Objective: This review was done to know the uses of digitalizing tablets for the tremor evaluation.

Background: Tremor is the most common movement disorder seen in clinical practice. Various transducer-based methods including digitalizing tablets have been used for tremor evaluation.^{1, 2}

Method: A PubMed search was made on 28^th February 2021 using the search term, ‘digitalizing tablet and tremor’, and 35 articles were retrieved.

Results: Spiral drawings using digitalizing tablets have been used in different types of tremor including essential tremor, parkinsonian tremor and primary writing tremor. In essential tremor patients, repeated spiral drawings have been used as a possible limb-based measure of motor learning. Spiral drawings have also been used for the evaluation of kinetic tremor in Parkinson’s disease and essential tremor patients. In another study task-dependent variability of the essential tremor was evaluated, where tremor was characterized clinically and electrophysiologically using accelerometry and digitizing tablet tasks. There was significant amplitude reduction overtime on repeated digital spirals, possibly due to the learning effect or adaptation. In Parkinson’s disease patients spiral drawing time has been used as a measure of bradykinesia and hand trajectories have been used for the objective evaluation of motor block. Movement irregularities have been reported in atypical parkinsonian syndromes.

Conclusion: A commercially available digitizing tablet can be interfaced to record any pathologic tremor induced by writing or drawing. Also, spectral analysis can be used to quantify the amplitude and frequency of tremor. However, they lack sufficient sensitivity to measure physiologic tremor.

References: 1. Lin PC, Chen KH, Yang BS, Chen YJ. A digital assessment system for evaluating kinetic tremor in essential tremor and Parkinson’s disease. BMC Neurol. 2018 Mar 9;18(1):25. 2. Legrand AP, Rivals I, Richard A, Apartis E, Roze E, Vidailhet M, Meunier S, Hainque E. New insight in spiral drawing analysis methods – Application to action tremor quantification. Clin Neurophysiol. 2017 Oct;128(10):1823-1834.

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