Automated analysis of pen-on-paper spirals for tremor detection, quantification, and differentiation.

OBJECTIVE: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. METHODS: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The alg...

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Published in:Annals of Movement Disorders Vol. 6; no. 1; pp. 17 - 26
Main Authors: Rajan, Roopa, Anandapadmanabhan, Reghu, Nageswaran, Sharmila, Radhakrishnan, Vineeth, Saini, Arti, Krishnan, Syam, Gupta, Anu, Vishnu, Venugopalan Y., Pandit, Awadh K., Singh, Rajesh Kumar, Radhakrishnan, Divya M, Singh, Mamta Bhushan, Bhatia, Rohit, Srivastava, Achal, Kishore, Asha, Padma Srivastava, M. V.
Format: research tables/charts Journal Article
Published: Wolters Kluwer India Pvt Ltd Jan-Apr2023
Online Access:View this record in EBSCOhost
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      dt: Jan-Apr2023
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      pub: Wolters Kluwer India Pvt Ltd
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        10.4103/aomd.aomd_50_22
        171864528
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        atl: Automated analysis of pen-on-paper spirals for tremor detection, quantification, and differentiation.
      aug:
        au:
          Rajan, Roopa
          Anandapadmanabhan, Reghu
          Nageswaran, Sharmila
          Radhakrishnan, Vineeth
          Saini, Arti
          Krishnan, Syam
          Gupta, Anu
          Vishnu, Venugopalan Y.
          Pandit, Awadh K.
          Singh, Rajesh Kumar
          Radhakrishnan, Divya M
          Singh, Mamta Bhushan
          Bhatia, Rohit
          Srivastava, Achal
          Kishore, Asha
          Padma Srivastava, M. V.
        affil: Department of Neurology, All India Institute of Medical Sciences, New Delhi.
      sug:
        subj:
          Tremor Diagnosis
          Algorithms Utilization
          Drawing
          Task Performance and Analysis
          Handwriting
          Human
          Descriptive Statistics
          Parkinson Disease
          Volunteer Workers
          Scales
          Accelerometers
          Sensitivity and Specificity
          Confidence Intervals
          Dystonic Disorders
          Movement Disorders
          Spearman's Rank Correlation Coefficient
          Analysis of Variance
          ROC Curve
          Data Analysis Software
          Post Hoc Analysis
          Exploratory Research
          Adult
          Middle Age
          Adult: 19-44 years
          Middle Aged: 45-64 years
      ab: OBJECTIVE: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. METHODS: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor variability from scanned images. MD and tremor variability were compared with 1) the Bain and Findley scale, 2) the Fahn–Tolosa–Marin tremor rating scale (FTM–TRS), and 3) the peak power and total power of the accelerometer spectra. Inter and intra loop widths were computed to differentiate between the tremor. RESULTS: MD was higher in the tremor group (48.9±26.3) than in HV (26.4±5.3; p < 0.001). The cut-off value of 30.3 had 80.9% sensitivity and 76.0% specificity for the detection of the tremor [area under the curve: 0.83; 95% confidence index (CI): 0.75, 0.91, p < 0.001]. MD correlated with the Bain and Findley ratings (rho = 0.491, p = 0 < 0.001), FTM–TRS part B (rho = 0.260, p = 0.032) and accelerometric measures of postural tremor (total power, rho = 0.366, p < 0.001; peak power, rho = 0.402, p < 0.001). Minimum Detectable Change was 19.9%. Inter loop width distinguished Parkinson’s disease spirals from dystonic tremor (p < 0.001, 95% CI: 54.6, 211.1), essential tremor (p = 0.003, 95% CI: 28.5, 184.9), or HV (p = 0.036, 95% CI: -160.4, -3.9). CONCLUSION: The automated analysis of pen-on-paper spirals generated robust variables to quantify the tremor and putative variables to distinguish them from each other. SIGNIFICANCE: This technique maybe useful for epidemiological surveys and follow-up studies on tremor.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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