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Mark Stacy Movement Disorders Vol. Proper treatment items tremor in writing and drawings of the TRS. The average of ET is contingent upon correct assessment of the severity, Spearman correlation was 0. Videotape tency between the two videotapes, but correlations for Part A recordings of 17 subjects with ET evaluated with the TRS were were somewhat better than for Part B.
It is best when the same produced and sent to 59 raters. Once the raters returned the rater performs repeated measures of tremor on a patient, par- videotape and completed the score sheet, they were mailed a ticularly when judging tremor in handwriting and drawings. Essential tremor ET is the most common adult and disability related to the tremor. Symptoms are often In , Sweet and colleagues4 developed a clinical progressive and potentially disabling, and may force rating scale for ET to assist in evaluating the effects of patients to change jobs or seek early retirement.
Mark A. E-mail: stacy mc. The scale is Members of the Tremor Assessment Group are listed as an Appen- divided into three parts. Part A assesses examiner-re- dix. Published online 7 March in Wiley InterScience www. DOI: The tremor speaking, eating, drinking, hygiene, dressing, study protocol was approved by an Institutional Review writing, working, and social activities.
Finally, the TRS Board. All participants gave their informed consent to be includes one separate item dealing with global assess- videotaped for the purpose of this study. Some segments contained the same patient fo- tions. This study builds upon a previous assessment of cusing on different tremor locations, and some segments Fahn—Tolosa—Marin TRS reliability using only two contained different patients focusing on the same type of raters.
The raters were from clinical research sites that would Raters scored each of the 25 video segments using use the TRS in a clinical study of Topamax topiramate scoring sheets containing the TRS Part A and B items. Once clinical evaluation scale; however, evaluators were not the raters returned the completed score sheet, they were given an option of scoring a tremor or zero, because all mailed a second tape with the same ET recordings pre- video segments contained abnormal tremor.
Pouring sented in a different order. The scoring sheet was presented in an order that reliability [see Appendix A, available on-line] Part A of matched the videotape segments and not the standard the TRS assesses tremor severity at rest, with posture TRS scoring sheet. Assessment of Reliability Part B of the TRS assesses action tremor while writ- Fifty-nine physicians or other medical personnel ing, drawing, and pouring liquids.
Training backgrounds included 48 neu- abnormal, unable to keep pencil or pen on paper without rologists, 2 internal medicine physicians, 2 nurses, 1 holding down their hand with the other hand.
Pouring is physician assistant, 1 occupational therapist, and 5 re- scored 0 to 4 depending on the volume of water spilled search assistants. Five raters evaluated only Tape 1 and with each hand. All patients had ET in the face, head, voice, limbs, ratings of the upper extremities8; therefore these areas Movement Disorders, Vol.
Items computed for the seven tremor type composites. The following item more consistent manner by the raters. The traditional type composites are shown in Tables 1 and 2 Tapes 1 Kappa statistic, presented by Cohen,9 for agreement be- and 2, respectively.
Davies and Fleiss10 have than for Part B items. Interrater reliabilities were also corrected measure of agreement for multinomial data slightly greater for neurologists than for nonneurologists, arrayed in a two-way multiple raters by multiple re- except in the case of left hand drawing Part B of TRS sponses layout. TABLE 2. TABLE 3. If on any of the composites, a rater power analyses and sample size estimations in future responds the same across all the items in the composite studies.
Raters who that certain types of ET are rated more reliably than rated all four or all three items in the composite the same others using the Fahn—Tolosa—Marin TRS. Intrarater reliability both Tape 1 and Tape 2. Intrarater reliability was also very slightly greater interrater reliability in Part A.
Experience and training for neurologists than for nonneurologists, except in the may play a role in the variable interrater reliabilities. The means and standard deviation of the differ- drawing. The raters were all experienced neurologists or Movement Disorders, Vol.
For example, additional scales for evaluating tremor severity have some raters may base assessment purely on the writing or been assessed. In , Bain et al. The scale rated postural and rest tremor of the limbs, are more readily evaluated on videotapes than the writing voice, and head. The authors evaluated the inter- and and drawing tasks. The ferent raters. When making judgment about tremor severity, rat- ment. Differences in these in- a single site.
Reliability of TRSs in 10 patients with multiple sclerosis. Eight raters yield a chance-corrected measure of agreement for multi- at a single site independently viewed the videotape and nomial data arrayed in a two-way multiple raters by rated tremor during the self-assessment section. Interob- multiple responses layout.
This different statistical ap- server reliability was, as in the Bain et al. Better assess- ond videotapes. Reliability may have been improved in ment criteria for Part B appear to be needed. Alterna- this study had the assessment protocol been more stan- tively, digitizing tablets might be used to quantify tremor dardized across sites.
Training of raters on use of the more precisely in writing and drawing. Propranolol treat- Natalie C. Edwards assisted in drafting the methods, statistical ment of essential tremor.
Neurology ; — Clinical Rating Scale for manuscript. In: Jankovic J, Tolosa E, editors. Evaluacion del temblor: propuesta The following are the members of the Tremor Assessment Group: de una nueva escala.
In: Gimenez Roldan S, editor. Escala de evalucacion en la enfermedad de Parkinson y trastornos del movi- Tremor Assessment Group miento. A double-blind, placebo-controlled trial. Findley LJ, Koller W. Handbook of tremor disorders.
Cohen J. Davies M, Fleiss JL. Measuring agreement for multinomial data. Biometrics ;— Arch Phys Med Rehabil ; — How common is the most A teaching videotape for the common adult movement disorder?
Estimates of the prevalence of assessment of essential tremor. Mov Disord ;16 1 — Mov Disord ;— Elble RJ. Tremor in ostensibly normal elderly people. Mov Disord Assessing tremor severity. J Neurol Neurosurg Psychiatry ;56 8 — Essential tremor. Epide- Neurologist ;10 5 — essential tremor in writing and drawing.
Mov Disord ; — Movement Disorders, Vol.
Fahn, Tolosa, Marin Tremor Rating Scale
Mark Stacy Movement Disorders Vol. Proper treatment items tremor in writing and drawings of the TRS. The average of ET is contingent upon correct assessment of the severity, Spearman correlation was 0. Videotape tency between the two videotapes, but correlations for Part A recordings of 17 subjects with ET evaluated with the TRS were were somewhat better than for Part B. It is best when the same produced and sent to 59 raters.
Fahn Tolosa Marin Tremor Rating Scale Pdf Plans
For head and trunk, when lying down. UE: arms outstretched, wrists mildly extended, fingers spread apart. LE: legs flexed at hips and knees; foot dorsi-flexed. Tremor in Latin texts of Dutch physicians: 1. The shaking palsy, the first forty- five years: a journey through the British literature. Objective: The objective of this report is to describe the effect of both unilateral and bilateral Gamma Knife thalamotomy GKT on axial tremor.