A comprehensive review of tremor

Wearable Sensors for Measuring Movement in Short Sessions of Mindfulness Sitting Meditation: A Pilot Study

Mindfulness techniques are useful tools in health and well-being. To improve and facilitate formal training, beginners need to know if they are in a stable sitting posture and if they can hold it. Previous monitoring studies did not consider stability during sitting meditation or were specific for longer traditional practices. In this paper, we have extended and adapted previous studies to modern mindfulness practices and posed two questions: (a) Which is the best meditation seat for short sessions? In this way, the applications of stability measures are expanded to meditation activities, in which the sitting posture favors stability, and (b) Which is the most sensitive location of an accelerometer to measure body motion during short meditation sessions? A pilot study involving 31 volunteers was conducted using inertial sensors. The results suggest that thumb, head, or infraclavicular locations can be chosen to measure stability despite the habitual lumbar or sacral region found in the literature. Another important finding of this study is that zafus, chairs, and meditation benches are suitable for short meditation sessions in a sitting posture, although the zafu seems to allow for fewer postural changes. This finding opens new opportunities to design very simple and comfortable measuring systems.

Potential for Intrathecal Baclofen in Treatment of Essential Tremor

INTRODUCTION

Essential tremor (ET) is the most common movement disorder of adults, affecting an estimated 7 million Americans. Symptoms of ET range from slightly noticeable to debilitating, with 1 cohort study finding 15% of patients were forced into early retirement. Additionally, depression has also been correlated with the severity of disability of ET. Treatment options include propranolol and primidone. Current treatment options are not very effective, with more than half (56.3%) of patients discontinuing medications because of no changes in symptoms.

METHODS

Unfortunately, there is a relative void and controversy in the literature explaining ET pathophysiology; however, the gamma-aminobutyric acid (GABA) hypothesis is the strongest. We conducted a PubMed search on 30 September 2015 with no time constraints using the search terms "essential tremor" and "baclofen," which resulted in a total of 5 articles.

RESULTS

Neurohistopathologic studies have demonstrated decreased GABA-A and GABA-B receptors in the cerebellar cortex of ET patients. GABA, the major inhibitory neurotransmitter in the central nervous system, is proposed to have an inhibitory effect on pacemaker output activity of the cerebello-thalamo-cortical pathway, with lower receptors resulting in decreased inhibition of baseline tremors. Tariq et al showed delayed onset and intensity of tremor with oral administration of R-baclofen in a mouse model of ET.

CONCLUSION

With a better side-effect profile and success in a physiologically related condition, we propose more clinical trials and research be carried out on intrathecal baclofen as a potential treatment option, especially drug refractory ET, so as to increase the quality of life of this patient population.

Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression

Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor signal by 99.8%, while the intentional component power was reduced by <1%.

Desktop Haptic Interface for Simulation of Hand-Tremor

This paper presents a haptic system that is conceived to support the design process of a class of products or services in order to make them more accessible to people affected by hand tremor diseases. The main aim is to foster the designer empathy allowing her/him to directly feel the effect of the impairment in first person. Specifically, a desktop haptic device is employed to induce a programmable hand-tremor, that is typically observed in people affected by some kind of neurological diseases, on healthy subjects (i.e., the designers). The developed tool is based on a wrist-attached haptic interface with a workspace that is comparable to that of the arm of the user. Such device is able to exert controlled forces on the user's wrist and induces a hand-tremor whose frequency and amplitude are correlated with those measured on impaired people. The control of the device is based on a custom trajectory-tracking algorithm that takes as input tremor signals that are acquired on patients using an optical motion tracking system. In this paper, we present the employed haptic system, the structure of the control system and the experimental validation of the controller done through the acquisition of data on six patients affected by Parkinson's disease.

The approximate entropy of the electromyographic signals of tremor correlates with the osmotic fragility of human erythrocytes

BACKGROUND

The main problem of tremor is the damage caused to the quality of the life of patients, especially those at more advanced ages. There is not a consensus yet about the origins of this disorder, but it can be examined in the correlations between the biological signs of aging and the tremor characteristics.

METHODS

This work sought correlations between the osmotic fragility of erythrocytes and features extracted from electromyographic (EMG) activity resulting from physiological tremor in healthy patients (N = 44) at different ages (24-87 years). The osmotic fragility was spectrophotometrically evaluated by the dependence of hemolysis, provided by the absorbance in 540 nm (A54o), on the concentration of NaCl. The data were adjusted to curves of sigmoidal regression and characterized by the half transition point (H50), amplitude of lysis transition (dx) and values of A540 in the curve regions that characterize the presence of lysed (A1) and preserved erythrocytes (A2). The approximate entropy was estimated from EMG signals detected from the extensor carpi ulnaris muscle during the movement of the hand of subjects holding up a laser pen towards an Archimedes spiral, fixed in a whiteboard. The evaluations were carried out with the laser pen at rest, at the center of the spiral, and in movement from the center to the outside and from outside to the center. The correlations among the parameters of osmotic fragility, tremor and age were tested.

RESULTS

Negative correlations with age were found for A1 and dx. With the hand at rest, a positive correlation with H50 was found for the approximate entropy. Negative correlations with H50 were found for the entropy with the hand in movement, as from the center to the outside or from the outside to the center of the spiral.

CONCLUSION

In healthy individuals, the increase in the erythrocyte osmotic fragility was associated with a decrease in the approximate entropy for rest tremor and with an increase of the entropy for movement tremor. This suggests that the neuromuscular degeneration associated with tremor entails also the mechanisms involved in the breakdown of structural homeostasis of the erythrocyte membrane.

Transmissibility studies of vacuolar changes in the rostral colliculus of pigs

Background

Histopathological examinations of brains from healthy pigs have revealed localised vacuolar changes, predominantly in the rostral colliculus, that are similar to the neuropil vacuolation featured in the transmissible spongiform encephalopathies and have been described in pigs challenged parenterally with the agent causing bovine spongiform encephalopathy (BSE). Feedstuff containing BSE-contaminated meat and bone meal (MBM) may have been fed to pigs prior to the ban of mammalian MBM in feed of farmed livestock in the United Kingdom in 1996, but there is no evidence of the natural occurrence of a transmissible spongiform encephalopathy (TSE) in the domestic pig. Furthermore, experimental transmission of BSE to pigs by the oral route has been unsuccessful. A study was conducted to investigate whether the localised vacuolar changes in the porcine brain were associated with a transmissible aetiology and therefore biologically significant. Two groups of ten pigs were inoculated parenterally with vacuolated rostral colliculus from healthy pigs either born before 1996 or born after 1996. Controls included ten pigs similarly inoculated with rostral colliculus from New Zealand-derived pigs and nine pigs inoculated with a bovine BSE brain homogenate.

Results

None of the pigs inoculated with rostral colliculus developed a TSE-like neurological disease up to five years post inoculation when the study was terminated, and disease-associated prion protein, PrP^d, was not detected in the brains of these pigs. By contrast, eight of nine BSE-inoculated pigs developed neurological signs, two of which had detectable PrP^d by postmortem tests. No significant histopathological changes were detected to account for the clinical signs in the PrP^d-negative, BSE-inoculated pigs.

Conclusion

The findings in this study suggest that vacuolation in the porcine rostral colliculus is not caused by a transmissible agent and is probably a clinically insignificant change. The presence of neurological signs in pigs inoculated with BSE without detectable PrP^d raises the possibility that the BSE agent may produce a prion disease in pigs that remains undetected by the current postmortem tests.