Tremor modulation in patients with Parkinson’s disease compared to healthy counterparts during loaded postural holding

Hwang, Ing Shiou; Lin, Chii Jeng; Wu, Pei‐Ju

doi:10.1016/j.jelekin.2009.03.005

Cited by 9 publications

(9 citation statements)

References 37 publications

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“…This occurred in patients with both PD and ET, and has been previously reported in two studies dealing with inertial or force loading in tremor. The first was a study on coordination during postural holding in PD, where the authors found that mass loading of the index finger enhanced the tremor at the proximal segments while posture was maintained [63]. The second focused on the attenuation of tremors of different etiology (mainly ET) with a wearable robot that applied a constant viscosity to the affected joints [21].…”

Section: Discussionmentioning

confidence: 99%

A neuroprosthesis for tremor management through the control of muscle co-contraction

Gallego

Rocón

Lois

et al. 2013

J NeuroEngineering Rehabil

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BackgroundPathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks.MethodsWe implemented a neuroprosthesis that regulated the level of muscle co-contraction by injecting current at a pair of antagonists through transcutaneous neurostimulation. Co-contraction was adapted to the instantaneous parameters of tremor, which were estimated from the raw recordings of a pair of solid state gyroscopes with a purposely designed adaptive algorithm. For the experimental validation, we enrolled six patients suffering from parkinsonian or essential tremor of different severity, and evaluated the effect of the neuroprosthesis during standard tasks employed for neurological examination.ResultsThe neuroprosthesis attained significant attenuation of tremor (p<0.001), and reduced its amplitude up to a 52.33±25.48%. Furthermore, it alleviated both essential and parkinsonian tremor in spite of their different etiology and symptomatology. Tremor severity was not a limiting factor on the performance of the neuroprosthesis, although there was a subtle trend towards larger attenuation of more severe tremors. Tremor frequency was not altered during neurostimulation, as expected from the central origin of Parkinson’s disease and essential tremor. All patients showed a good tolerance to neurostimulation in terms of comfort and absence of pain, and some spontaneously reported that they felt that tremor was reduced when the neuroprosthesis was activated.ConclusionsThe results presented herein demonstrate that the neuroprosthesis provides systematic attenuation of the two major types of tremor, irrespectively from their severity. This study sets the basis for the validation of the neuroprosthesis as an alternative, non-invasive means for tremor management.

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Section: Discussionmentioning

confidence: 99%

A neuroprosthesis for tremor management through the control of muscle co-contraction

Gallego

Rocón

Lois

et al. 2013

J NeuroEngineering Rehabil

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“…Indeed, when this approach has been adopted, very clear and notable differences in tremor are found as a function of normal aging [24, 72], Parkinson's disease [27, 85, 86, 88, 89], and multiple sclerosis [83]. The typical pattern of results for this type of approach, as shown in Figures 2 and 3, is that older persons tend to exhibit greater hand and finger tremor coupled with increased muscle activity in the forearm extensors when required to hold the entire arm against gravity, compared to the EMG/tremor responses when only the finger is extended (the other segments were supported externally).…”

Section: Physiological Tremor With Agingmentioning

confidence: 99%

Aging, Neuromuscular Decline, and the Change in Physiological and Behavioral Complexity of Upper-Limb Movement Dynamics

Morrison

Newell

2012

Journal of Aging Research

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Aging is characterized by a general decline in physiological and behavioral function that has been widely interpreted within the context of the loss of complexity hypothesis. In this paper, we examine the relation between aging, neuromuscular function and physiological-behavioral complexity in the arm-hand effector system, specifically with reference to physiological tremor and isometric force production. Experimental findings reveal that the adaptive behavioral consequences of the aging-related functional decline in neurophysiological processes are less pronounced in simple motor tasks which provides support for the proposition that the motor output is influenced by both extrinsic (e.g., task related) and intrinsic (e.g., coordination, weakness) factors. Moreover, the aging-related change in complexity can be bidirectional (increase or decrease) according to the influence of task constraints on the adaptation required of the intrinsic properties of the effector system.

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“…Although some studies have explored tremor modulation when performing certain types of tasks (for example, pointing and grip tasks, entrainment, tapping, wrist extension, different loads weights [9][10][11][12][13]), in this work we plan to understand which type of upper limb movement positions, such as, relaxing, postural postures, ascending or descending upper limbs movements, with or without a 0.5 kg wrist load, is able to interfere with tremor. The frequency and amplitude of tremor modulations are compared across periods with and without, both, voluntary calibrated motion and limb load, in PD and essential tremor (ET) patients and a cohort of healthy controls using movement quantification (accelerometry analysis).…”

Section: Introductionmentioning

confidence: 99%

Tremor modulations across periods with and without voluntary motion and limb load task demands using movement quantification

Pascoal‐Faria¹,

Patrício

Philipiak

et al. 2013

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Understanding the neurobiological mechanisms underlying different types of tremor and the altered functional connectivity of the involved areas is a timely goal in clinical neuroscience. If successful, this quest may open new perspectives on how to achieve tremor modulation, which is notably relevant, in Parkinson's disease (PD). Tremor can be characterized by simple parameters such as frequency and amplitude. It is therefore prone to be objectively targeted by neuromodulation and quantitatively investigated using multimodal techniques, such as, accelerometry, EMG and functional Magnetic Resonance Imaging (fMRI). Embarking on the latter challenge requires an a priori knowledge of how effective functional connectivity is altered in PD tremor. This works aims to ascertain which postural and voluntary movement tasks with distinct types of physical load are suitable for designing efficient fMRI protocols, by performing an accelerometry analysis to measure spontaneous and imposed tremor modulation on cohorts of PD patients, essential tremor patients and a group of voluntary healthy controls.

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Tremor modulation in patients with Parkinson’s disease compared to healthy counterparts during loaded postural holding

Cited by 9 publications

References 37 publications

A neuroprosthesis for tremor management through the control of muscle co-contraction

A neuroprosthesis for tremor management through the control of muscle co-contraction

Aging, Neuromuscular Decline, and the Change in Physiological and Behavioral Complexity of Upper-Limb Movement Dynamics

Tremor modulations across periods with and without voluntary motion and limb load task demands using movement quantification

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