ABSTRACT
I. Introduction 94
II. Essential Tremor-Behavioral Characteristics 94
III. Measuring Essential Tremor in Therapeutic Trials 95
IV. Clinical Measurement of Impairment, Disability, and Social
Handicap Caused by Essential Tremor 96
A. Subjective Clinical Measures of Tremor 96
1. Clinical Rating Scales for Essential Tremor 96
2. Spirographic and Handwriting Analysis 98
B. Objective Functional Performance Tests 98
1. Volumetric Methods 98
2. The 9-Hole Pegboard Test 99
3. The Gibson Maze Test 99
C. Assessing the Impact of Essential Tremor on Patients’ Lives 99
1. Disability Questionnaires 100
2. Social Handicap 101
3. Quality of Life Measures 101
V. Physiological Outcome Measures 102
A. Accelerometer Based Methods 102
B. Electromyographic Recordings 103
1. Short-Term Recordings 103
2. Long-Term Electromyographic Recordings 104
C. Mechanical and Optically Based Systems 104
D. Kinematic Measurement Systems 104
E. Gyroscopic Techniques 105
F. Computerized Tracking Tasks 105
G. Digitizing Tablets 106
VI. Conclusion 106
References 107
Appendix 1-Tremor Severity Rating Scale 110
Appendix 2-Fahn, Tolosa, Marin Tremor Rating Scale 111
Appendix 3-Activities of Daily Living Questionnaire 113
Appendix 4-Tremor Disability Questionnaire 114
Appendix 5-Assessment of Tremor Related Handicap 115
I. INTRODUCTION
Assessment of essential tremor is fundamental to the process of developing an
understanding of the condition, documenting its natural history and evaluating
the effects of therapy. Although tremor is simply defined as “an involuntary
rhythmical, oscillatory movement of a body part” the process of assessing essen-
tial tremor is complicated by several factors (1). These include natural predomi-
nantly amplitude variations in the tremor and the fact that essential tremor
may spread from the arms to other parts of the body. There are also complex
interactions between essential tremor, the sufferer, society, and the observer.
