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Digitizing Tablet and Fahn–Tolosa–Marı´n Ratings of Archimedes Spirals have Comparable Minimum Detectable Change in Essential Tremor
Open accessAbstract
Background: Drawing Archimedes spirals is a popular and valid method of assessing action tremor in the upper limbs. We performed the first blinded comparison of Fahn–Tolosa–Marý´n (FTM) ratings and tablet measures of essential tremor to determine if a digitizing tablet is better than 0–4 ratings in detecting changes in essential tremor that exceed random variability in tremor amplitude. Methods: The large and small spirals of FTM were drawn with each hand on two consecutive days by 14 men and four women (age 60¡8.7 years [mean¡SD]) with mild to severe essential tremor. The drawings were simultaneously digitized with a digitizing tablet. Tremor in each digitized drawing was computed with spectral analysis in an independent laboratory, blinded to the clinical ratings. The mean peak-to-peak tremor displacement (cm) in the four spirals and mean FTM ratings were compared statistically. Results: Test–retest intraclass correlations (ICCs) (two-way random single measures, absolute agreement) were excellent for the FTM ratings (ICC 0.90, 95% CI 0.76–0.96) and tablet (ICC 0.97, 95% CI 0.91–0.99). Log10 tremor amplitude (T) and FTM were strongly correlated (logT=αFTM + β, α≈0.6, β≈–1.27, r=0.94). The minimum detectable change for the tablet and FTM were 51% and 67% of the initial assessment. Discussion: Digitizing tablets are much more precise than clinical ratings, but this advantage is mitigated by the natural variability in tremor. Nevertheless, the digitizing tablet is a robust method of quantifying tremor that can be used in lieu of or in combination with clinical ratings.
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Spiral drawing is well-suited to the study of electronic recording of ET.
“Spiral drawing, often used by clinicians as a pen-and-paper assessment of tremor disorders [40], is well-suited to the study of electronic recording of ET [41].”
From Wearable Accelerometer and Gyroscope Sensors for Estimating the Severity of Essential Tremor (2024) · cites this paper as [41]
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Metadata
- Authors
- Elble, R. J., & Ellenbogen, A.
- Affiliations
- SIU Medicine (US)
- Michigan Institute for Neurological Disorders (US)
- Corresponding author
- Elble, Rodger J
- Venue
- Tremor and Other Hyperkinetic Movements
- Publisher
- Ubiquity Press, Ltd.
- Published
- 2017-07-07
- Volume
- 7
- Issue
- 0
- Pages
- 481
- ISSN
- 2160-8288 (ISSN-L)
- OpenAlex
- W4241930734
- Cited by
- 16
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 2 · 2019: 1 · 2018: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- creativecommons.org/licenses/by/4.0 (vor)
- Locations
- Tremor and Other Hyperkinetic Movements (publishedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
- Health Sciences › Medicine › Clinical Neurology › Botulinum Toxin and Related Neurological Disorders
- Keywords
- essential tremor, digitizing tablet, tremor amplitude, minimal detectable change, test-retest reliability, tremor quantification
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