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Publications (3)1.33 Total impact

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    ABSTRACT: Objective: One the greatest challenges of BoNT A therapy for tremor lies in the complexity and variation of components involved in tremor movement, and the lack of objective measures to determine these components. This 3 month open-label single injection study aims to couple clinician best judgment with kinematics to improve effect of BoNT A (incobotulinumtoxinA) injection in 7 patients with upper limb Parkinson's disease (PD) tremor. Methods: Injection was guided with clinical and kinematic assessment of tremor using angular wrist position in 3 degrees of freedom: flexion/extension, pronation/supination, and radial/ulnar deviation. Overall tremor severity and change were measured by linear finger acceleration. Results: Kinematic data from static and functional tasks demonstrate no improvement at one month post-injection, but significant improvement at two and three months. Clinical scales across UPDRS Items 20 (1, 2, 3 months post) and 21 (2 months), and spiral drawings (3 months) showed significant improvement from baseline, while line drawings did not. Conclusions: This study suggests injection of BoNT A as a viable focal management option for upper limb PD tremor. In addition to clinical judgment, objective quantification of tremor dynamics by kinematics may be a feasible assessment and guidance tool which can be used to optimize injection conditions for focal tremor therapy. Kinematic analysis of tremor across a variety of joints in all degrees of movement may provide important insight into tremor dynamics, allowing optimized, targeted focal therapy.
    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 09/2013; 40(5):663-9. · 1.33 Impact Factor
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    ABSTRACT: Previous, studies have demonstrated variability in the frequency and amplitude in tremor between subjects and between trials in both healthy individuals and those with disease states. However, to date, few studies have examined the composition of tremor. Efficacy of treatment for tremor using techniques such as Botulinum neurotoxin type A (BoNT A) injection may benefit from a better understanding of tremor variability, but more importantly, tremor composition. In the present study, we evaluated tremor variability and composition in 8 participants with either essential tremor or Parkinson disease tremor using kinematic recording methods. Our preliminary findings suggest that while individual patients may have more intra-trial and intra-task variability, overall, task effect was significant only for amplitude of tremor. Composition of tremor varied among patients and the data suggest that tremor composition is complex involving multiple muscle groups. These results may support the value of kinematic assessment methods and the improved understanding of tremor composition in the management of tremor.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:470-3.
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    ABSTRACT: While many studies have reported on the use of kinematic analysis on well-controlled, in-laboratory mobility tasks, few studies have examined the challenges of recording dynamic mobility in home environments. This preliminary study evaluated whole body mobility in eleven patients with Parkinson disease (H&Y 2-4). Patients were recorded in their home environment during scripted and non-scripted mobility tasks while wearing a full-body kinematic recording system using 11 inertial motion sensors (IMU). Data were analyzed with principal component analysis (PCA) in order to identify kinematic variables which best represent mobility tasks. Results indicate that there was a large degree of variability within subjects for each task, across tasks for individual subjects, and between scripted and non-scripted tasks. This study underscores the potential benefit of whole body multi-sensor kinematic recordings in understanding the variability in task performance across patients during daily activity which may have a significant impact on rehabilitation assessment and intervention.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:5833-8.