PT  - JOURNAL ARTICLE
AU  - Jane Alty
AU  - Jeremy Cosgrove
AU  - Deborah Thorpe
AU  - Peter Kempster
TI  - How to use pen and paper tasks to aid tremor diagnosis in the clinic
AID  - 10.1136/practneurol-2017-001719
DP  - 2017 Dec 01
TA  - Practical Neurology
PG  - 456--463
VI  - 17
IP  - 6
4099  - http://pn.bmj.com/content/17/6/456.short
4100  - http://pn.bmj.com/content/17/6/456.full
SO  - Pract Neurol2017 Dec 01; 17
AB  - When a patient presents with tremor, it can be useful to perform a few simple pen and paper tests. In this article, we explain how to maximise the value of handwriting and of drawing Archimedes spirals and straight lines as clinical assessments. These tasks take a matter of seconds to complete but provide a wealth of information that supplements the standard physical examination. They aid the diagnosis of a tremor disorder and can contribute to its longitudinal monitoring. Watching the patient’s upper limb while they write and draw may reveal abnormalities such as bradykinesia, dystonic posturing and distractibility. The finished script and drawings can then be evaluated for frequency, amplitude, direction and symmetry of oscillatory pen movements and for overall scale of penmanship. Essential, dystonic, functional and parkinsonian tremor each has a characteristic pattern of abnormality on these pen and paper tests.