Background
Orthostatic Tremor (OT) is characterized by the presence of a sensation of instability while standing, associated with high frequency (13–18 Hz) lower extremity tremor. Diagnosis is confirmed with surface electromyography (EMG). An accurate screening tool that could be used in the routine clinical setting, without any specialized equipment, would be useful in earlier detection of OT and judicial use of additional testing.
Objective
The objective of this study was to evaluate OT diagnostic test characteristics at bedside using iPhone's built‐in accelerometer and available applications for tremor recordings.
Methods
We obtained recordings using iPhones (Model 5, 5s, and 6) and free Applications (“LiftPulse” by LiftLabs [App1] and “iSeismometer” by ObjectGraph LLC [App2]) at default settings.
Results
24 EMG‐confirmed OT subjects (mostly females, 22/24) and 15 age‐matched controls (mostly males, 11/15) were evaluated. App1 detected OT range tremor in 22/24 patients and none of the controls. (Sensitivity = 92%, Specificity = 100%, NPV = 88%). App2 detected OT range tremor in 21/24 patients and in 1/13 controls (Sensitivity = 88%, Specificity = 92%, NPV = 80%). When combined, 24/24 patients and 1/13 controls had OT range tremor (Sensitivity = 100%, Specificity = 92%, NPV = 100%).
Conclusions
Smartphone apps that use the built‐in accelerometer provide a simple, accurate and inexpensive bedside screening diagnostic tool for patients with OT.
Objectives: To consider the impact of juvenile Huntington disease (JHD) from a biomedical, symptom burden, and total pain palliative care perspective. Methods: This case report was informed by a narrative review of the literature with inclusion of expert opinion from pediatric palliative care, an adult and pediatric neurologist, and a child psychiatrist. Audio-recorded qualitative interview and coauthorship with the pediatric patient's primary caregiver (his mother). Results: The JHD impacts all domains of child and family function. Significance of Results: Application of the concept of total pain to JHD informs and guides care for this complex, challenging condition.
Blepharospasm is a focal dystonia characterized by involuntary closure of the eyelids [Stacy, 2007]. It usually affects both orbicularis oculi, and can progress into causing significant disability. It may occur in isolation, or be associated with other dystonias. Parkinsonism, dystonic cerebral palsy, and tardive phenomena are some of the commonly associated disorders. Adequate treatment of blepharospasm is necessary to allow maintenance of quality of life, avoid functional blindness, and to prevent complications such as corneal abrasions and dermatochalasis. In 1989, blepharospasm (in patients older than 12 years old) was the first indication approved by the United States Food and Drug Administration (FDA) for the use of BoNT-A [Ramirez-Castaneda and Jankovic, 2013]. Before the introduction of chemodenervation through botulinum neurotoxin (BoNT) injections, treatment was challenging, as oral medications had minimal effectiveness and produced limiting side effects. We provide here an up-todate review of the use of BoNT for blepharospasm. Epidemiology Prevalence estimates of blepharospasm range from 16-133 cases per million [Defazio and
The fractal analysis of stride-to-stride fluctuations in walking has become an integral part of human gait research. Fractal analysis of stride time intervals can provide insights into locomotor function and dysfunction, but its application requires a large number of strides, which can be difficult to collect from people with movement disorders such as Parkinson’s disease. It has recently been suggested that “stitching” together short gait trials to create a longer time series could be a solution. The objective of this study was to determine if scaling exponents from “stitched” stride time series were similar to those from continuous, longer stride time series. Fifteen young adults, fourteen older adults, and thirteen people with Parkinson’s disease walked around an indoor track in three blocks: one time 15 min, five times 3 min, and thirty times 30 s. Stride time intervals were determined from gait events recorded with instrumented insoles, and the detrended fluctuation analysis was applied to each stride time series of 512 strides. There was no statistically significant difference between scaling exponents in the three blocks, but intra-class correlation revealed very low between-blocks reliability of scaling exponents. This result challenges the premise that the stitching procedure could provide reliable information about gait dynamics, as it suggests that fractal analysis of stitched time series does not capture the same dynamics as gait recorded continuously. The stitching procedure cannot be considered as a valid alternative to the collection of continuous, long trials. Further studies are recommended to determine if the application of fractal analysis is limited by its own methodological considerations (i.e., long time series), or if other solutions exists to obtain reliable scaling exponents in populations with movement disorders.
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