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How to use pen and paper tasks to aid tremor diagnosis in the clinic.

Authors
  • Alty, Jane1
  • Cosgrove, Jeremy1
  • Thorpe, Deborah2, 3
  • Kempster, Peter4, 5
  • 1 Department of Neurology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • 2 Department of Electronics, University of York, York, UK.
  • 3 Centre for Medieval Studies, University of York, York, UK.
  • 4 Department of Neurosciences, Monash Medical Centre, Clayton, Australia. , (Australia)
  • 5 Department of Medicine, Monash University, Clayton, Australia. , (Australia)
Type
Published Article
Journal
Practical neurology
Publication Date
Dec 01, 2017
Volume
17
Issue
6
Pages
456–463
Identifiers
DOI: 10.1136/practneurol-2017-001719
PMID: 28844041
Source
Medline
Keywords
License
Unknown

Abstract

When a patient presents with tremor, it can be useful to perform a few simple pen and paper tests. In this article, we explain how to maximise the value of handwriting and of drawing Archimedes spirals and straight lines as clinical assessments. These tasks take a matter of seconds to complete but provide a wealth of information that supplements the standard physical examination. They aid the diagnosis of a tremor disorder and can contribute to its longitudinal monitoring. Watching the patient's upper limb while they write and draw may reveal abnormalities such as bradykinesia, dystonic posturing and distractibility. The finished script and drawings can then be evaluated for frequency, amplitude, direction and symmetry of oscillatory pen movements and for overall scale of penmanship. Essential, dystonic, functional and parkinsonian tremor each has a characteristic pattern of abnormality on these pen and paper tests.

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