Tremor

INDEX

Sample of handwriting

Spiral drawing

The Archimedes spiral drawing captures the frequency, amplitude and direction of tremor.  Encourage the patient to draw spontaneously (ideally not copy the doctor’s version), without resting the arm on the paper in an effort to steady the hand.

Since it requires a continuous pen movement without brief breaks as seen when writing words, the spiral emphasises the abnormal movements of dystonia, hypokinesia and tremor4.  (Similarly, when testing for micrographia, it is necessary for the patient to write continuously in order to bring out the sequence effect of progressive decrease in amplitude of the letters).

The patient can be asked to draw continuous loops (or cursive “Ls”) across a page, trying not to break when drawing the loops. The patient could also be asked to draw a line connecting dots.

Examples of abnormalities for specific conditions may be found in the following sections under Types of Tremor:

Essential Tremor

Dystonic Tremor

Parkinson’s Disease

 

Typical characteristics of tremor types seen in writing and drawing tasks1.

1Alty J, Cosgrove J, Thorpe D, Kempster P. How to use pen and paper tasks to aid tremor diagnosis in the clinic. Pract Neurol. 2017;17(6):456-463. doi:10.1136/practneurol-2017-001719