Digitised spirography as an evaluation tool for intention tremor in multiple sclerosis

This study investigated validity and reliability of digitised circle and square spiral drawing for quantifying intention tremor severity and related disability in patients with multiple sclerosis (MS). The tremor amplitude was measured as the standard deviation of the drawing velocity of the arm in the radial and tangential direction for circle spiral drawing, and in the horizontal and vertical direction for square spiral drawing. Results were compared with those of MS patients without tremor and healthy controls, and correlated with clinical assessments of tremor severity and arm functionality including Fahn's tremor rating scale, Test d'Evaluation des Membres supérieurs des Personnes Agées (TEMPA) and the nine-hole-peg test to examine validity. Comparison of patient's performance between four repeated trials examined short-term test-retest reliability.All digitised spirography variables discriminated between the MS-tremor and both MS-no-tremor and healthy control groups. Validity was also shown by high spearman correlation coefficients between spirography variables and clinical ratings. Tremor appeared to be most profound in the radial and vertical direction during circle and square spiral drawing, respectively. The consistency and high correlations between four repeated executions indicated short-term test-retest reliability.We conclude that the digitised spirography provide a useful instrumentation for quantifying MS intention tremor.