Introduction Tremor is among the most common movement disorders and is characterized by rhythmic oscillations of a part of the body around one or more joints. Methods of tremor assessment include simple clinical observation, standardized rating scales, objective clinical assessment of drawn figures, and computerized tremor analysis. A broad overview of tremor, and the relative advantages and disadvantages of tremor assessment methods are discussed below. As there are different kinds of tremor with numerous underlying causes, the process of tremor classification and evaluation is of critical importance to establish a correct diagnosis and initiate the most appropriate treatment.

PDF On Jan 1, 1988, S. Fahn and others published Clinical Rating Scale for Tremor We use cookies to make interactions with our website easy and meaningful, to better understand the use of our. At all visits, tremor severity and arm functionality were reported using the Fahn-Tolosa-Marin (FTM) tremor rating scale. FTM scale assessed tremor severity (part.

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Classification of tremor Tremor can be most effectively classified based on the circumstances under which it occurs. Rest tremor can be distinguished from other forms of tremor based on its occurrence when the tremoring body part is completely supported against gravity without voluntary muscle contraction, in contrast to action tremor, which occurs with voluntary muscle contraction. Action tremor can be further divided into postural or sustention tremor (occurring while maintaining a posture against gravity) and kinetic tremor (occurring during active movement). Kinetic tremor includes task-specific tremor and tremor that is specific to goal-directed movements ( intention tremor).

It can also be associated with situations where there is active muscle contraction against a fixed object ( isometric tremor). While the tremors encountered in clinical practice are usually involuntary, patients can present with psychogenic tremor in isolation or in combination with other neurologic complaints of psychogenic origin, as in psychogenic parkinsonism. In addition to provoking circumstances, other tremor characteristics have been used to try to classify tremor (such as frequency, amplitude, or distribution). However, such classifications are often problematic as these characteristics can vary greatly within tremor etiologies.

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Evaluation of tremor Though tremor may be the most quantifiable of all movement disorders, there is currently no universally accepted method of rating or measuring tremor., There can be considerable variability in the manner in which clinicians assess the presence of tremor and its severity. In an attempt to standardize the evaluation of tremor (particularly for clinical research purposes), a number of rating scales have been developed that optimize comparability between studies and patient populations. One of the earlier tremor scales developed that is still in use today is the Fahn–Tolosa–Marin Tremor Rating Scale (TRS). This 5-point scale rates tremor severity based on tremor amplitude, from 0 (no tremor) to 4 (severe tremor) in each part of the body, and includes assessments of specific abilities and functional disability. A number of other scales have been developed, which include smaller severity gradations or are disease specific., Although tremor scales vary regarding reliability and validity,,, even the best clinical scale may not be sensitive enough to discern minimal abnormality and subtle changes over time, or objective enough to determine significant responses to therapy. While graphic evidence of tremor activity can be evaluated clinically by examining writing or drawn spirals, these are still interpreted subjectively and are not easily standardized across subjects. Thus, the objective and quantifiable data analysis afforded by computerized assessment of tremor can be an important tool in research and certain clinical settings.