Toward quantitative characterization of essential tremor for future tremor suppression

Charles, Steven K.; Geiger, Daniel W; Davidson, Andrew D.; Pigg, Adam C.; Curtis, Christina; Allen, Brendon C.

doi:10.1109/icorr.2017.8009242

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…Many orthoses considered the WFE but only seven orthoses suppress involuntary movements of the FPS, a reason being the mechanical complexity of FPS intervention [32]. Regardless, the exact biomechanical processes and origins of tremor are still unclear and there is a need for further investigations to achieve an optimal suppression [95]. In general, it can be assumed that WFE and FPS suppression are sufficient for an adequate physical intervention in tremor because those are the most affected DOF in PD, ET and cerebellar tremor [96].…”

Section: Discussionmentioning

confidence: 99%

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Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

Fromme

Camenzind

Riener

et al. 2019

J NeuroEngineering Rehabil

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Introduction Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson’s disease or essential tremor over the age of 65. Conventionally, tremor diseases like Parkinson’s are treated with medication. An alternative non-invasive symptom treatment is the mechanical suppression of the oscillation movement. The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments. Method A systematic literature search was conducted by performing a keyword combination search of the title, abstract and keyword sections in the four databases Web of Science, MedLine, Scopus, and ProQuest. Initially, the retrieved articles were selected by title and abstract using selection criteria. The same criteria were then applied to the full publication text. After the selection process, relevant information on the retrieved orthoses was isolated, sorted and analysed systematically. Results Forty-six papers, representing 21 orthoses, were identified and analysed according to the mechanical and ergonomic properties. The identified orthoses can be divided into 5 concepts and 16 functional prototypes, then subdivided further based upon their use of passive, semi-active, or active suppression mechanisms. Most of the orthoses concentrate on the wrist and elbow flexion and extension. They mainly rely on rigid structures and actuators while having tremor-suppression efficacies for tremorous subjects from 30 to 98% using power spectral density or other methods. Conclusion The comparison of tremor-suppression orthoses considered and mapped their various mechanical and ergonomic properties, including the degrees of freedom, weight, suppression characteristics, and efficacies. This review shows that most of the orthoses are bulky and heavy, with a non-adapted human-machine interface which can cause rejection by the user. The main challenge of the design of an effective, minimally intrusive and portable tremor-suppressing orthosis is the integration of compact, powerful, lightweight, and non-cumbersome suppression mechanisms. None of the existing prototypes combine all the desired characteristics. Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance.

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Section: Discussionmentioning

confidence: 99%

“…In order to develop appropriate tremor-suppression orthoses, the biomechanics of the tremorous movement need to be characterized, as proposed by Charles et al [95]. Further investigations for the human-machine interface are needed, to improve the connection of a wearable device to the human body with an ideal force transmission.…”

Section: Discussionmentioning

confidence: 99%

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

Fromme

Camenzind

Riener

et al. 2019

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

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“…A variety of effective but technically intensive methods are described for quantitative evaluation of tremor. These include electromyograms that assess changes in voltage over active muscle groups as a surrogate for tremor amplitude and frequency ( Breit et al, 2008 ; Zhang et al, 2017 ), electromagnetic motion capture ( Charles et al, 2017 ; Geiger et al, 2018 ), laser-based displacement sensors ( Duval et al, 2000 ) and wearable devices based on accelerometry ( Hossen et al, 2013 ; Luft et al, 2019 ) or gyroscopic measurements of angular speed ( Jeon et al, 2017 ; Berbakov et al, 2019 ). Gyroscopes may be more appropriate compared to accelerometers when measuring movements with a significant angular velocity component such as head tremors ( Elble et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, smart-watches do not add a significant weight-loading element, are more readily adapted to the neurological exam, and can serve as a wearable for longer-term evaluation. Analysis of tremor of the upper limb in each of the seven degrees of freedom identifies the wrist as holding the greatest amount of power associated with ET ( Charles et al, 2017 ; Geiger et al, 2018 ), and allows capture of most of the tremor power during the different positions used in a structured clinical exam. Barriers to wider application of wristwatch accelerometers include lack of standardized administration protocols, cumbersome data analysis and sparse validation in clinical practice ( Elble and McNames, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…This information can contribute to diagnosis by distinguishing lower frequency tremors from high frequency tremors, or in some cases support the diagnosis of a functional tremor when there is no consistent peak ( Grimaldi and Manto, 2013 ; Louis, 2013 ; Hallett, 2016 ; Deuschl et al, 2022 ). The total power of acceleration and peak power are effective quantitative measures of tremor severity and may be used as an archive for follow-up studies of tremor progression and treatment efficacy ( Elble et al, 2006 ; Grimaldi and Manto, 2013 ; Hossen et al, 2013 ; Charles et al, 2017 ; Lopez-Blanco et al, 2018 ; Luft et al, 2019 ; van Brummelen et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

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A standardized accelerometry method for characterizing tremor: Application and validation in an ageing population with postural and action tremor

Gauthier-Lafreniere

Aljassar

Rymar

et al. 2022

Front. Neuroinform.

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BackgroundOrdinal scales based on qualitative observation are the mainstay in the clinical assessment of tremor, but are limited by inter-rater reliability, measurement precision, range, and ceiling effects. Quantitative tremor evaluation is well-developed in research, but clinical application has lagged, in part due to cumbersome mathematical application and lack of established standards.ObjectivesTo develop a novel method for evaluating tremor that integrates a standardized clinical exam, wrist-watch accelerometers, and a software framework for data analysis that does not require advanced mathematical or computing skills. The utility of the method was tested in a sequential cohort of patients with predominant postural and action tremor presenting to a specialized surgical clinic with the presumptive diagnosis of Essential Tremor (ET).MethodsWristwatch accelerometry was integrated with a standardized clinical exam. A MATLAB application was developed for automated data analysis and graphical representation of tremor. Measures from the power spectrum of acceleration of tremor in different upper limb postures were derived in 25 consecutive patients. The linear results from accelerometry were correlated with the commonly used non-linear Clinical Rating Scale for Tremor (CRST).ResultsThe acceleration power spectrum was reliably produced in all consecutive patients. Tremor frequency was stable in different postures and across patients. Both total and peak power of acceleration during postural conditions correlated well with the CRST. The standardized clinical examination with integrated accelerometry measures was therefore effective at characterizing tremor in a population with predominant postural and action tremor. The protocol is also illustrated on repeated measures in an ET patient who underwent Magnetic Resonance-Guided Focused Ultrasound thalamotomy.ConclusionQuantitative assessment of tremor as a continuous variable using wristwatch accelerometry is readily applicable as a clinical tool when integrated with a standardized clinical exam and a user-friendly software framework for analysis. The method is validated for patients with predominant postural and action tremor, and can be adopted for characterizing tremor of different etiologies with dissemination in a wide variety of clinical and research contexts in ageing populations.

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

Paredes-Acuna,

Utpadel-Fischler,

Ding

et al. 2024

J NeuroEngineering Rehabil

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Background Tremors are involuntary rhythmic movements commonly present in neurological diseases such as Parkinson's disease, essential tremor, and multiple sclerosis. Intention tremor is a subtype associated with lesions in the cerebellum and its connected pathways, and it is a common symptom in diseases associated with cerebellar pathology. While clinicians traditionally use tests to identify tremor type and severity, recent advancements in wearable technology have provided quantifiable ways to measure movement and tremor using motion capture systems, app-based tasks and tools, and physiology-based measurements. However, quantifying intention tremor remains challenging due to its changing nature. Methodology & Results This review examines the current state of upper limb tremor assessment technology and discusses potential directions to further develop new and existing algorithms and sensors to better quantify tremor, specifically intention tremor. A comprehensive search using PubMed and Scopus was performed using keywords related to technologies for tremor assessment. Afterward, screened results were filtered for relevance and eligibility and further classified into technology type. A total of 243 publications were selected for this review and classified according to their type: body function level: movement-based, activity level: task and tool-based, and physiology-based. Furthermore, each publication's methods, purpose, and technology are summarized in the appendix table. Conclusions Our survey suggests a need for more targeted tasks to evaluate intention tremors, including digitized tasks related to intentional movements, neurological and physiological measurements targeting the cerebellum and its pathways, and signal processing techniques that differentiate voluntary from involuntary movement in motion capture systems.

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Toward quantitative characterization of essential tremor for future tremor suppression

Cited by 4 publications

References 28 publications

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

A standardized accelerometry method for characterizing tremor: Application and validation in an ageing population with postural and action tremor

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

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