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Chan PY, Ripin ZM, Halim SA, Arifin WN, Yahya AS, Eow GB, Tan K, Hor JY, Wong CK. Motion characteristics of subclinical tremors in Parkinson's disease and normal subjects. Sci Rep 2022; 12:4021. [PMID: 35256707 PMCID: PMC8901710 DOI: 10.1038/s41598-022-07957-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ping Yi Chan
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Zaidi Mohd Ripin
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Sanihah Abdul Halim
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nor Arifin
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Shukri Yahya
- School of Civil Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Gaik Bee Eow
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Kenny Tan
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Jyh Yung Hor
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Chee Keong Wong
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
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Li Y, Wolf MD, Kulkarni AD, Bell J, Chang JS, Nimunkar A, Radwin RG. In Situ Tremor in Vitreoretinal Surgery. HUMAN FACTORS 2021; 63:1169-1181. [PMID: 32286884 PMCID: PMC8521350 DOI: 10.1177/0018720820916629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgeon tremor was measured during vitreoretinal microscopic surgeries under different hand support conditions. BACKGROUND While the ophthalmic surgeon's forearm is supported using a standard symmetric wrist rest when operating on the patient's same side as the dominant hand (SSD), the surgeon's hand is placed directly on the patient's forehead when operating on the contralateral side of the dominant hand (CSD). It was hypothesized that more tremor is associated with CSD surgeries than SSD surgeries and that, using an experimental asymmetric wrist rest where the contralateral wrist bar gradually rises and curves toward the patient's operative eye, there is no difference in tremor associated with CSD and SSD surgeries. METHODS Seventy-six microscope videos, recorded from three surgeons performing macular membrane peeling operations, were analyzed using marker-less motion tracking, and movement data (instrument path length and acceleration) were recorded. Tremor acceleration frequency and magnitude were measured using spectral analysis. Following 47 surgeries using a conventional symmetric wrist support, surgeons incorporated the experimental asymmetric wrist rest into their surgical routine. RESULTS There was 0.11 mm/s2 (22%) greater (p = .05) average tremor acceleration magnitude for CSD surgeries (0.62 mm/s2, SD = 0.08) than SSD surgeries (0.51 mm/s2, SD = 0.09) for the symmetric wrist rest, while no significant (p > .05) differences were observed (0.57 mm, SD = 0.13 for SSD and 0.58 mm, SD = 0.11 for CSD surgeries) for the experimental asymmetric wrist rest. CONCLUSION The asymmetric wrist support reduced the difference in tremor acceleration between CSD and SSD surgeries.
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Affiliation(s)
- Yifan Li
- University of Wisconsin-Madison, USA
| | | | | | - James Bell
- SSM Health Dean Medical Group, Madison, WI, USA
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Byun SW, Lee SP. Implementation of Hand Gesture Recognition Device Applicable to Smart Watch Based on Flexible Epidermal Tactile Sensor Array. MICROMACHINES 2019; 10:mi10100692. [PMID: 31614813 PMCID: PMC6843450 DOI: 10.3390/mi10100692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 11/27/2022]
Abstract
Ever since the development of digital devices, the recognition of human gestures has played an important role in many Human-Computer interface applications. Various wearable devices have been developed, and inertial sensors, magnetic sensors, gyro sensors, electromyography, force-sensitive resistors, and other types of sensors have been used to identify gestures. However, there are different drawbacks for each sensor, which affect the detection of gestures. In this paper, we present a new gesture recognition method using a Flexible Epidermal Tactile Sensor based on strain gauges to sense deformation. Such deformations are transduced to electric signals. By measuring the electric signals, the sensor can estimate the degree of deformation, including compression, tension, and twist, caused by movements of the wrist. The proposed sensor array was demonstrated to be capable of analyzing the eight motions of the wrist, and showed robustness, stability, and repeatability throughout a range of experiments aimed at testing the sensor array. We compared the performance of the prototype device with those of previous studies, under the same experimental conditions. The result shows our recognition method significantly outperformed existing methods.
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Affiliation(s)
- Sung-Woo Byun
- Department of Computer Science, Graduate School, SangMyung University, 20, Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea.
| | - Seok-Pil Lee
- Department of Electronic Engineering, SangMyung University, 20, Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea.
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Daneault JF, Carignan B, Codère CÉ, Sadikot AF, Duval C. Using a smart phone as a standalone platform for detection and monitoring of pathological tremors. Front Hum Neurosci 2013; 6:357. [PMID: 23346053 PMCID: PMC3548411 DOI: 10.3389/fnhum.2012.00357] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/25/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction: Smart phones are becoming ubiquitous and their computing capabilities are ever increasing. Consequently, more attention is geared toward their potential use in research and medical settings. For instance, their built-in hardware can provide quantitative data for different movements. Therefore, the goal of the current study was to evaluate the capabilities of a standalone smart phone platform to characterize tremor. Results: Algorithms for tremor recording and online analysis can be implemented within a smart phone. The smart phone provides reliable time- and frequency-domain tremor characteristics. The smart phone can also provide medically relevant tremor assessments. Discussion: Smart phones have the potential to provide researchers and clinicians with quantitative short- and long-term tremor assessments that are currently not easily available. Methods: A smart phone application for tremor quantification and online analysis was developed. Then, smart phone results were compared to those obtained simultaneously with a laboratory accelerometer. Finally, results from the smart phone were compared to clinical tremor assessments.
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Affiliation(s)
- Jean-François Daneault
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Montreal, QC, Canada ; Centre de Recherche de l'Institut, Universitaire de Gériatrie de Montréal Montréal, QC, Canada
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Barroso Júnior MC, Esteves GP, Nunes TP, Silva LMG, Faria ACD, Melo PL. A telemedicine instrument for remote evaluation of tremor: design and initial applications in fatigue and patients with Parkinson's disease. Biomed Eng Online 2011; 10:14. [PMID: 21306628 PMCID: PMC3042428 DOI: 10.1186/1475-925x-10-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/09/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A novel system that combines a compact mobile instrument and Internet communications is presented in this paper for remote evaluation of tremors. The system presents a high potential application in Parkinson's disease and connects to the Internet through a TCP/IP protocol. Tremor transduction is carried out by accelerometers, and the data processing, presentation and storage were obtained by a virtual instrument. The system supplies the peak frequency (fp), the amplitude (Afp) and power in this frequency (Pfp), the total power (Ptot), and the power in low (1-4 Hz) and high (4-7 Hz) frequencies (Plf and Phf, respectively). METHODS The ability of the proposed system to detect abnormal tremors was initially demonstrated by a fatigue study in normal subjects. In close agreement with physiological fundamentals, the presence of fatigue increased fp, Afp, Pfp and Pt (p < 0.05), while the removal of fatigue reduced all the mentioned parameters (p < 0.05). The system was also evaluated in a preliminary in vivo test in parkinsonian patients. Afp, Pfp, Ptot, Plf and Phf were the most accurate parameters in the detection of the adverse effects of this disease (Se = 100%, Sp = 100%), followed by fp (Se = 100%, Sp = 80%). Tests for Internet transmission that realistically simulated clinical conditions revealed adequate acquisition and analysis of tremor signals and also revealed that the user could adequately receive medical recommendations. CONCLUSIONS The proposed system can be used in a wide spectrum of telemedicine scenarios, enabling the home evaluation of tremor occurrence under specific medical treatments and contributing to reduce the costs of the assistance offered to these patients.
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Affiliation(s)
- Mário C Barroso Júnior
- Biomedical Instrumentation Laboratory State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Nitta H, Kinoyama M, Watanabe A, Fujita Y, Ueda H, Shirao K. Measurement of Carbon Monoxide in Exhaled Breath as a Possible Marker of Stress. ACTA ACUST UNITED AC 2007. [DOI: 10.1248/jhs.53.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hayami Nitta
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
| | - Maki Kinoyama
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
| | - Akiharu Watanabe
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
| | - Yoshiaki Fujita
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
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Abstract
Tremor is one of the most common involuntary movement disorders seen in clinical practice. In addition to the detailed history, the differential diagnosis is mainly clinical based on the distinction at rest, postural and intention, activation condition, frequency, and topographical distribution. The causes of tremor are heterogeneous and it can present alone (for example, essential tremor) or as a part of a neurological syndrome (for example, multiple sclerosis). Essential tremor and the tremor of Parkinson's disease are the most common tremors encountered in clinical practice. This article focuses on a practical approach to these different forms of tremor and how to distinguish them clinically. Evidence supporting various strategies used in the differentiation is then presented, followed by a review of formal guidelines or recommendations when they exist.
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Affiliation(s)
- R Bhidayasiri
- Department of Neurology, Reed Neurological Research Institute, UCLA Medical Center, Los Angeles, CA 90095, USA.
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Tarata MT. Mechanomyography versus electromyography, in monitoring the muscular fatigue. Biomed Eng Online 2003; 2:3. [PMID: 12625837 PMCID: PMC443861 DOI: 10.1186/1475-925x-2-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2002] [Accepted: 02/11/2003] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The use of the mechanomyogram (MMG) which detects muscular vibrations generated by fused individual fiber twitches has been refined. The study addresses a comparison of the MMG and surface electromyogram (SEMG) in monitoring muscle fatigue. METHODS The SEMG and MMG were recorded simultaneously from the same territory of motor units in two muscles (Biceps, Brachioradialis) of the human (n = 18), during sustained contraction at 25 % MVC (maximal voluntary contraction). RESULTS The RMS (root mean square) of the SEMG and MMG increased with advancing fatigue; MF (median frequency) of the PSD (power density spectra) progressively decreased from the onset of the contraction. These findings (both muscles, all subjects), demonstrate both through the SEMG and MMG a central component of the fatigue. The MF regression slopes of MMG were closer to each other between men and women (Biceps 1.55%; Brachialis 13.2%) than were the SEMG MF slopes (Biceps 25.32%; Brachialis 17.72%), which shows a smaller inter-sex variability for the MMG vs. SEMG. CONCLUSION The study presents another quantitative comparison (MF, RMS) of MMG and SEMG, showing that MMG signal can be used for indication of the degree of muscle activation and for monitoring the muscle fatigue when the application of SEMG is not feasible (chronical implants, adverse environments contaminated by electrical noise).
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Affiliation(s)
- Mihai T Tarata
- Department of Medical Informatics, University of Medicine and Pharmacy of Craiova, Bul, Antonescu 62, Craiova, Romania.
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Zaninelli R, Bauer M, Jobert M, Müller-Oerlinghausen B. Changes in quantitatively assessed tremor during treatment of major depression with lithium augmented by paroxetine or amitriptyline. J Clin Psychopharmacol 2001; 21:190-8. [PMID: 11270916 DOI: 10.1097/00004714-200104000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tremor is a relatively frequent side effect of lithium and of antidepressants with serotonergic properties. It can be expected that combinations of lithium (which is itself serotonergic) with such antidepressants will enhance not only efficacy, but also the incidence of side effects, including tremor. To quantitatively monitor the effect of antidepressant augmentation of ongoing lithium therapy on tremor, lithium-maintained patients with a breakthrough episode of major depression were randomly assigned under double-blind conditions to receive paroxetine 20 mg/day (N = 14) or amitriptyline 75 mg/day (N = 17). The initial dosages could be increased after 2 weeks to 40 mg/day and 150 mg/day, respectively, and the patients were treated for 6 weeks. Tremor activity was assessed weekly, quantitatively by accelerometry and qualitatively with the Dosage Record and Treatment Emergent Symptom Scale. Statistical analysis detected no significant difference between the treatment groups with respect to changes in mean tremor activity relative to baseline. However, analysis of the pooled data showed that tremor increased significantly during the course of combined lithium and antidepressant therapy, with the greatest increments occurring independent of dosage approximately 3 weeks after initiation of combination treatment. Although the mean tremor activity subsided toward the end of treatment, tremor activity on the whole was still significantly greater after 6 weeks of combined lithium and antidepressant treatment than at the start of combination therapy. Increased tremor was not associated with decreased medication compliance, and no patient discontinued treatment because of increased tremor. Tremor frequency was not affected by the study treatments.
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Affiliation(s)
- R Zaninelli
- Clinical Development CNS/GI, SmithKline Beecham Pharmaceuticals, Philadelphia, PA, USA.
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Keil A, Elbert T, Taub E. Relation of Accelerometer and EMG Recordings for the Measurement of Upper Extremity Movement. J PSYCHOPHYSIOL 1999. [DOI: 10.1027//0269-8803.13.2.77] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract In order to determine the value of accelerometry as a measure of real world outcome when a subject is outside the laboratory, accelerometer recordings from the wrist were compared with simultaneous electromyogram (EMG) recordings from the lower and upper arm. Accelerometer and EMG signals were recorded simultaneously by the “Kölner Vitaport System,” an ambulatory device. Six male subjects performed standardized tasks as well as activities of daily life (ADL). Low correlations between accelerometer counts and integrated EMG were found in the standardized tasks, whereas there were considerably higher correlations for ADL. However, there was a strong relation between several parameters derived from EMG and accelerometer recordings. The two techniques appear to measure different aspects of movement and may be complementary.
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Affiliation(s)
- Andreas Keil
- Department of Psychology, University of Konstanz, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Germany
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, USA
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