Journal of Neurology

, Volume 241, Issue 1, pp 54–61 | Cite as

Assessing the impact of essential tremor on upper limb function

  • Peter G. Bain
  • Judit Mally
  • Michael Gresty
  • Leslie J. Findley
Original Communication


We compared the impact of essential tremor on the performance of three manual tasks: drawing spirals, holding a cup full of water and a joystick-controlled tracking test. Tremor amplitude and frequency were measured by accelerometry during the tracking test, when holding the cup and whilst a standard posture was maintained. The inter-relationships between tremor amplitude, frequency and task impairment were then examined. The results showed that the amplitude and frequency of essential tremor (measured from the principal spectral peak) changed with different activities, with the mildest postural tremors changing most in frequency (by up to 4–5 Hz). The amplitude of tremor decreased in almost every case during the tasks, relative to posture, and this decrement was greatest for the most severe tremors. We also demonstrate that for practical purposes, such as routine clinical situations and therapeutic trials, the effect of essential tremor upon upper limb function can be usefully assessed by two simple complementary techniques: rating spirals and measuring the volume of water split from a cup. The impairments in carrying out these tasks and the tracking test were highly correlated with one another and also with the amplitude and frequency of postural tremor. The concept of tremor “suppressability” is introduced: the relative percentage decrease in the amplitude of a particular tremor during the performance of a specific task compared to that recorded whilst holding a standard posture.

Key words

Hereditary essential tremor Accelerometry Functional measures Suppressability 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Association of the British Pharmaceutical Industry (1991) Data sheet compendium 1991–92 Datapharm Publications, London, 603–606, 608–609Google Scholar
  2. 2.
    Bain PG, Findley LJ, Atchison P, Behari M, Vidailhet M, Gresty M, Rothwell JC, Thompson PD, Marsden CD (1993) Assessing tremor severity. J Neurol Neurosurg Psychiatry 56:868–873PubMedGoogle Scholar
  3. 3.
    Baruzzi A, Procaccianti G, Martinelli P, Riva R, Denoth F, Montanaro N, Lugaresi E (1983) Phenobarbital and propranolol in essential tremor: a double-blind controlled clinical trial. Neurology 33:296–300PubMedGoogle Scholar
  4. 4.
    Britton TC, Thompson PD, Day BL, Rothwell JC, Findley LJ, Marsden CD (1992) “Resetting” of postural tremors at the wrist with mechanical stretches in Parkinson's disease, essential tremor and normal subjects mimicking tremor. Ann Neurol 31:507–514PubMedGoogle Scholar
  5. 5.
    Busenbark K, Pahwa R, Hubble J, Koller WC (1992) The effect of acetazolamide on essential tremor: an openlabel trial. Neurology 42:1394–1395PubMedGoogle Scholar
  6. 6.
    Cleeves L, Findley LJ (1988) Propranolol and propranolol LA in essential tremor: a double-blind comparative study. J Neurol Neurosurg Psychiatry 51:379–384PubMedGoogle Scholar
  7. 7.
    Elble RJ (1989) Analysis of tremor with methods of non-linear dynamics: attractor dimensions. Soc Neurosci Abstr 15:604Google Scholar
  8. 8.
    Elble RJ, Koller WC (1990) Parkinson tremor. In: Elble RJ, Koller WC (eds) Tremor. John Hopkins University Press, Baltimore, pp 118–119Google Scholar
  9. 9.
    Findley LJ, Calzetti S (1982) Double-blind controlled study of primidone in essential tremor: preliminary results. BMJ 285:608PubMedGoogle Scholar
  10. 10.
    Findley LJ, Cleeves L (1985) Phenobarbitone in essential tremor. Neurology 35:1784–1787PubMedGoogle Scholar
  11. 11.
    Findley LJ, Koller WJ, De Witt P, Elble R, Jankovic J, Lang A, Rajput A (1993) Classification and definition of tremor. In: Lord Walton of Detchant (ed) Indications for and clinical implications of Botulinum toxin therapy. Royal Society of Medicine Services Limited, pp 22–23Google Scholar
  12. 12.
    Grassberger P, Procaccia I (1983) Measuring the strangeness of strange attractors. Physica 9D:189–208Google Scholar
  13. 13.
    Kachi T, Rothwell JC, Cowan JMA, Marsden CD (1985) Writing tremor: its relationship to benign essential tremor. J Neurol Neurosurg Psychiatry 48:545–550PubMedGoogle Scholar
  14. 14.
    Klawans HL, Glantz R, Tanner CM, Goetz CG (1982) Primary writing tremor: a selective action tremor. Neurology 32:203–206PubMedGoogle Scholar
  15. 15.
    Koller WC, Martyn B (1986) Writing tremor: its relationship to essential tremor. J Neurol Neurosurg Psychiatry 49:220Google Scholar
  16. 16.
    Koller WC, Biary N, Cone S (1986) Disability in essential tremor: Effect of treatment. Neurology 36:1001–1004PubMedGoogle Scholar
  17. 17.
    Larsen TA, Calne DB (1983) Essential tremor. Clin Neuropharmacol 6:185–206PubMedGoogle Scholar
  18. 18.
    Mally J (1989) Aminophylline and essential tremor. Lancet II:278–279CrossRefGoogle Scholar
  19. 19.
    Marsden CD (1987) Origins of normal and pathological tremor. In: Findley LJ, Capildeo R (eds) Movement disorders: tremor. MacMillan, London, pp 37–55Google Scholar
  20. 20.
    O'Brien MD, Upton AR, Toseland PA (1981) Benign familial tremor treated with primidone. BMJ 282:178–180PubMedGoogle Scholar
  21. 21.
    Rothwell JC, Traub MM, Marsden CD (1979) Primary writing tremor. J Neurol Neurosurg Psychiatry 42:1106–1114PubMedGoogle Scholar
  22. 22.
    Tolosa ES, Loewenson RD (1975) Essential tremor: treatment with propranolol. Neurology 25:1041–1044PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Peter G. Bain
    • 1
  • Judit Mally
    • 1
  • Michael Gresty
    • 1
  • Leslie J. Findley
    • 1
  1. 1.MRC Human Movement and Balance UnitInstitute of NeurologyLondonUK

Personalised recommendations