Novel Functional MRI Task for Studying the Neural Correlates of Upper Limb Tremor

Thumbnail Image
File version
Version of Record (VoR)
Boonstra, Frederique MC
Perera, Thushara
Noffs, Gustavo
Marotta, Cassandra
Vogel, Adam P
Evans, Andrew H
Butzkueven, Helmut
Moffat, Bradford A
van der Walt, Anneke
Kolbe, Scott C
Griffith University Author(s)
Primary Supervisor
Other Supervisors
File type(s)

Introduction: Tremor of the upper limbs is a disabling symptom that is present during several neurological disorders and is currently without treatment. Functional MRI (fMRI) is an essential tool to investigate the pathophysiology of tremor and aid the development of treatment options. However, no adequately or standardized protocols for fMRI exists at present. Here we present a novel, online available fMRI task that could be used to assess the in vivo pathology of tremor. Objective: This study aims to validate the tremor-evoking potential of the fMRI task in a small group of tremor patients outside the scanner and assess the reproducibility of the fMRI task related activation in healthy controls. Methods: Twelve HCs were scanned at two time points (baseline and after 6-weeks). There were two runs of multi-band fMRI and the tasks included a "brick-breaker" joystick game. The game consisted of three conditions designed to control for most of the activation related to performing the task by contrasting the conditions: WATCH (look at the game without moving joystick), MOVE (rhythmic left/right movement of joystick without game), and PLAY (playing the game). Task fMRI was analyzed using FSL FEAT to determine clusters of activation during the different conditions. Maximum activation within the clusters was used to assess the ability to control for task related activation and reproducibility. Four tremor patients have been included to test ecological and construct validity of the joystick task by assessing tremor frequencies captured by the joystick. Results: In HCs the game activated areas corresponding to motor, attention and visual areas. Most areas of activation by our game showed moderate to good reproducibility (intraclass correlation coefficient (ICC) 0.531-0.906) with only inferior parietal lobe activation showing poor reproducibility (ICC 0.446). Furthermore, the joystick captured significantly more tremulous movement in tremor patients compared to HCs (p = 0.01) during PLAY, but not during MOVE. Conclusion: Validation of our novel task confirmed tremor-evoking potential and reproducibility analyses yielded acceptable results to continue further investigations into the pathophysiology of tremor. The use of this technique in studies with tremor patient will no doubt provide significant insights into the treatment options.

Journal Title
Frontiers in Neurology
Conference Title
Book Title
Thesis Type
Degree Program
Publisher link
Patent number
Grant identifier(s)
Rights Statement
© 2018 Boonstra, Perera, Noffs, Marotta, Vogel, Evans, Butzkueven, Moffat, van der Walt and Kolbe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Rights Statement
Item Access Status
Access the data
Related item(s)
Clinical sciences
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Persistent link to this record
Boonstra, FMC; Perera, T; Noffs, G; Marotta, C; Vogel, AP; Evans, AH; Butzkueven, H; Moffat, BA; van der Walt, A; Kolbe, SC, Novel Functional MRI Task for Studying the Neural Correlates of Upper Limb Tremor, Frontiers in Neurology, 2018, 9, 99. 513