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R J Elble

Publications and source records attributed to R J Elble.

At least 37 records · Page 2Linked to original sources
PubMed1994

Factors influencing the amplitude and frequency of essential tremor.

Quantitative electromyography (EMG) and triaxial accelerometry were used to measure hand tremor, finger tremor, and forearm motor unit activity in 36 men and 23 women with essential tremor. Hand tremor was studied with and without 300-g mass loading. Tremor and EMG were recorded twice, with a 3-min rest interval, to assess the spontaneous intertrial variability in tremor amplitude, frequency, and motor unit entrainment. In general, the minimum detectable differences in tremor amplitude, frequency, and motor unit entrainment were roughly 30%, 5%, and 10% of the initial sample means, respectively, assuming a sample size of 30 patients, a statistical power of 0.9, and a significance level of 0.05. Linear regression analyses were performed to test the hypotheses that (a) there is an age-associated decrease in tremor frequency that is independent of symptom duration and (b) tremor frequency and motor unit entrainment make independent contributions to tremor amplitude. Our data supported both hypotheses.

Adolescent↗
PubMed1994

Essential tremor entrains rapid voluntary movements.

The effect of essential tremor on the timing of rapid wrist flexion was examined in 10 patients with moderate to severe disability. The mean reaction time and motor time of the patients did not differ from the mean values of 10 healthy age- and sex-matched controls. The latencies of the triphasic agonist and antagonist EMG bursts did not differ between patients and controls. The initiation of movement was time-locked to the tremor cycle in all patients. The initial agonist muscle activation occurred in phase with the rhythmic bursts of EMG, but the onset of rapid wrist flexion occurred when the momentum of essential tremor opposed the volitional movement. Essential tremor has subtle effects on motor control that transcend oscillation per se. These effects probably contribute to the impaired performance of fine motor tasks in patients with advanced disease.

Aged↗
PubMed1992

Distribution of amyloid in the brainstem of patients with Alzheimer disease.

A4 protein (beta-protein, beta-amyloid) deposits were identified with silver stains in postmortem brainstem sections from 13 patients with Alzheimer disease (AD), 6 patients with mixed Alzheimer disease and Parkinson disease (AD-PD), 5 disease controls, and 2 elderly controls. A rostro-caudal gradient of A4 was found in patients with AD and AD-PD, such that A4 was most prevalent in the midbrain and least prevalent in the medulla. The brainstem of the controls contained little or no A4. The midbrain tectum and tegmentum contained the greatest densities of A4, but the red nucleus and substantia nigra pars reticulata were largely spared. This distribution of A4 suggests that A4 deposition is a function of synaptic connectivity rather than passive diffusion from vascular sources.

Adult↗
PubMed1992

The syndrome of senile gait.

Infrared computed stroboscopic photometry was used to quantify the kinematic profiles of walking in 10 elderly patients with symmetrical neurological disturbances of gait and in 19 age-matched neurologically healthy people. Clinical examination of the patients revealed similar profiles of walking even though their diagnoses were vascular dementia (2), normal pressure hydrocephalus (2), Alzheimer dementia with possible normal pressure hydrocephalus (2), mixed Alzheimer and vascular dementia (1), peripheral neuropathy (1), Alzheimer dementia with parkinsonian features (1), and undetermined (1). Quantitatively, the patients' gait kinematics deviated greatly from control values, but these deviations were statistically attributable to reductions in stride. We suggest that many gait disturbances in elderly people are similar, regardless of etiology, because the characteristics of these gait disturbances are heavily veiled by nonspecific stride-dependent changes that comprise the syndrome of senile gait.

Aged↗
PubMed1992

Phase resetting and frequency entrainment of essential tremor.

Step and sinusoidal forcings were delivered to the wrists of 10 patients with advanced essential tremor using a computer-controlled torque motor. Consistent (type 0) phase resetting was produced in only 5 patients, whereas all 10 patients exhibited harmonic and 2:1 subharmonic entrainment of essential tremor. These results indicate that the oscillator of essential tremor is coupled to the stretch-reflex arc. Irregularity in the tremor rhythm and postperturbation mechanical-reflex oscillations obscured the phase of essential tremor, thereby impeding the computation of phase resetting curves. Sinusoidal forcings circumvented these problems, but frequency entrainment was produced only by forcings at frequencies within +/- 1 Hz of the tremor frequency and its second harmonic. Resonance accompanied frequency entrainment and probably plays a role in the clinical expression of tremor.

Adult↗
PubMed1992

Longitudinal study of essential tremor.

We measured wrist tremor and forearm EMG in 18 patients with essential tremor on two occasions separated by periods of 4 to 8 years. The frequency of tremor decreased 0.28 Hz to 3.21 Hz in 10 patients and changed less than 0.25 Hz in the remaining eight patients. Thus, the frequency of essential tremor may decrease over time.

Adult↗
PubMed1991

Inhibition of forearm EMG by palatal myoclonus.

The forearm electromyogram (EMG), pharyngeal EMG, and wrist tremor were recorded simultaneously from a 74-year-old woman with the syndrome of palatal myoclonus and progressive ataxia. Her wrist tremor had the characteristics of enhanced physiologic tremor. The enhancement of her tremor was attributable to 50- to 80-ms silent periods in the forearm EMG that followed the 1.9-Hz bursts of palatal myoclonus by 50 to 60 ms. This observation and those of previous authors support the notion that rhythmic olivocerebellar discharges can cause tremorogenic excitation and inhibition of postural EMG activity in the upper extremities.

Aged↗
PubMed1991

Stride-dependent changes in gait of older people.

Infrared computerized stroboscopic photometry was used to measure the kinematic profile of walking of 20 young adults and 20 neurologically healthy elderly people. Compared with the young adults, the elderly exhibited 17-20% reductions in the velocity of gait and length of stride. The elderly also exhibited comparable reductions in the maximum toe-floor clearance, arm swing, and rotations of the hips and knees, but these alterations in gait were attributable to the reduction in stride length, which may have non-neurological causes. The influence of reduced gait velocity and stride length on the other characteristics of walking must be considered when evaluating the pattern of walking in elderly people.

Adult↗
PubMed1990

Primary writing tremor. A form of focal dystonia?

Five patients exhibited severe tremor in the upper extremity, primarily when attempting to write or draw. Electromyography was performed to determine the patterns of muscle activity that were responsible for this tremor. Tremor was measured with an accelerometer and with a digitizing tablet. Two patients had postural tremor that was indistinguishable from mild, high-frequency essential tremor. All patients exhibited a severe 5-7-Hz tremor during the acts of writing and drawing. Muscles throughout the affected extremity exhibited rhythmic 5-7-Hz bursts of motor unit discharge, and the average level of motor unit activity was tonically increased in antagonistic muscles. This abnormal coactivation of antagonistic muscles produced subtle dystonic posturing of the affected limb that was overshadowed by severe tremor. Electromyography was useful in confirming the coexistence of tremor and dystonia in our patients. The nonspecificity of dystonia and postural tremor must be considered when discussing the nosology and pathophysiology of primary writing tremor.

Adult↗
PubMed1990

Quantification of tremor with a digitizing tablet.

Handwriting and drawing are commonly employed in the clinical assessment of tremor. These tasks have been quantified heretofore by subjective rating schemes, which are incapable of providing precise measures of the amplitude and frequency of tremor. A commercially-available digitizing tablet and personal computer can be interfaced so as to reliably record any pathologic tremor that is induced by writing or drawing. Numerical differentiation and spectral analysis can be used to conveniently quantify the amplitude and frequency of tremor. However, digitizing tablets lack sufficient sensitivity to measure physiologic tremor.

Handwriting↗
PubMed1987

Stretch reflex oscillations and essential tremor.

Using a computer-controlled torque motor and manipulandum, 50 ms torque pulses and 70 second trains of binary pseudorandom torque disturbances were applied to the wrists of 10 adult controls and 22 patients with essential tremor in order to study the interaction between mechanically-induced stretch-reflex oscillations and essential tremor. These two oscillations were separated by applying inertial and spring loads to the wrist. There was no evidence of increased or unstable stretch-reflex activity in the essential tremor patients, and stretch-reflex latencies did not correlate with the frequency of essential tremor. Essential tremor and mechanically-induced stretch-reflex oscillations are separate phenomena capable of complex interaction.

Adult↗
PubMed1986

Physiologic and essential tremor.

We studied physiologic and essential hand tremor using inertial loading; hand acceleration and forearm EMG data were analyzed by auto- and cross-spectral analysis. Early essential tremor was qualitatively similar to the 8- to 12-Hz component of physiologic tremor, suggesting that this tremor component is a forme fruste of essential tremor. Advanced essential tremor had a frequency of 4 to 8 Hz. Patients with tremor frequencies in both ranges were observed in each of 10 families. In antagonistic forearm muscles, both synchronous and alternating tremor bursts were observed in 11 of 44 patients. Essential tremor should not be classified solely on the basis of frequency or EMG pattern.

Adolescent↗
PubMed1984

Activity of muscle spindles, motor cortex and cerebellar nuclei during action tremor.

Repeated electrode penetration of the dentate and interpositus nuclei in a rhesus monkey transformed an 11-13 Hz physiologic tremor into a much larger action tremor at 5-7 Hz. This tremor was associated with muscle spindle spike train modulation and reflexly evoked tremor modulation of interpositus and motor cortex neurons as well as electromyogram (EMG). No tremor modulation was observed in spike trains recorded from dentate. The timing relationships of the spindle, EMG, and interpositus tremor discharges suggest that the interpositus plays a direct role in tremor suppression. Dentate, by contrast, may function indirectly by setting optimal transcortical long loop reflex dynamics concerned with intended voluntary movement.

Animals↗
PubMed1976

Motor-unit activity responsible for 8- to 12-Hz component of human physiological finger tremor.

Tremor of the extended third digit and bipolar surface and needle electromyograms of the extensor digitorum were recorded from six healthy volunteers for the purpose of elucidating the motor-unit activity responsible for the 8- to 12-Hz component of physiological finger tremor. Tremor was measured with a force transducer during steady voluntary contractions of approximately 200-250 g. The surface EMGs were full-wave rectified and low-pass filtered (-3 dB at 21 Hz), producing the envelope of the surface EMG (the demodulated EMG). Spectral analyses of simultaneous tremor and demodulated EMG records were performed. In four of six subjects, a pronounced 8- to 12-Hz amplitude modulation in the surface EMG was present, and coherency analysis demonstrated that this modulation was strongly correlated with the well-known 8- to 12-Hz tremor. In two subjects this amplitude modulation and tremor were barely detectable, despite the sensitive recording and analysis techniques used in this study. Spectral analysis was performed on 43 motor-unit spike trains. Twenty-two spike trains, having mean firing frequencies in the range of 10-22 spikes/s, produced statistically significant spectral peaks at 8-12 Hz, in addition to the expected spectral peaks at the mean firing frequencies. Of the 22 8- to 12-Hz-producing motor units, 12 had mean firing frequencies in the range of 17-22 spikes/s and exhibited the greatest 8- to 12-Hz activities of all motor units recorded. These motor units displayed transient sequences of double discharges in which interspike intervals (ISIS) of approximately 8-30 ms alternated with ISIS of 60-90 ms, thus producing an 8- to 12-Hz spectral peak. Adjacent ISIS of these motor units were correlated in the range of -0.5 to -0.9. Coherency analyses demonstrated that the 8- to 12-Hz activities of these motor units were correlated with the 8- to 12-Hz finger tremor and surface EMG modulation. The remaining 10 8- to 12-Hz-producing motor units had mean firing frequencies in the range of 10-17 spike/s. Although these motor units did not display the intense double-discharge firing pattern of the more rapidly firing motor units, a tendency toward action potential grouping was present and resulted in 8- to 12-Hz spectral activities which were correlated with the tremor and surface EMG modulation. .. ..

Adult↗