{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:14:40Z","timestamp":1788020080663,"version":"build-2784847793"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Despite the widespread use of deep brain stimulation (DBS) for movement disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist of performing passive movements of the patient's arm or wrist while the amplitude of the stimulation current is increased. At each position, the amplitude that best alleviates rigidity is identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of such evaluations have been reported. The aim of the present study was to evaluate the use of an acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing that such a change will alter the speed of the passive movements. Furthermore, the combined analysis of such quantitative results with anatomy would generate a more reproducible description of the most effective stimulation sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>To test the reliability of the method, it was applied during postoperative follow-up examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9 bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by extracting relevant outcome measures from the accelerometer data. These values were used to identify rigidity-suppressing stimulation current amplitudes, which were statistically compared with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation that would have been chosen based on the acceleration data were compared with clinical choices. The data were also analyzed with respect to the anatomical location of the stimulating electrode.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Outcome measures extracted from the accelerometer data were reproducible for the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigidity-suppressing amplitudes were found increased from 144 to 170 when the accelerometer evaluations were considered. In general, rigidity release could be observed at significantly lower amplitudes with accelerometer evaluation (mean 0.9 \u00b1 0.6 mA) than with subjective evaluation (mean 1.4 \u00b1 0.6 mA) (p &lt; 0.001). Of 14 choices for the implant location of the DBS lead, only 2 were the same for acceleration-based and subjective evaluations. The comparison across anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>This article describes and validates a new assistive method for assessing rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The initial results indicate that the proposed method may be a clinically useful aid for optimal DBS lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target for PD.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.8.jns152770","type":"journal-article","created":{"date-parts":[[2016,12,16]],"date-time":"2016-12-16T15:54:04Z","timestamp":1481903644000},"page":"602-612","source":"Crossref","is-referenced-by-count":12,"title":["A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors"],"prefix":"10.3171","volume":"127","author":[{"given":"Ashesh","family":"Shah","sequence":"first","affiliation":[{"name":"Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Coste","sequence":"additional","affiliation":[{"name":"Image-Guided Clinical Neuroscience and Connectomics, and"},{"name":"Service de Neurochirurgie and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Jacques","family":"Lemaire","sequence":"additional","affiliation":[{"name":"Image-Guided Clinical Neuroscience and Connectomics, and"},{"name":"Service de Neurochirurgie and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Schkommodau","sequence":"additional","affiliation":[{"name":"Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Taub","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Derost","sequence":"additional","affiliation":[{"name":"Neuro-Psycho-Pharmacologie des Syst\u00e8mes Dopaminergiques Sous-Corticaux, Universit\u00e9 Clermont Auvergne, Universit\u00e9 d'Auvergne; and"},{"name":"Service de Neurologie, CHU Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Hemm","sequence":"additional","affiliation":[{"name":"Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns152770","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000343207","article-title":"An international survey of deep brain stimulation procedural steps","volume":"91","author":"Abosch A,","year":"2013","unstructured":"Abosch A, Timmermann L, Bartley S, Rietkerk HG, Whiting D, Connolly PJ, : An international survey of deep brain stimulation procedural steps. Stereotact Funct Neurosurg 91:1\u201311, 20132315475510.1159\/000343207"},{"key":"b2-jns152770","series-title":"Conf Proc IEEE Eng Med Biol Soc","doi-asserted-by":"publisher","first-page":"98","DOI":"10.3233\/JPD-2012-11071","article-title":"An EMG-based system for continuous monitoring of clinical efficacy of Parkinson's disease treatments","volume":"2010","author":"Askari S,","year":"2010","unstructured":"Askari S, Zhang M, Won DS: An EMG-based system for continuous monitoring of clinical efficacy of Parkinson's disease treatments. Conf Proc IEEE Eng Med Biol Soc 2010:98\u2013101, 20102109564510.3233\/JPD-2012-11071"},{"key":"b3-jns152770","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1159\/000314357","article-title":"Patient-specific model-based investigation of speech intelligibility and movement during deep brain stimulation","volume":"88","author":"Astr\u00f6m M,","year":"2010","unstructured":"Astr\u00f6m M, Tripoliti E, Hariz MI, Zrinzo LU, Martinez-Torres I, Limousin P, : Patient-specific model-based investigation of speech intelligibility and movement during deep brain stimulation. Stereotact Funct Neurosurg 88:224\u2013233, 20102046095210.1159\/000314357"},{"key":"b4-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"2218","DOI":"10.1002\/mds.22752","article-title":"A novel method for systematic analysis of rigidity in Parkinson's disease","volume":"24","author":"Endo T,","year":"2009","unstructured":"Endo T, Okuno R, Yokoe M, Akazawa K, Sakoda S: A novel method for systematic analysis of rigidity in Parkinson's disease. Mov Disord 24:2218\u20132224, 20091976872910.1002\/mds.22752"},{"key":"b5-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1002\/1531-8257(200001)15:1<48::AID-MDS1009>3.0.CO;2-E","article-title":"Objective quantification of resting and activated parkinsonian rigidity: a comparison of angular impulse and work scores","volume":"15","author":"Fung VS,","year":"2000","unstructured":"Fung VS, Burne JA, Morris JG: Objective quantification of resting and activated parkinsonian rigidity: a comparison of angular impulse and work scores. Mov Disord 15:48\u201355, 20001063424110.1002\/1531-8257(200001)15:1<48::AID-MDS1009>3.0.CO;2-E"},{"key":"b6-jns152770","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1007\/s00415-006-0222-z","article-title":"Subthalamic nucleus stimulation in Parkinson's disease: anatomical and electrophysiological localization of active contacts","volume":"253","author":"Godinho F,","year":"2006","unstructured":"Godinho F, Thobois S, Magnin M, Guenot M, Polo G, Benatru I, : Subthalamic nucleus stimulation in Parkinson's disease: anatomical and electrophysiological localization of active contacts. J Neurol 253:1347\u20131355, 200610.1007\/s00415-006-0222-z16788774"},{"key":"b7-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results","volume":"23","author":"Goetz CG,","year":"2008","unstructured":"Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, : Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129\u20132170, 20081902598410.1002\/mds.22340"},{"key":"b8-jns152770","series-title":"J Parkinsons Dis","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3233\/JPD-2012-11071","article-title":"Automated assessment of bradykinesia and dyskinesia in Parkinson's disease","volume":"2","author":"Griffiths RI,","year":"2012","unstructured":"Griffiths RI, Kotschet K, Arfon S, Xu ZM, Johnson W, Drago J, : Automated assessment of bradykinesia and dyskinesia in Parkinson's disease. J Parkinsons Dis 2:47\u201355, 20122393940810.3233\/JPD-2012-11071"},{"key":"b9-jns152770","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1136\/jnnp.74.8.1036","article-title":"Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: evaluation of active electrode contacts","volume":"74","author":"Hamel W,","year":"2003","unstructured":"Hamel W, Fietzek U, Morsnowski A, Schrader B, Herzog J, Weinert D, : Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: evaluation of active electrode contacts. J Neurol Neurosurg Psychiatry 74:1036\u20131046, 200310.1136\/jnnp.74.8.103612876231"},{"key":"b10-jns152770","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1212\/WNL.17.5.427","article-title":"Parkinsonism: onset, progression and mortality","volume":"17","author":"Hoehn MM,","year":"1967","unstructured":"Hoehn MM, Yahr MD: Parkinsonism: onset, progression and mortality. Neurology 17:427\u2013442, 1967606725410.1212\/WNL.17.5.427"},{"key":"b11-jns152770","series-title":"Br J Clin Pharmacol","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1046\/j.1365-2125.1996.38313.x","article-title":"Objective measurement of activation of rigidity: diagnostic, pathogenetic and therapeutic implications in parkinsonism","volume":"41","author":"Kirollos C,","year":"1996","unstructured":"Kirollos C, Charlett A, O'Neill CJ, Kosik R, Mozol K, Purkiss AG, : Objective measurement of activation of rigidity: diagnostic, pathogenetic and therapeutic implications in parkinsonism. Br J Clin Pharmacol 41:557\u2013564, 1996879952210.1046\/j.1365-2125.1996.38313.x"},{"key":"b12-jns152770","series-title":"Biomed Mater Eng","doi-asserted-by":"publisher","first-page":"2273","DOI":"10.1016\/S1353-8020(13)70044-0","article-title":"Quantitative evaluation of parkinsonian rigidity during intraoperative deep brain stimulation","volume":"24","author":"Kwon Y,","year":"2014","unstructured":"Kwon Y, Park SH, Kim JW, Ho Y, Jeon HM, Bang MJ, : Quantitative evaluation of parkinsonian rigidity during intraoperative deep brain stimulation. Biomed Mater Eng 24:2273\u20132281, 20142522692710.1016\/S1353-8020(13)70044-0"},{"key":"b13-jns152770","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1016\/S1353-8020(13)70044-0","article-title":"Contribution of 4.7 Tesla MRI in the analysis of the MRI anatomy of the human subthalamic area","volume":"146","author":"Lemaire JJ,","year":"2004","unstructured":"Lemaire JJ, Caire F, Bony JM, Kemeny JL, Villeger A, Chazal J: Contribution of 4.7 Tesla MRI in the analysis of the MRI anatomy of the human subthalamic area. Acta Neurochir (Wien) 146:906\u2013907, 200410.1016\/S1353-8020(13)70044-0"},{"key":"b14-jns152770","series-title":"Int J Comput Assist Radiol Surg","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s11548-007-0124-2","article-title":"MRI anatomical mapping and direct stereotactic targeting in the subthalamic region: functional and anatomical correspondence in Parkinson's disease","volume":"2","author":"Lemaire JJ,","year":"2007","unstructured":"Lemaire JJ, Coste J, Ouchchane L, Hemm S, Derost P, Ulla M, : MRI anatomical mapping and direct stereotactic targeting in the subthalamic region: functional and anatomical correspondence in Parkinson's disease. Int J Comput Assist Radiol Surg 2:75\u201385, 200710.1007\/s11548-007-0124-2"},{"key":"b15-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1002\/mds.22291","article-title":"Objective measurement of muscle rigidity in Parkinsonian patients treated with subthalamic stimulation","volume":"24","author":"Levin J,","year":"2009","unstructured":"Levin J, Krafczyk S, Valkovic P, Eggert T, Claassen J, B\u00f6tzel K: Objective measurement of muscle rigidity in Parkinsonian patients treated with subthalamic stimulation. Mov Disord 24:57\u201363, 20091885592510.1002\/mds.22291"},{"key":"b16-jns152770","series-title":"J Adv Nurs","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1111\/j.1365-2648.2010.05313.x","article-title":"Unified Parkinson's Disease Rating Scale-Motor Exam: interrater reliability of advanced practice nurse and neurologist assessments","volume":"66","author":"Palmer JL,","year":"2010","unstructured":"Palmer JL, Coats MA, Roe CM, Hanko SM, Xiong C, Morris JC: Unified Parkinson's Disease Rating Scale-Motor Exam: interrater reliability of advanced practice nurse and neurologist assessments. J Adv Nurs 66:1382\u20131387, 201010.1111\/j.1365-2648.2010.05313.x"},{"key":"b17-jns152770","series-title":"IEEE Trans Neural Syst Rehabil Eng","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1109\/TNSRE.2010.2091149","article-title":"Analysis of viscoelastic properties of wrist joint for quantification of parkinsonian rigidity","volume":"19","author":"Park BK,","year":"2011","unstructured":"Park BK, Kwon Y, Kim JW, Lee JH, Eom GM, Koh SB, : Analysis of viscoelastic properties of wrist joint for quantification of parkinsonian rigidity. IEEE Trans Neural Syst Rehabil Eng 19:167\u2013176, 20112107573910.1109\/TNSRE.2010.2091149"},{"key":"b18-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1002\/mds.20640","article-title":"Unified Parkinson's disease rating scale motor examination: are ratings of nurses, residents in neurology, and movement disorders specialists interchangeable?","volume":"20","author":"Post B,","year":"2005","unstructured":"Post B, Merkus MP, de Bie RM, de Haan RJ, Speelman JD: Unified Parkinson's disease rating scale motor examination: are ratings of nurses, residents in neurology, and movement disorders specialists interchangeable?. Mov Disord 20:1577\u20131584, 20051611661210.1002\/mds.20640"},{"key":"b19-jns152770","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1002\/mds.870120106","article-title":"Measurement of rigidity in Parkinson's disease","volume":"12","author":"Prochazka A,","year":"1997","unstructured":"Prochazka A, Bennett DJ, Stephens MJ, Patrick SK, Sears-Duru R, Roberts T, : Measurement of rigidity in Parkinson's disease. Mov Disord 12:24\u201332, 1997899005010.1002\/mds.870120106"},{"key":"b20-jns152770","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.3171\/jns.2002.97.5.1152","article-title":"Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging","volume":"97","author":"Saint-Cyr JA,","year":"2002","unstructured":"Saint-Cyr JA, Hoque T, Pereira LCM, Dostrovsky JO, Hutchison WD, Mikulis DJ, : Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 97:1152\u20131166, 200210.3171\/jns.2002.97.5.115212450038"},{"key":"b21-jns152770","series-title":"Ann Biomed Eng","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1007\/s10439-007-9379-6","article-title":"Quantification of rigidity in Parkinson's disease","volume":"35","author":"Sepehri B,","year":"2007","unstructured":"Sepehri B, Esteki A, Ebrahimi-Takamjani E, Shahidi GA, Khamseh F, Moinodin M: Quantification of rigidity in Parkinson's disease. Ann Biomed Eng 35:2196\u20132203, 20071790997010.1007\/s10439-007-9379-6"},{"key":"b22-jns152770","series-title":"6th Annual International IEEE EMBS Conference on Neural Engineering","article-title":"A method to quantitatively evaluate changes in tremor during deep brain stimulation surgery","author":"Shah A,","year":"2013","unstructured":"Shah A, Coste J, Lemaire JJ, Schkommodau E, Hemm-Ode S: A method to quantitatively evaluate changes in tremor during deep brain stimulation surgery. 6th Annual International IEEE EMBS Conference on Neural Engineering San Diego, 2013. (http:\/\/ieeexplore.ieee.org\/abstract\/document\/6696155\/) [Accessed November 30, 2016]"},{"issue":"Suppl 1","key":"b23-jns152770","series-title":"Parkinsonism Relat Disord","first-page":"S187","article-title":"Where are we with surgical therapies for Parkinson's disease?","volume":"20","author":"Strauss I,","year":"2014","unstructured":"Strauss I, Kalia SK, Lozano AM: Where are we with surgical therapies for Parkinson's disease?. Parkinsonism Relat Disord 20:Suppl 1S187\u2013S191, 2014"},{"key":"b24-jns152770","series-title":"IEEE Trans Biomed Eng","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1109\/10.979357","article-title":"An advanced detrending method with application to HRV analysis","volume":"49","author":"Tarvainen MP,","year":"2002","unstructured":"Tarvainen MP, Ranta-Aho PO, Karjalainen PA: An advanced detrending method with application to HRV analysis. IEEE Trans Biomed Eng 49:172\u2013175, 20021206688510.1109\/10.979357"},{"key":"b25-jns152770","series-title":"Basal Ganglia","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.baga.2011.05.001","article-title":"Deep-brain stimulation for basal ganglia disorders","volume":"1","author":"Wichmann T,","year":"2011","unstructured":"Wichmann T, Delong MR: Deep-brain stimulation for basal ganglia disorders. Basal Ganglia 1:65\u201377, 20112180495310.1016\/j.baga.2011.05.001"},{"key":"b26-jns152770","series-title":"Conf Proc IEEE Eng Med Biol Soc","first-page":"2825","article-title":"Research and development of a portable device to quantify muscle tone in patients with Parkinsons disease","volume":"2008","author":"Wright D,","year":"2008","unstructured":"Wright D, Nakamura K, Maeda T, Kutsuzawa K, Miyawaki K, Nagata K: Research and development of a portable device to quantify muscle tone in patients with Parkinsons disease. Conf Proc IEEE Eng Med Biol Soc 2008:2825\u20132827, 200819163293"},{"key":"b27-jns152770","series-title":"Etiology and Pathophysiology of Parkinson's Disease.","doi-asserted-by":"publisher","first-page":"485","DOI":"10.5772\/17849","article-title":"Physiological and biomechanical analyses of rigidity in Parkinson's disease","author":"Xia R,","year":"2011","unstructured":"Xia R, Physiological and biomechanical analyses of rigidity in Parkinson's disease. Rana AQ: Etiology and Pathophysiology of Parkinson's Disease. Rijeka, Croatia, InTech, 2011. 485\u201350610.5772\/17849"},{"key":"b28-jns152770","series-title":"Chin Med J (Engl)","first-page":"2419","article-title":"Subthalamic deep brain stimulation for Parkinson's disease: correlation of active contacts and electrophysiologically mapped subthalamic nucleus","volume":"122","author":"Zheng Z,","year":"2009","unstructured":"Zheng Z, Zhang YQ, Li JY, Zhang XH, Zhuang P, Li YJ: Subthalamic deep brain stimulation for Parkinson's disease: correlation of active contacts and electrophysiologically mapped subthalamic nucleus. Chin Med J (Engl) 122:2419\u20132422, 200920079152"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/127\/3\/article-p602.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/127\/3\/article-p602.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/127\/3\/article-p602.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T02:47:24Z","timestamp":1742698044000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/127\/3\/article-p602.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":28,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2016.8.jns152770","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9]]}}}