invasive markers of the adaptations of the sensorimotor control system to various constraints. The measures of efficiency and variability ought to be considered as complementary since they convey specific information on the organization of control processes. The reported weak age effect on variability and complexity measures suggests that the behavioral expression of the loss of complexity hypothesis is not as straightforward as conventionally admitted. However, group differences did not completely vanish, which suggests that age differences can be more or less apparent depending on task properties and whether difficulty is scaled in relative or absolute terms.

Evaluation of the leap motion controller as a new contact-free pointing device

This paper presents a Fitts' law-based analysis of the user's performance in selection tasks with the Leap Motion Controller compared with a standard mouse device. The Leap Motion Controller (LMC) is a new contact-free input system for gesture-based human-computer interaction with declared sub-millimeter accuracy. Up to this point, there has hardly been any systematic evaluation of this new system available. With an error rate of 7.8% for the LMC and 2.8% for the mouse device, movement times twice as large as for a mouse device and high overall effort ratings, the Leap Motion Controller's performance as an input device for everyday generic computer pointing tasks is rather limited, at least with regard to the selection recognition provided by the LMC.

Functional Brain Activity Relates to 0-3 and 3-8 Hz Force Oscillations in Essential Tremor

It is well-established that during goal-directed motor tasks, patients with essential tremor have increased oscillations in the 0-3 and 3-8 Hz bands. It remains unclear if these increased oscillations relate to activity in specific brain regions. This study used task-based functional magnetic resonance imaging to compare the brain activity associated with oscillations in grip force output between patients with essential tremor, patients with Parkinson's disease who had clinically evident tremor, and healthy controls. The findings demonstrate that patients with essential tremor have increased brain activity in the motor cortex and supplementary motor area compared with controls, and this activity correlated positively with 3-8 Hz force oscillations. Brain activity in cerebellar lobules I-V was reduced in essential tremor compared with controls and correlated negatively with 0-3 Hz force oscillations. Widespread differences in brain activity were observed between essential tremor and Parkinson's disease. Using functional connectivity analyses during the task evidenced reduced cerebellar-cortical functional connectivity in patients with essential tremor compared with controls and Parkinson's disease. This study provides new evidence that in essential tremor 3-8 Hz force oscillations relate to hyperactivity in motor cortex, 0-3 Hz force oscillations relate to the hypoactivity in the cerebellum, and cerebellar-cortical functional connectivity is impaired.

Analysis of the accuracy and robustness of the leap motion controller

The Leap Motion Controller is a new device for hand gesture controlled user interfaces with declared sub-millimeter accuracy. However, up to this point its capabilities in real environments have not been analyzed. Therefore, this paper presents a first study of a Leap Motion Controller. The main focus of attention is on the evaluation of the accuracy and repeatability. For an appropriate evaluation, a novel experimental setup was developed making use of an industrial robot with a reference pen allowing a position accuracy of 0.2 mm. Thereby, a deviation between a desired 3D position and the average measured positions below 0.2 mm has been obtained for static setups and of 1.2 mm for dynamic setups. Using the conclusion of this analysis can improve the development of applications for the Leap Motion controller in the field of Human-Computer Interaction.

The dynamics of finger tremor in multiple sclerosis is affected by whole body position

Multiple sclerosis (MS) is a disease that results in widespread damage to the nervous system. One consequence of this disease is the emergence of enhanced tremor. This study was designed to (1) compare the tremor responses of persons with MS to that of healthy adults and to (2) examine the impact of whole body position (i.e., seated/standing) on tremor. Bilateral postural tremor was recorded using accelerometers attached to each index finger. Results revealed some similarity of tremor between groups in regard to the principal features (e.g., presence of peaks in similar frequency ranges). However, significant differences were observed with tremor for the MS persons being of greater amplitude, more regular (lower ApEn) and more strongly coupled across limbs compared to the elderly. The effects of body position were consistent across all subjects, with tremor increasing significantly from sitting-to-standing. However, the tremor increase for the MS group was greater than the elderly. Overall, the tremor for MS group was negatively affected by both this disease process and the nature of the task being performed. This latter result indicates that tremor does not simply reflect the feed-forward output of the neuromotor system but that it is influenced by the task constraints.

Aging, neuromuscular decline, and the change in physiological and behavioral complexity of upper-limb movement dynamics

Aging is characterized by a general decline in physiological and behavioral function that has been widely interpreted within the context of the loss of complexity hypothesis. In this paper, we examine the relation between aging, neuromuscular function and physiological-behavioral complexity in the arm-hand effector system, specifically with reference to physiological tremor and isometric force production. Experimental findings reveal that the adaptive behavioral consequences of the aging-related functional decline in neurophysiological processes are less pronounced in simple motor tasks which provides support for the proposition that the motor output is influenced by both extrinsic (e.g., task related) and intrinsic (e.g., coordination, weakness) factors. Moreover, the aging-related change in complexity can be bidirectional (increase or decrease) according to the influence of task constraints on the adaptation required of the intrinsic properties of the effector system.

Postural sway during quiet standing is related to physiological tremor and muscle volume in young and elderly adults

To examine the age-related deterioration in postural control, we investigated the association between postural sway during quiet standing and either amplitude of physiological tremor or muscle volume of the plantar flexors in 20 young and 20 elderly adults. They maintained a quiet standing position on a force platform for 60s with their eyes open or closed. During quiet standing, physiological tremors detected using a piezoresistive accelerometer were recorded from the soleus muscle, and the center of pressure (COP) displacement and body acceleration in the antero-posterior direction were calculated using the ground reaction forces as an assessment of postural sway. Muscle volume was predicted from muscle thickness by an ultrasonographic image. The physiological tremor of the soleus muscle during quiet standing was significantly greater in elderly than in young adults, and a positive association between physiological tremor and the amplitude of postural sway was found for young and elderly adults combined. Furthermore, physiological tremor was positively correlated with the high-frequency component of COP sway during quiet standing. A significantly negative relation between the muscle volume of the plantar flexors and postural sway was found in both age groups. These results suggest that physiological tremor reflects high-frequency fluctuations in postural sway during quiet standing in young and elderly adults, and age-related increases in the postural sway amplitude in the antero-posterior direction may be related to a decrease in muscle volume of the plantar flexors for maintaining an upright posture.

Aging and motor variability: a test of the neural noise hypothesis

Experimental tests of the neural noise hypothesis of aging, which holds that aging-related increments in motor variability are due to increases in white noise in the perceptual-motor system, were conducted. Young (20-29 years old) and old (60-69 and 70-79 years old) adults performed several perceptual-motor tasks. Older adults were progressively more variable in their performance outcome, but there was no age-related difference in white noise in the motor output. Older adults had a greater frequency-dependent structure in their motor variability that was associated with performance decrements. The findings challenge the main tenet of the neural noise hypothesis of aging in that the increased variability of older adults was due to a decreased ability to adapt to the constraints of the task rather than an increment of neural noise per se.

Investigation of age-related changes in physiological kinetic tremor

Tremor is the most common movement disorder characterized by repetitive and stereotyped movements. Most investigations on tremor attempt to understand its relation to neuromuscular dysfunctions. Therefore, there is a lack of studies that aim to investigate the complex relation between the physiological tremor and aging, especially in kinetic conditions. In this context, the main motivation of this research was to quantify age-related changes in the kinetic tremor of clinically healthy individuals. For this, a number of features extracted from tremor activity, obtained from digitized drawings of Archimedes' spirals, were analyzed. In total, 59 subjects participated in the experiments. These individuals were divided into seven groups according to their ages and two types of analysis were carried out. First, the tremor activity of young and elderly adults was investigated by means of traditional features commonly used in tremor analysis, and secondly, linear discriminant analysis (LDA) was employed for the study of the correlation between age and tremor. The results showed significant statistical differences between the kinetic tremor activity of the young and elderly groups. Furthermore, it was found that LDA allowed for the estimate of a unique feature, so-called LDA-value, which showed to be linearly correlated with age.

The approximate entropy of the electromyographic signals of tremor correlates with the osmotic fragility of human erythrocytes

BACKGROUND

The main problem of tremor is the damage caused to the quality of the life of patients, especially those at more advanced ages. There is not a consensus yet about the origins of this disorder, but it can be examined in the correlations between the biological signs of aging and the tremor characteristics.

METHODS

This work sought correlations between the osmotic fragility of erythrocytes and features extracted from electromyographic (EMG) activity resulting from physiological tremor in healthy patients (N = 44) at different ages (24-87 years). The osmotic fragility was spectrophotometrically evaluated by the dependence of hemolysis, provided by the absorbance in 540 nm (A54o), on the concentration of NaCl. The data were adjusted to curves of sigmoidal regression and characterized by the half transition point (H50), amplitude of lysis transition (dx) and values of A540 in the curve regions that characterize the presence of lysed (A1) and preserved erythrocytes (A2). The approximate entropy was estimated from EMG signals detected from the extensor carpi ulnaris muscle during the movement of the hand of subjects holding up a laser pen towards an Archimedes spiral, fixed in a whiteboard. The evaluations were carried out with the laser pen at rest, at the center of the spiral, and in movement from the center to the outside and from outside to the center. The correlations among the parameters of osmotic fragility, tremor and age were tested.

RESULTS

Negative correlations with age were found for A1 and dx. With the hand at rest, a positive correlation with H50 was found for the approximate entropy. Negative correlations with H50 were found for the entropy with the hand in movement, as from the center to the outside or from the outside to the center of the spiral.

CONCLUSION

In healthy individuals, the increase in the erythrocyte osmotic fragility was associated with a decrease in the approximate entropy for rest tremor and with an increase of the entropy for movement tremor. This suggests that the neuromuscular degeneration associated with tremor entails also the mechanisms involved in the breakdown of structural homeostasis of the erythrocyte membrane.

Concurrent adaptation of force and impedance in the redundant muscle system

This article examines the validity of a model to explain how humans learn to perform movements in environments with novel dynamics, including unstable dynamics typical of tool use. In this model, a simple rule specifies how the activation of each muscle is adapted from one movement to the next. Simulations of multijoint arm movements with a neuromuscular plant that incorporates neural delays, reflexes, and signal-dependent noise, demonstrate that the controller is able to compensate for changing internal or environment dynamics and noise properties. The computational model adapts by learning both the appropriate forces and required limb impedance to compensate precisely for forces and instabilities in arbitrary directions with patterns similar to those observed in motor learning experiments. It learns to regulate reciprocal activation and co-activation in a redundant muscle system during repeated movements without requiring any explicit transformation from hand to muscle space. Independent error-driven change in the activation of each muscle results in a coordinated control of the redundant muscle system and in a behavior that reduces instability, systematic error, and energy.

Surface EMG pattern analysis of the wrist muscles at different speeds of contraction

The aim of this study is to investigate the characteristics of surface electromyographic signals, particularly in pattern analysis. The data were collected from the wrist muscles (flexor carpi ulnaris and extensor carpi radialis) of 20 healthy participants. The study focuses on the movement of the wrist muscles at different frequencies. Participants were asked to contract their muscles at four different speeds (60, 90 and 120 cycles a minute and maximum speed) during wrist flexion and extension, co-contraction and isometric contraction. In this work, moving approximate entropy, mean absolute value and kurtosis are evaluated from the surface electromyographic signals at the four speeds. Moving approximate entropy and kurtosis analysis show that there are significant differences at three states of contraction; start, middle and end. It is shown that there are more regular data in a surface electromyographic signal at the beginning and end of a muscle contraction with low regularity during the middle part.

Novel parameters of surface EMG in patients with Parkinson's disease and healthy young and old controls

The aim of this study was to evaluate a variety of traditional and novel surface electromyography (SEMG) characteristics of biceps brachii muscle in patients with Parkinson's disease (PD) and compare the results with the healthy old and young control subjects. Furthermore, the aim was to define the optimal biceps brachii loading level that would most likely differentiate patients from controls. The results indicated that such nonlinear SEMG parameters as %Recurrence, %Determinism and SEMG distribution kurtosis, correlation dimension and sample entropy were significantly different between the PD patients and healthy controls. These novel nonlinear parameters, unlike traditional spectral or amplitude parameters, correlated with the Unified Parkinson's Disease Rating Scale (UPDRS) and finger tapping scores. The most significant between group differences were found in the loading condition where no additional weights were applied in isometric elbow flexion. No major difference of SEMG characteristics was detected between old and young control subjects. In conclusion, the novel SEMG parameters can differentiate the patients with PD from healthy control subjects and these parameters may have potential in the assessment of the severity of PD.

Deep brain stimulation and medication for parkinsonian tremor during secondary tasks

This study examined the efficacy of subthalamic nucleus (STN), deep brain stimulation (DBS), and medication for resting tremor during performance of secondary tasks. Hand tremor was recorded using accelerometry and electromyography (EMG) from 10 patients with Parkinson's disease (PD) and ten matched control subjects. The PD subjects were examined off treatment, on STN DBS, on medication, and on STN DBS plus medication. In the first experiment, tremor was recorded in a quiet condition and during a cognitive task designed to enhance tremor. In the second experiment, tremor was recorded in a quiet condition and during isometric finger flexion (motor task) with the contralateral limb at 5% of the maximal voluntary contraction (MVC) that was designed to suppress tremor. Results showed that: (1) STN DBS and medication reduced tremor during a cognitive task that exacerbated tremor, (2) STN DBS normalized tremor frequency in both the quiet and cognitive task conditions, whereas tremor amplitude was only normalized in the quiet condition, (3) a secondary motor task reduced tremor in a similar manner to STN DBS. These findings demonstrate that STN DBS still suppresses tremor in the presence of a cognitive task. Furthermore, a secondary motor task of the opposite limb suppresses tremor to levels comparable to STN DBS.

Age effect on fatigue-induced limb acceleration as a consequence of high-level sustained submaximal contraction

In reference to electromyographic measurement, the study was conducted to reassess differences in the behavior of fatigue-related neuromuscular function between young and elderly humans with limb acceleration (LA). Fourteen young and fourteen elderly subjects performed sustained index abduction at 75% of their maximal voluntary contractions (MVC) until task failure. Measures of neuromuscular function, including temporal/spectral features of muscle activity of the first dorsal interosseous (FDI) and LA of the index and hand, were monitored. The results showed a manifest fatigue-induced increase in LA of the index in the elderly group, but not in the young group. In contrast, only the young group developed a significant increase in amplitude of the electromyography (EMG) until task failure. Spectral analyses of LA in the index reflected marked age-dependent reorganization following muscle fatigue, with a greater reduction of relative spectral amplitude of LA in the range of 20-40 Hz, but a lesser reduction in coherence between EMG and LA in the elderly group. In line with fatigue-associated restructuring of LA, the mechanical coupling of the metacarpophalangeal joint was more severely undermined in the elderly group than in the young group. The present study manifested an age-related difference in the relative contributions of neural versus mechanical factors to muscle fatigue. Subsequent to a high-level sustained submaximal isometric contraction, a predominant mechanical failure of the musculotendon complex in the elderly was featured with LA, whereas EMG measurement characterized prevailing impairment of neuromuscular propagation in the young.

Inverse relations in the patterns of muscle and center of pressure dynamics during standing still and movement postures

The aim of this study was to investigate the postural center of pressure (COP) and surface muscle (EMG) dynamics of young adult participants under conditions where they were required to voluntarily produce random and regular sway motions in contrast to that of standing still. Frequency, amplitude and regularity measures of the COP excursion and EMG activity were assessed, as were measures of the coupling relations between the COP and EMG outputs. The results demonstrated that, even when standing still, there was a high degree of regularity in the COP output, with little difference in the modal frequency dynamics between standing still and preferred motion. Only during random conditions was a significantly greater degree of irregularity observed in the COP measures. The random-like movements were also characterized by a decrease in the level of synchrony between COP motion on the anterior-posterior (AP) and medio-lateral (ML) axes. In contrast, at muscle level, the random task resulted in the highest level of regularity (decreased ApEn) for the EMG output for soleus and tibialis anterior. The ability of individuals to produce a random motion was achieved through the decoupling of the COP motion in each dimension. This decoupling strategy was reflected by increased regularity of the EMG output as opposed to any significant change in the synchrony in the firing patterns of the muscles examined. Increased regularity across the individual muscles was accompanied by increased irregularity in COP dynamics, which can be characterized as a complexity tradeoff. Collectively, these findings support the view that the dynamics of muscle firing patterns does not necessarily map directly to the dynamics at the movement task level and vice versa.