Validation of a precision tremor measurement system for multiple sclerosis

Thushara Perera, Wee Lih Lee, Shivanthan A.C. Yohanandan, Ai Lan Nguyen, Belinda Cruse, Frederique M.C. Boonstra, Gustavo Noffs, Adam P. Vogel, Scott C. Kolbe, Helmut Butzkueven, Andrew Evans, Anneke van der Walt

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Background: Tremor is a debilitating symptom of Multiple Sclerosis (MS). Little is known about its pathophysiology and treatments are limited. Clinical trials investigating new interventions often rely on subjective clinical rating scales to provide supporting evidence of efficacy. New Method: We present a novel instrument (TREMBAL) which uses electromagnetic motion capture technology to quantify MS tremor. We aim to validate TREMBAL by comparison to clinical ratings using regression modelling with 310 samples of tremor captured from 13 MS participants who performed five different hand exercises during several follow-up visits. Minimum detectable change (MDC) and test-retest reliability were calculated and comparisons were made between MS tremor and data from 12 healthy volunteers. Results: Velocity of the index finger was most congruent with clinical observation. Regression modelling combining different features, sensor configurations, and labelling exercises did not improve results. TREMBAL MDC was 84% of its initial measurement compared to 91% for the clinical rating. Intra-class correlations for test-retest reliability were 0.781 for TREMBAL and 0.703 for clinical ratings. Tremor was lower (p = 0.002) in healthy subjects. Comparison with Existing Methods: Subjective scales have low sensitivity, suffer from ceiling effects, and mitigation against inter-rater variability is challenging. Inertial sensors are ubiquitous, however, their output is nonlinearly related to tremor frequency, compensation is required for gravitational artefacts, and their raw data cannot be intuitively comprehended. Conclusions: TREMBAL, compared with clinical ratings, gave measures in agreement with clinical observation, had marginally lower MDC, and similar test-retest reliability.

Original languageEnglish
Pages (from-to)377-384
Number of pages8
JournalJournal of Neuroscience Methods
Publication statusPublished - 1 Jan 2019


  • Multiple sclerosis
  • Objective monitoring
  • Quantification
  • Tremor

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