The Kløve–Matthews Static Steadiness Test Compared with the DPD TREMORComparison of a Fine Motor Control Task with Measures of Tremor in Smokers and Manganese-Exposed Workers

Tremor measurements in a 22-year cohort study of workers exposed to hand-held vibrating tools

OBJECTIVES

The objectives of this cohort study were to evaluate possible long-term effects of occupational exposure to hand-arm vibration (HAV) in terms of increased tremor. The aims were to evaluate whether exposure during follow-up, baseline hand-arm vibration syndrome (HAVS), baseline manual dexterity or current medical conditions or life-style habits might be associated with increased tremor. A further aim was to compare two different activation conditions: postural vs rest tremor.

METHODS

Forty men (current age: 60.4 years) who had previously worked as manual workers in a specialized engineering and construction company enrolled in the study. Their hand functions had been examined in 1994. At the baseline examination, 27 had been diagnosed with HAVS, while 13 were not exposed. The follow-up examination in 2016-2017 comprised the CATSYS Tremor Pen^® for measuring postural and rest tremor and the Grooved Pegboard Test for assessing manual dexterity. Blood samples were taken for assessing biomarkers that might have impact on tremor.

RESULTS

Neither cumulative exposure to HAV during follow-up nor HAVS at baseline were associated with increased tremor. A test for manual dexterity at baseline was significantly associated with increased tremor (Tremor Intensity) at follow-up. Blood markers of current medical conditions and tobacco consumption were associated with increased tremor. Rest tremor frequency was higher than postural tremor frequency (p < 0.001).

CONCLUSIONS

The main findings of this 22-year cohort study were no indications of long-term effects on tremor related to HAV exposure and previous HAVS status. However, baseline manual dexterity was significantly associated with increased tremor at follow-up. Activation conditions (e.g., hand position) are important when testing tremor.

Tremor and hand-arm vibration syndrome (HAVS) in road maintenance workers

Objectives

The aim of this study was to evaluate postural and rest tremor among workers using vibrating hand tools, taking into account the possible effects of toxicants such as alcohol and tobacco. A further aim was to study workers diagnosed with hand-arm vibration syndrome (HAVS) at the time of examination.

Methods

This study comprises 103 road maintenance workers, 55 exposed to vibrating hand tools (age 41.0 years; range 21–62) and 48 referents (age 38.5 years; range 19–64). They were examined with the CATSYS Tremor Pen^®. Exposure to vibrating tools and serum biomarkers of alcohol and tobacco consumption were measured.

Results

Cumulative exposure to vibrating tools was associated with increased postural (p < 0.01) and rest tremor (p < 0.05) and with a higher Center Frequency of postural tremor (p < 0.01) among smokers and users of smokeless tobacco. Rest tremor Center Frequency was higher than postural tremor frequency (p < 0.001).

Conclusions

The main findings indicate an association between cumulative exposure to hand-held vibrating tools, tremor parameters and consumption of tobacco products. The hand position is important when testing for tremor. Rest tremor had a higher Center Frequency. Postural tremor was more strongly associated with exposure than rest tremor. The finding of increased tremor among the HAVS subjects indicated that tremor might be a part of the clinical picture of a HAVS diagnosis. As with all cross-sectional studies, inferences should be made with caution when drawing conclusions about associations between exposure and possible effects. Future research using longitudinal design is required to validate the findings of the present study.

Reconsideration of the WHO NCTB strategy and test selection

The World Health Organization-recommended neurobehavioral core test battery (NCTB) became the international standard for identifying adverse human behavioral effects due to neurotoxic chemical exposure when it was first proposed in 1983. Since then the WHO NCTB has been repeatedly cited as the basis for test selection in human neurotoxicology research. A discussion group was held before the International Symposium on Neurobehavioral Methods and Effects in Occupational and Environmental Health to review the NCTB and reconsider its tests. The workshop made three consensus recommendations to the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP):. 1. A 'screening' battery of broadly sensitive tests is needed as guidance to the field of human neurotoxicology 2. The SCNP should convene a panel to reconsider the functions measured and the tests in the WHO NCTB 3. Three disciplines should be represented in the panel recommending a revised NCTB: neuropsychology; experimental psychology; neurology. This recommendation will be pursued at the next meeting of the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP).

A neurobehavioral study of current and former welders exposed to manganese

Neurobehavioral functions were studied in 96 welders currently exposed to the geometric mean (GM) concentration of 121 microg/m(3) (range 7-2322) manganese (Mn) in welding fume (air-Mn) based on the individual mean from two successive days of sampling. They were compared to 96 age-matched referents. The arithmetic mean (AM) concentration of Mn in whole blood (B-Mn) was 8.6 microg/L versus 6.9 microg/L in the referents. Associations between the Digit Symbol and Finger Tapping test scores and B-Mn and air-Mn, respectively, were observed. The welders exposed to the highest air-Mn concentrations (GM 423 microg/m(3) range 204-2322) had statistically significantly poorer Finger Tapping test score as compared to their age-matched referents. The welders with the highest AM concentration of B-Mn (12.6 microg/L) scored statistically significantly poorer on the Digit Symbol test when compared to the age-matched referents (AM B-Mn 7.5 microg/L). The same neurobehavioral test battery was applied to 27 patients diagnosed, and financially compensated, as having welding related manganism. They were on average 44.9 (range 34-51) years old at the time of diagnosis, which on average was 5.8 years prior to this study. They had worked as welders for 23.1 years on average (range 15-30). The most affected neurobehavioral functions were associated with impaired Finger Tapping speed and Grooved Pegboard performance. The patients had no alterations in hand tremor as assessed by the CATSYS system, while a few subjects had noticeable tremor as assessed by the Static Steadiness test.