CleveMed Blogs

The Movement Disorders Division of CleveMed has primarily focused on monitoring motor symptoms associated with Parkinson’s disease (PD). A more common movement disorder is essential tremor (ET), which affects approximately 4% of the population over age 40 in the United States. In Parkinson’s disease, tremor (involuntary shaking) occurs primarily at rest, but essential tremor is mainly characterized by tremor of a moving limb.

Measuring Tremor

Subjective Rating: Tremor associated with essential tremor is traditionally rated by various subjective tremor rating scales. These scales all provide a discrete, subjective symptom rating at a discrete point in time. They require a clinician to visually assess the patient, and cannot capture complex fluctuations that occur throughout the day in response to interventions.

Objective Rating: Objectively capturing essential tremor symptoms continuously during daily activities, and using adaptive algorithms to both classify tremor types and severity, could help clinicians better adjust therapy to minimize symptom fluctuations, and expand care to rural and underserved populations. Therefore, CleveMed has recently begun development on a system to objectively monitor essential tremor.

CleveMed previously developed a compact wireless system, Kinesia™, to quantify Parkinson’s disease symptoms. In a clinical study, this system successfully demonstrated objective quantification of Parkinson’s disease motor symptoms. These promising results for Parkinson’s disease suggest the system may be adapted for quantifying tremor in essential tremor patients by developing specific ET algorithms. More continuous portable monitoring can capture the tremor fluctuations that can occur throughout the day. Using a combination of accelerometers and gyroscopes will provide a system with much greater sensitivity for tremor type discrimination and severity rating. (Existing systems contain only a single-axis accelerometer). Continuous ratings throughout the day can aid clinicians and researchers in therapy development and optimizing symptom management for patients with essential tremor.

To demonstrate the benefits of Kinesia, a compact patient worn device for assessing Parkinson’s disease (PD) motor symptom severity, and the tremor scoring feature recently released, CleveMed has launched the new interactive website UPDRS.CleveMed.com.

Parkinson’s disease motor symptoms are typically assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), a subjective rating scale in which clinicians visually assess patient tremor symptoms and assign a 0 to 4 score based on severity. UPDRS.CleveMed.com highlights some of the reliability and consistency issues of the current method of PD patient evaluation.

The CleveMed UPDRS Scoring Challenge is an online educational tool intended for movement disorder clinicians and researchers, patients, caregivers or anyone interested in Parkinson’s disease motor symptom evaluations. The interactive site allows a visitor to view and rate a series of videos displaying Parkinson’s disease patients performing tasks for evaluating tremor. After each short video is complete, the user enters the score they feel is appropriate ranging from 0 to 4, 0 being the absence of symptoms and 4 being the most severe, and the next video starts. Once the twelve videos are scored, the user scores are compared to scores from two movement disorder specialists for the same videos. This demonstrates the variability in scores that can occur between different clinicians for the same patient, which is an issue with the subjective UPDRS. Scores are also compared to the automated scoring provided by Kinesia which demonstrates the benefits of having a device that can provide consistent, repeatable results.

Everyone is encouraged to try the site out and see how you would perform again actual clinicians when rating tremor symptom severity. If you find it interesting, please pass it along to others who may feel the same. Any comments, suggestions or questions on the site are welcome at any time.