Classification of Essential Tremor and Parkinson’s Tremor Based on a Low-Power Wearable Device

Intelligent devices for assessing essential tremor: a comprehensive review

Essential tremor (ET) stands as the most prevalent movement disorder, characterized by rhythmic and involuntary shaking of body parts. Achieving an accurate and comprehensive assessment of tremor severity is crucial for effectively diagnosing and managing ET. Traditional methods rely on clinical observation and rating scales, which may introduce subjective biases and hinder continuous evaluation of disease progression. Recent research has explored new approaches to quantifying ET. A promising method involves the use of intelligent devices to facilitate objective and quantitative measurements. These devices include inertial measurement units, electromyography, video equipment, and electronic handwriting boards, and more. Their deployment enables real-time monitoring of human activity data, featuring portability and efficiency. This capability allows for more extensive research in this field and supports the shift from in-lab/clinic to in-home monitoring of ET symptoms. Therefore, this review provides an in-depth analysis of the application, current development, potential characteristics, and roles of intelligent devices in assessing ET.

Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools

INTRODUCTION

Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages.

AREAS COVERED

In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field.

EXPERT OPINION

Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.

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.

Resveratrol and 1,25-dihydroxyvitamin D decrease Lingo-1 levels, and improve behavior in harmaline-induced Essential tremor, suggesting potential therapeutic benefits

Essential tremor (ET) is a neurological disease that impairs motor and cognitive functioning. A variant of the Lingo-1 genetic locus is associated with a heightened ET risk, and increased expression of cerebellar Lingo-1. Lingo-1 has been associated with neurodegenerative processes; however, neuroprotection from ET-associated degeneration can be conferred by the protein Sirt1. Sirt1 activity can be promoted by Resveratrol (Res) and 1,25-dihydroxyvitamin D3 (VitD3), and thus these factors may exert neuroprotective properties through a Sirt1 mechanism. As Res and VitD3 are linked to Sirt1, enhancing Sirt1 could counteract the negative effects of increased Lingo-1. Therefore, we hypothesized that a combination of Res-VitD3 in a harmaline injection model of ET would modulate Sirt1 and Lingo-1 levels. As expected, harmaline exposure (10 mg/kg/every other day; i.p.) impaired motor coordination, enhanced tremors, rearing, and cognitive dysfunction. When Res (5 mg/kg/day; i.p.) and VitD3 (0.1 mg/kg/day; i.p.) were given to adult rats (n = 8 per group) an hour before harmaline, tremor severity, rearing, and memory impairment were reduced. Individual treatment with Res and VitD3 decreased Lingo-1 gene expression levels in qPCR assays. Co-treatment with Res and VitD3 increased and decreased Sirt1 and Lingo-1 gene expression levels, respectively, and in some cases, beneficial effects on behavior were noted, which were not seen when Res or VitD3 were individually applied. Taken together, our study found that Res and VitD3 improved locomotor and cognitive deficits, modulated Sirt1 and Lingo-1. Therefore, we would recommend co-treatment of VitD3 and Res to leverage complementary effects for the management of ET symptoms.

Upper limb intention tremor assessment: opportunities and challenges in wearable technology

BACKGROUND

Tremors are involuntary rhythmic movements commonly present in neurological diseases such as Parkinson's disease, essential tremor, and multiple sclerosis. Intention tremor is a subtype associated with lesions in the cerebellum and its connected pathways, and it is a common symptom in diseases associated with cerebellar pathology. While clinicians traditionally use tests to identify tremor type and severity, recent advancements in wearable technology have provided quantifiable ways to measure movement and tremor using motion capture systems, app-based tasks and tools, and physiology-based measurements. However, quantifying intention tremor remains challenging due to its changing nature.

METHODOLOGY & RESULTS

This review examines the current state of upper limb tremor assessment technology and discusses potential directions to further develop new and existing algorithms and sensors to better quantify tremor, specifically intention tremor. A comprehensive search using PubMed and Scopus was performed using keywords related to technologies for tremor assessment. Afterward, screened results were filtered for relevance and eligibility and further classified into technology type. A total of 243 publications were selected for this review and classified according to their type: body function level: movement-based, activity level: task and tool-based, and physiology-based. Furthermore, each publication's methods, purpose, and technology are summarized in the appendix table.

CONCLUSIONS

Our survey suggests a need for more targeted tasks to evaluate intention tremors, including digitized tasks related to intentional movements, neurological and physiological measurements targeting the cerebellum and its pathways, and signal processing techniques that differentiate voluntary from involuntary movement in motion capture systems.

A Wearable Multi-Segment Upper Limb Tremor Assessment System for Differential Diagnosis of Parkinson's Disease Versus Essential Tremor

Upper limb tremor is a prominent symptom of both Parkinson's disease and essential tremor. Its kinematic parameters overlap substantially for these two pathological conditions, thus leading to high rate of misdiagnosis, especially for community doctors. Several groups have proposed various methods for improving differential diagnosis. These prior studies have attempted to identify better kinematic parameters, however they have mainly focused on single limb features including tremor intensity, tremor frequency, and tremor variability. In this paper, we propose a wearable system for multi-segment assessment of upper limb tremor and differential diagnosis of Parkinson's disease versus essential tremor. The proposed system collected tremor data from both wrist and fingers simultaneously. From this data, we extracted multi-segment features in the form of phase relationships between limb segments. Using support vector machine classifiers, we then performed differential diagnosis from the extracted features. We evaluated the performance of the proposed system on 19 Parkinson's disease patients and 12 essential tremor patients. Moreover, we also assessed the performance cost associated with reducing task load and sensor array size. The proposed system reached perfect accuracy in leave-one-out cross validation. Task reduction and sensor array reduction were associated with penalties of 2% and 9-10% respectively. The results demonstrated that the proposed system could be simplified for clinical applications, and successfully applied to the differential diagnosis of Parkinson's disease versus essential tremor in real-world setting.

Objective measurement versus clinician-based assessment for Parkinson's disease

INTRODUCTION

Although clinician-based assessment through standardized clinical rating scales is currently the gold standard for quantifying motor impairment in Parkinson's disease (PD), it is not without limitations, including intra- and inter-rater variability and a degree of approximation. There is increasing evidence supporting the use of objective motion analyses to complement clinician-based assessment. Objective measurement tools hold significant potential for improving the accuracy of clinical and research-based evaluations of patients.

AREAS COVERED

The authors provide several examples from the literature demonstrating how different motion measurement tools, including optoelectronics, contactless and wearable systems allow for both the objective quantification and monitoring of key motor symptoms (such as bradykinesia, rigidity, tremor, and gait disturbances), and the identification of motor fluctuations in PD patients. Furthermore, they discuss how, from a clinician's perspective, objective measurements can help in various stages of PD management.

EXPERT OPINION

In our opinion, sufficient evidence supports the assertion that objective monitoring systems enable accurate evaluation of motor symptoms and complications in PD. A range of devices can be utilized not only to support diagnosis but also to monitor motor symptom during the disease progression and can become relevant in the therapeutic decision-making process.

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.

Integrated Equipment for Parkinson’s Disease Early Detection Using Graph Convolution Network

There is an increasing need to diagnose Parkinson’s disease (PD) in an early stage. Existing solutions mainly focused on traditional ways such as MRI, thus suffering from the ease-of-use issue. This work presents a new approach using video and skeleton-based techniques to solve this problem. In this paper, an end-to-end Parkinson’s disease early diagnosis method based on graph convolution networks is proposed, which takes patients’ skeletons sequence as input and returns the diagnosis result. The asymmetric dual-branch network architecture is designed to process global and local information separately and capture the subtle manifestation of PD. To train the network, we present the first Parkinson’s disease gait dataset, PD-Walk. This dataset consists of 95 PD patients and 96 healthy people’s walking videos. All the data are annotated by experienced doctors. Furthermore, we implement our method on portable equipment, which has been in operation in the First Affiliated Hospital, Zhejiang University School of Medicine. Experiments show that our method can achieve 84.1% accuracy and achieve real-time performance on the equipment in the real environment. Compared with traditional solutions, the proposed method can detect suspicious PD symptoms quickly and conveniently. Integrated equipment can be easily placed in hospitals or nursing homes to provide services for elderly people.

A deep explainable artificial intelligent framework for neurological disorders discrimination

Pathological hand tremor (PHT) is a common symptom of Parkinson's disease (PD) and essential tremor (ET), which affects manual targeting, motor coordination, and movement kinetics. Effective treatment and management of the symptoms relies on the correct and in-time diagnosis of the affected individuals, where the characteristics of PHT serve as an imperative metric for this purpose. Due to the overlapping features of the corresponding symptoms, however, a high level of expertise and specialized diagnostic methodologies are required to correctly distinguish PD from ET. In this work, we propose the data-driven [Formula: see text] model, which processes the kinematics of the hand in the affected individuals and classifies the patients into PD or ET. [Formula: see text] is trained over 90 hours of hand motion signals consisting of 250 tremor assessments from 81 patients, recorded at the London Movement Disorders Centre, ON, Canada. The [Formula: see text] outperforms its state-of-the-art counterparts achieving exceptional differential diagnosis accuracy of [Formula: see text]. In addition, using the explainability and interpretability measures for machine learning models, clinically viable and statistically significant insights on how the data-driven model discriminates between the two groups of patients are achieved.