Validation of the tremor biomechanics analysis laboratory (TREMBAL) software in MS tremor
Author(s): ,
A Van der Walt
Affiliations:
Melbourne Brain Centre, Department of Medicine, University of Melbourne, Parkville;Neurology, Royal Melbourne Hospital
,
F.M.C Boonstra
Affiliations:
Neuroimaging group, Melbourne Brain Centre, University of Melbourne, Melbourne
,
S.A.C Yohanandan
Affiliations:
The Bionics Institute, East Melbourne;School of Computer Science and Information Technology, RMIT University
,
A.P Vogel
Affiliations:
Audiology and Speech Pathology;Centre for Neuroscience for Speech
,
S.C Kolbe
Affiliations:
Neuroimaging group, Melbourne Brain Centre, University of Melbourne, Melbourne
,
J Ly
Affiliations:
Melbourne Brain Centre, Department of Medicine, University of Melbourne, Parkville
,
G Noffs
Affiliations:
Centre for Neuroscience for Speech
,
H Butzkueven
Affiliations:
Neurology, Royal Melbourne Hospital;Melbourne Brain Centre, University of Melbourne;Eastern Health Research Unit, Monash University
,
A.H Evans
Affiliations:
Neurology, Royal Melbourne Hospital;Melbourne Brain Centre, Department of Medicine, University of Melbourne, Parkville0
T Perera
Affiliations:
The Bionics Institute, East Melbourne;Melbourne Brain Centre, Department of Medicine, University of Melbourne, ParkvilleMelbourne Brain Centre, Department of Medicine, University of Melbourne, Parkville
ECTRIMS Online Library. Van Der Walt A. 09/15/16; 146207; P367
Anneke Van Der Walt
Anneke Van Der Walt
Contributions
Abstract

Abstract: P367

Type: Poster

Abstract Category: Clinical aspects of MS - Clinical assessment tools

Background: Tremor in MS (MST) is difficult to treat and the development of new interventions is limited by the absence of universal measuring systems. At present, therapeutic outcomes are measured by a variety of clinical rating scales that are subjective and lack sufficient sensitivity. With increasing use of interventional treatments such as Botulinum toxin injections or Deep Brain Stimulation for MST, it has become critical to develop precise measurement instruments.

Objective: To clinically validate the TREMBAL software in MST.

Methods: TREMBAL (Bionics Institute, Melbourne, Australia) utilises an electromagnetic motion tracker (Ascension, Vermont, US) to acquire absolute displacements and rotations of a tremulous body part. Tremor was recorded bilaterally from four locations (second phalanx of the middle finger, wrist dorsum, forearm and upper arm) in five positions (hands resting on lap, arms outstretched in front, finger-nose, batwing static and batwing action). Tremor exercises were video recorded (GoPro Hero3, GoPro Inc., San Mateo, California) and rated by two experts using the 5-point Unified Tremor Rating Assessment (UTRA) scale where 0=no tremor and 4=severe. TREMBAL tremor displacements (measured in units of millimetres) were averaged and log transformed to match the distribution of clinical ratings. Data were pooled across exercises. Congruence between TREMBAL measures and mean clinical ratings was explored using regression analysis and Pearson´s correlation.

Results: We assessed ten MST patients over 6 months and rated 200 videos. The median pooled UTRA score was 0.5 (interquartile range 0, 1.5). The average TREMBAL recorded tremor displacement was 1.65 mm (standard deviation 2.1). A strong correlation between UTRA scores and log transformed TREMBAL displacement was found, r = 0.749, p< 0.001.

Conclusions: TREMBAL measurements are highly accurate when compared to clinical measurements. While other objective tremor measures exist, only a few have been benchmarked specifically against MST clinical ratings. The validation of an objective, 3 dimensional tremor measurement system provides real-time tremor severity measurements for clinicians and can be applied in clinical trials of putative therapies for MST.

Disclosure:

A. van der Walt served on scientific advisory boards for Novartis, Biogen and Merck. She received conference travel support from Biogen, Novartis, Merck and Teva.

F.M.C. Boonstra has nothing to disclose.

S.A.C. Yohanandan has nothing to disclose.

A.P. Vogel has nothing to disclose.

S.C. Kolbe has nothing to disclose.

J. Ly has nothing to disclose.

G. Noffs has nothing to disclose.

H. Butzkueven served on advisory boards for Biogen, Novartis and Sanofi and has received conference travel support from Novartis, Biogen and Sanofi. He serves on steering committees for trials conducted by Biogen and Novartis, and has received

research support from Merck Serono, Novartis and Biogen.

A. Evans has received honoraria from Novartis for giving presentations and providing consultancy services. He has participated in scientific advisory board meetings for Novartis, UCB Pharma, Allergan, and Boehringer Ingelheim.

T Perera has nothing to disclose.

Abstract: P367

Type: Poster

Abstract Category: Clinical aspects of MS - Clinical assessment tools

Background: Tremor in MS (MST) is difficult to treat and the development of new interventions is limited by the absence of universal measuring systems. At present, therapeutic outcomes are measured by a variety of clinical rating scales that are subjective and lack sufficient sensitivity. With increasing use of interventional treatments such as Botulinum toxin injections or Deep Brain Stimulation for MST, it has become critical to develop precise measurement instruments.

Objective: To clinically validate the TREMBAL software in MST.

Methods: TREMBAL (Bionics Institute, Melbourne, Australia) utilises an electromagnetic motion tracker (Ascension, Vermont, US) to acquire absolute displacements and rotations of a tremulous body part. Tremor was recorded bilaterally from four locations (second phalanx of the middle finger, wrist dorsum, forearm and upper arm) in five positions (hands resting on lap, arms outstretched in front, finger-nose, batwing static and batwing action). Tremor exercises were video recorded (GoPro Hero3, GoPro Inc., San Mateo, California) and rated by two experts using the 5-point Unified Tremor Rating Assessment (UTRA) scale where 0=no tremor and 4=severe. TREMBAL tremor displacements (measured in units of millimetres) were averaged and log transformed to match the distribution of clinical ratings. Data were pooled across exercises. Congruence between TREMBAL measures and mean clinical ratings was explored using regression analysis and Pearson´s correlation.

Results: We assessed ten MST patients over 6 months and rated 200 videos. The median pooled UTRA score was 0.5 (interquartile range 0, 1.5). The average TREMBAL recorded tremor displacement was 1.65 mm (standard deviation 2.1). A strong correlation between UTRA scores and log transformed TREMBAL displacement was found, r = 0.749, p< 0.001.

Conclusions: TREMBAL measurements are highly accurate when compared to clinical measurements. While other objective tremor measures exist, only a few have been benchmarked specifically against MST clinical ratings. The validation of an objective, 3 dimensional tremor measurement system provides real-time tremor severity measurements for clinicians and can be applied in clinical trials of putative therapies for MST.

Disclosure:

A. van der Walt served on scientific advisory boards for Novartis, Biogen and Merck. She received conference travel support from Biogen, Novartis, Merck and Teva.

F.M.C. Boonstra has nothing to disclose.

S.A.C. Yohanandan has nothing to disclose.

A.P. Vogel has nothing to disclose.

S.C. Kolbe has nothing to disclose.

J. Ly has nothing to disclose.

G. Noffs has nothing to disclose.

H. Butzkueven served on advisory boards for Biogen, Novartis and Sanofi and has received conference travel support from Novartis, Biogen and Sanofi. He serves on steering committees for trials conducted by Biogen and Novartis, and has received

research support from Merck Serono, Novartis and Biogen.

A. Evans has received honoraria from Novartis for giving presentations and providing consultancy services. He has participated in scientific advisory board meetings for Novartis, UCB Pharma, Allergan, and Boehringer Ingelheim.

T Perera has nothing to disclose.

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