title: A telemedicine instrument for remote evaluation of tremor: design and initial applications in fatigue and patients with Parkinson's disease.
abstract: BACKGROUND
  A novel system that combines a compact mobile instrument and Internet communications is presented in this paper for remote evaluation of tremors. The system presents a high potential application in Parkinson's disease and connects to the Internet through a TCP/IP protocol. Tremor transduction is carried out by accelerometers, and the data processing, presentation and storage were obtained by a virtual instrument. The system supplies the peak frequency (fp), the amplitude (Afp) and power in this frequency (Pfp), the total power (Ptot), and the power in low (1-4 Hz) and high (4-7 Hz) frequencies (Plf and Phf, respectively).
  
  
  METHODS
  The ability of the proposed system to detect abnormal tremors was initially demonstrated by a fatigue study in normal subjects. In close agreement with physiological fundamentals, the presence of fatigue increased fp, Afp, Pfp and Pt (p < 0.05), while the removal of fatigue reduced all the mentioned parameters (p < 0.05). The system was also evaluated in a preliminary in vivo test in parkinsonian patients. Afp, Pfp, Ptot, Plf and Phf were the most accurate parameters in the detection of the adverse effects of this disease (Se = 100%, Sp = 100%), followed by fp (Se = 100%, Sp = 80%). Tests for Internet transmission that realistically simulated clinical conditions revealed adequate acquisition and analysis of tremor signals and also revealed that the user could adequately receive medical recommendations.
  
  
  CONCLUSIONS
  The proposed system can be used in a wide spectrum of telemedicine scenarios, enabling the home evaluation of tremor occurrence under specific medical treatments and contributing to reduce the costs of the assistance offered to these patients.
authors.affiliation: Biomedical Instrumentation Laboratory State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Mário C
authors.initials: MC
authors.lastname: Barroso Júnior
authors.forename: Guilherme P
authors.initials: GP
authors.lastname: Esteves
authors.forename: Thiago P
authors.initials: TP
authors.lastname: Nunes
authors.forename: Lucia M G
authors.initials: LM
authors.lastname: Silva
authors.forename: Alvaro C D
authors.initials: AC
authors.lastname: Faria
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Melo
mesh_terms: D000328:Adult; D034201:Computers, Handheld; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis*; D012984:Software; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D014202:Tremor / Q000175:diagnosis* / Q000503:physiopathology*; D014584:User-Computer Interface; D055815:Young Adult