Neurological Tremor: Sensors, Signal Processing and Emerging Applications

Neurological tremor is the most common movement disorder, affecting more than 4% of elderly people. Tremor is a non linear and non stationary phenomenon, which is increasingly recognized. The issue of selection of sensors is central in the characterization of tremor. This paper reviews the state-of-the-art instrumentation and methods of signal processing for tremor occurring in humans. We describe the advantages and disadvantages of the most commonly used sensors, as well as the emerging wearable sensors being developed to assess tremor instantaneously. We discuss the current limitations and the future applications such as the integration of tremor sensors in BCIs (brain-computer interfaces) and the need for sensor fusion approaches for wearable solutions

A Wavelet-Based Approach To Monitoring Parkinson's Disease Symptoms

Parkinson's disease is a neuro-degenerative disorder affecting tens of millions of people worldwide. Lately, there has been considerable interest in systems for at-home monitoring of patients, using wearable devices which contain inertial measurement units. We present a new wavelet-based approach for analysis of data from single wrist-worn smart-watches, and show high detection performance for tremor, bradykinesia, and dyskinesia, which have been the major targets for monitoring in this context. We also discuss the implication of our controlled-experiment results for uncontrolled home monitoring of freely behaving patients.Comment: ICASSP 201

Wearable inertial sensors for human movement analysis

Introduction: The present review aims to provide an overview of the most common uses of wearable inertial sensors in the field of clinical human movement analysis.Areas covered: Six main areas of application are analysed: gait analysis, stabilometry, instrumented clinical tests, upper body mobility assessment, daily-life activity monitoring and tremor assessment. Each area is analyzed both from a methodological and applicative point of view. The focus on the methodological approaches is meant to provide an idea of the computational complexity behind a variable/parameter/index of interest so that the reader is aware of the reliability of the approach. The focus on the application is meant to provide a practical guide for advising clinicians on how inertial sensors can help them in their clinical practice.Expert commentary: Less expensive and more easy to use than other systems used in human movement analysis, wearable sensors have evolved to the point that they can be considered ready for being part of routine clinical routine

Human Motion Analysis with Wearable Inertial Sensors

High-resolution, quantitative data obtained by a human motion capture system can be used to better understand the cause of many diseases for effective treatments. Talking about the daily care of the aging population, two issues are critical. One is to continuously track motions and position of aging people when they are at home, inside a building or in the unknown environment; the other is to monitor their health status in real time when they are in the free-living environment. Continuous monitoring of human movement in their natural living environment potentially provide more valuable feedback than these in laboratory settings. However, it has been extremely challenging to go beyond laboratory and obtain accurate measurements of human physical activity in free-living environments. Commercial motion capture systems produce excellent in-studio capture and reconstructions, but offer no comparable solution for acquisition in everyday environments. Therefore in this dissertation, a wearable human motion analysis system is developed for continuously tracking human motions, monitoring health status, positioning human location and recording the itinerary. In this dissertation, two systems are developed for seeking aforementioned two goals: tracking human body motions and positioning a human. Firstly, an inertial-based human body motion tracking system with our developed inertial measurement unit (IMU) is introduced. By arbitrarily attaching a wearable IMU to each segment, segment motions can be measured and translated into inertial data by IMUs. A human model can be reconstructed in real time based on the inertial data by applying high efficient twists and exponential maps techniques. Secondly, for validating the feasibility of developed tracking system in the practical application, model-based quantification approaches for resting tremor and lower extremity bradykinesia in Parkinson’s disease are proposed. By estimating all involved joint angles in PD symptoms based on reconstructed human model, angle characteristics with corresponding medical ratings are employed for training a HMM classifier for quantification. Besides, a pedestrian positioning system is developed for tracking user’s itinerary and positioning in the global frame. Corresponding tests have been carried out to assess the performance of each system

A smartphone-based system for detecting hand tremors in unconstrained environments

The detection of tremors can be crucial for the early diagnosis and proper treatment of some disorders such as Parkinson’s disease. A smartphone-based applica- tion has been developed for detecting hand tremors. This application runs in background and distinguishes hand tremors from common daily activities. This application can facilitate the continuous monitoring of patients or the early detection of this symptom. The evaluation analyzes 1770 accelerometer samples with cross-validation for assessing the ability of the system for processing unknown data, obtaining a sensitivity of 95.8 % and a specificity of 99.5 %. It also analyzes continuous data for some volun- teers for several days, which corroborated its high performance

Personalised profiling to identify clinically relevant changes in tremor due to multiple sclerosis

Background: There is growing interest in sensor-based assessment of upper limb tremor in multiple sclerosis and other movement disorders. However, previously such assessments have not been found to offer any improvement over conventional clinical observation in identifying clinically relevant changes in an individual's tremor symptoms, due to poor test-retest repeatability. Method: We hypothesised that this barrier could be overcome by constructing a tremor change metric that is customised to each individual's tremor characteristics, such that random variability can be distinguished from clinically relevant changes in symptoms. In a cohort of 24 people with tremor due to multiple sclerosis, the newly proposed metrics were compared against conventional clinical and sensor-based metrics. Each metric was evaluated based on Spearman rank correlation with two reference metrics extracted from the Fahn-Tolosa-Marin Tremor Rating Scale: a task-based measure of functional disability (FTMTRS B) and the subject's self-assessment of the impact of tremor on their activities of daily living (FTMTRS C). Results: Unlike the conventional sensor-based and clinical metrics, the newly proposed ’change in scale’ metrics presented statistically significant correlations with changes in self-assessed impact of tremor (max R2>0.5,p< 0.05 after correction for false discovery rate control). They also outperformed all other metrics in terms of correlations with changes in task-based functional performance (R2=0.25 vs. R2=0.15 for conventional clinical observation, both p< 0.05).Conclusions: The proposed metrics achieve an elusive goal of sensor-based tremor assessment: improving on conventional visual observation in terms of sensitivity to change. Further refinement and evaluation of the proposed techniques is required, but our core findings imply that the main barrier to translational impact for this application can be overcome. Sensor-based tremor assessments may improve personalised treatment selection and the efficiency of clinical trials for new treatments by enabling greater standardisation and sensitivity to clinically relevant changes in symptoms

Assessment of Tremor Severity in Patients with Essential Tremor Using Smartwatches

[Abstract] This paper presents a classification model for the automatic quantification of tremor severity in patients with essential tremor (ET). The system is based on the signals measured by two commercial smartwatches that the patients wear on their wrist and ankle. The smartwatches register acceleration and angular velocity in these body segments. A set of nine tremor features were used to train the classification algorithm. The proposed algorithm is based on a C4.5 decision tree classifier. It is able to assess rest and kinetic (postural or action) tremor. The method was evaluated using data collected from thirty-four patients with ET. The algorithm classifies the severity of tremor in five levels 0-4 corresponding to those in the Fahn-Tolosa-Marin tremor rating scale with a 94% accuracy. The method can be implemented in a networked platform for the remote monitoring and assessment of movement disorders such as ET or Parkinson’s disease.Ministerio de Economía, Industria u Competitividad; RTC-2015-3967-1Ministerio de Economía, Industria u Competitividad; DPI2015-68664-C4-1-RMinisterio de Economía, Industria u Competitividad; RTC-2015-4327-