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Liu Y, Hu N, Sun M, Qu F, Zhou X. The Effects of Hand Tremors on the Shooting Performance of Air Pistol Shooters with Different Skill Levels. SENSORS (BASEL, SWITZERLAND) 2024; 24:2438. [PMID: 38676055 PMCID: PMC11054876 DOI: 10.3390/s24082438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
Physiologic hand tremors are a critical factor affecting the aim of air pistol shooters. However, the extent of the effect of hand tremors on shooting performance is unclear. In this study, we aim to explore the relationship between hand tremors and shooting performance scores as well as investigate potential links between muscle activation and hand tremors. In this study, 17 male air pistol shooters from China's national team and the Air Pistol Sports Center were divided into two groups: the elite group and the sub-elite group. Each participant completed 40 shots during the experiment, with shooters' hand tremors recorded using three-axis digital accelerometers affixed to their right hands. Muscle activation was recorded using surface electromyography on the right anterior deltoid, posterior deltoid, biceps brachii (short head), triceps brachii (long head), flexor carpi radialis, and extensor carpi radialis. Our analysis revealed weak correlations between shooting scores and hand tremor amplitude in multiple directions (middle-lateral, ML: r2 = -0.22, p < 0.001; vertical, VT: r2 = -0.25, p < 0.001), as well as between shooting scores and hand tremor complexity (ML: r2 = -0.26, p < 0.001; VT: r2 = -0.28, p < 0.001), across all participants. Notably, weak correlations between shooting scores and hand tremor amplitude (ML: r2 = -0.27, p < 0.001; VT: r2 = -0.33, p < 0.001) and complexity (ML: r2 = -0.31, p < 0.001) were observed in the elite group but not in the sub-elite group. Moderate correlation were found between the biceps brachii (short head) RMS and hand tremor amplitude in the VT and ML directions (ML: r2 = 0.49, p = 0.010; VT: r2 = 0.44, p = 0.025) in all shooters, with a moderate correlation in the ML direction in elite shooters (ML: r2 = 0.49, p = 0.034). Our results suggest that hand tremors in air pistol shooters are associated with the skill of the shooters, and muscle activation of the biceps brachii (long head) might be a factor affecting hand tremors. By balancing the agonist and antagonist muscles of the shoulder joint, shooters might potentially reduce hand tremors and improve their shooting scores.
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Affiliation(s)
- Yu Liu
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China; (Y.L.); (F.Q.)
| | - Nijia Hu
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland;
| | - Mengzi Sun
- School of Sports Science, Nanjing Normal University, Nanjing 210023, China;
| | - Feng Qu
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China; (Y.L.); (F.Q.)
| | - Xinglong Zhou
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China; (Y.L.); (F.Q.)
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Free DB, Syndergaard I, Pigg AC, Muceli S, Hallett M, Farina D, Charles SK. Hand and distal joint tremor are most coherent with the activity of elbow flexors and wrist extensors in persons with essential tremor. J Appl Physiol (1985) 2024; 136:337-348. [PMID: 38126087 PMCID: PMC11218932 DOI: 10.1152/japplphysiol.00407.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Essential tremor (ET) affects millions of people. Although frontline treatment options (medication, deep brain stimulation, and focused ultrasound ablation) have provided significant relief, many patients are unsatisfied with the outcomes. Peripheral suppression techniques, such as injections of botulinum toxin or sensory electrical stimulation of muscles, are gaining popularity, but could be optimized if the muscles most responsible for a patient's tremor were identified. The purpose of this study was to quantify the relationship between the activity in various upper limb muscles and the resulting tremor in patients with ET. Surface electromyogram (sEMG) from the 15 major superficial muscles of the upper limb and displacement of the hand and upper limb joints were recorded from 22 persons with ET while they performed kinetic and postural tasks representative of activities of daily living. We calculated the peak coherence (frequency-dependent correlation) in the tremor band (4-8 Hz) between the sEMG of each muscle and the displacement in each major degree of freedom (DOF). Averaged across subjects with ET, the highest coherence was found between elbow flexors (particularly biceps brachii and brachioradialis) and the distal DOF (forearm, wrist, and hand motion), and between wrist extensors (extensor carpi radialis and ulnaris) and the same distal DOF. These coherence values represent the upper bound on the proportion of the tremor caused by each muscle. We conclude that, without further information, elbow flexors and wrist extensors should be among the first muscles considered for peripheral suppression techniques in persons with ET.NEW & NOTEWORTHY We characterized the relationships between activity in upper limb muscles and tremor in persons with essential tremor using coherence, which provides an upper bound on the proportion of the tremor due to each muscle. Averaged across subjects and various tasks, tremor in the hand and distal joints was most coherent with elbow flexors and wrist extensors. We conclude that, without further information, these muscle groups should be among the first considered for peripheral suppression techniques.
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Affiliation(s)
- Daniel B Free
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Ian Syndergaard
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Adam C Pigg
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Silvia Muceli
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Mark Hallett
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, Maryland, United States
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Steven K Charles
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, United States
- Department of Neuroscience, Brigham Young University, Provo, Utah, United States
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Free DB, Syndergaard I, Pigg AC, Muceli S, Thompson-Westra J, Mente K, Maurer CW, Haubenberger D, Hallett M, Farina D, Charles SK. Essential Tremor accentuates the pattern of tremor-band coherence between upper-limb muscles. J Neurophysiol 2023; 129:524-540. [PMID: 36695518 PMCID: PMC9970651 DOI: 10.1152/jn.00398.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/28/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Although Essential Tremor is one of the most common movement disorders, current treatment options are relatively limited. Peripheral tremor suppression methods have shown potential, but we do not currently know which muscles are most responsible for patients' tremor, making it difficult to optimize suppression methods. The purpose of this study was to quantify the relationships between the tremorogenic activity in muscles throughout the upper limb. Muscle activity was recorded from the 15 major superficial upper-limb muscles in 24 subjects with Essential Tremor while they held various postures or made upper-limb movements. We calculated the coherence in the tremor band (4-12 Hz) between the activity of all muscle pairs and the time-varying phase difference between sufficiently coherent muscle pairs. Overall, the observed pattern somewhat mirrored functional relationships: agonistic muscle pairs were most coherent and in phase, whereas antagonist and unrelated muscle pairs exhibited less coherence and were either consistently in phase, consistently antiphase, consistently out of phase (unrelated pairs only), or else inconsistent. Patients exhibited significantly more coherence than control subjects (p<0.001) in the vast majority of muscle pairs (95 out of 105). Furthermore, differences between patients and controls were most pronounced among agonists; thus, the coherence pattern existing in control subjects was accentuated in patients with ET. We conclude that tremor-band activity is broadly distributed among the muscles of the upper limb, challenging efforts to determine which muscles are most responsible for a patient's tremor.
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Affiliation(s)
- Daniel B Free
- Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Ian Syndergaard
- Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Adam C Pigg
- Mechanical Engineering, Brigham Young University, Provo, Utah, United States
| | - Silvia Muceli
- Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Johanna Thompson-Westra
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States
| | - Karin Mente
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States
| | - Carine W Maurer
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States
| | - Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States
| | - Dario Farina
- Bioengineering, Imperial College London, London, United Kingdom
| | - Steven K Charles
- Mechanical Engineering, Brigham Young University, Provo, Utah, United States
- Neuroscience, Brigham Young University, Provo, Utah, United States
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Standring DJ, Pigg AC, Thompson-Westra J, Mente K, Maurer CW, Haubenberger D, Hallett M, Charles SK. Distribution of tremorogenic activity among the major superficial muscles of the upper limb in persons with Essential tremor. Clin Neurophysiol 2022; 142:20-32. [PMID: 35930890 PMCID: PMC9529895 DOI: 10.1016/j.clinph.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Peripheral tremor suppression has the potential to reduce tremor, but we do not currently know where best to intervene. The purpose of this study was to characterize the distribution of tremorogenic activity among upper-limb muscles. METHODS Surface electromyography was recorded from the 15 major superficial muscles of the upper limb while 25 patients with Essential Tremor performed postural and kinetic tasks. We defined tremorogenic activity as power in the tremor band (4-8 Hz) and determined the distribution of this power among muscles. RESULTS The distribution varied considerably between patients (mean r = 0.58), but on average, the greatest power was found in the anterior deltoid and extensor carpi ulnaris muscles. Other muscles with high power included the extensor carpi radialis, pectoralis major, lateral deltoid, and brachialis muscles. This distribution was similar (mean r ≥ 0.88) for postural and kinetic tremor, various limb configurations, repetitions, and patient characteristics (sex, tremor severity, age of onset, and duration). CONCLUSIONS We identified a rough pattern in which muscles opposing gravity appeared to have the highest tremor-band power; we hypothesize that the distribution of tremorogenic muscle activity depends in part on the distribution of voluntary activity required by the task. SIGNIFICANCE Understanding which muscles exhibit the most tremorogenic activity is one of the steps in the pursuit of optimizing peripheral tremor suppression.
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Affiliation(s)
- David J Standring
- Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA
| | - Adam C Pigg
- Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA
| | - Johanna Thompson-Westra
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Karin Mente
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Carine W Maurer
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Steven K Charles
- Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; Neuroscience, Brigham Young University, Provo, UT 84602, USA.
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Zhou Y, Box D, Hardy KG, Jenkins ME, Garland J, Naish MD, Trejos AL. Survey-based identification of design requirements and constraints for a wearable tremor suppression device. J Rehabil Assist Technol Eng 2022; 9:20556683221094480. [PMID: 35548101 PMCID: PMC9083043 DOI: 10.1177/20556683221094480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Parkinsonian tremor has severely impacted the lives of 65% of individuals with Parkinson’s disease, and nearly 25% do not respond to traditional treatments. Although wearable tremor suppression devices (WTSDs) have become a promising alternative approach, this technology is still in the early stages of development, and no studies have reported the stakeholders’ opinions on this technology and their desired design requirements. Methods An online survey was distributed to affected Canadians and Canadian movement disorder specialists (MDS) to acquire information on demographics, the current state of treatments, opinions on the WTSDs, and the desired design requirements of future WTSDs. Results A total of 101 affected individuals and 24 MDS completed the survey. It was found that both groups are generally open to using WTSDs to manage tremor. The most important design requirement to end users is the adaptability to lifestyle, followed by weight and size, accurate motion, comfort, safety, quick response, and cost. Lastly, most of the participants (65%) think that the device should cost under $500. Conclusions The findings from this study can be used as guidelines for the development of future WTSDs, such that the future generations could be evaluated and accepted by the end users.
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Affiliation(s)
- Yue Zhou
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Devin Box
- School of Kinesiology, Western University, London, ON, Canada
| | - Kenneth G Hardy
- Ivey Business School, Western University, London, ON, Canada
| | - Mary E Jenkins
- Movement Disorders Program, Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Jayne Garland
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Michael D Naish
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Ana Luisa Trejos
- School of Biomedical Engineering, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
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Gebai S, Cumunel G, Hammoud M, Foret G, Roze E, Hainque E. Design and Simulation of a Passive Absorber to Reduce Measured Postural Tremor Signal. J Biomech Eng 2022; 144:1137927. [PMID: 35237796 DOI: 10.1115/1.4053998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 11/08/2022]
Abstract
Tremor is a semi-rhythmic oscillatory movement of a body part caused by alternating simultaneous contractions of an antagonistic muscle group. Medical and surgical treatments used to reduce the symptoms of involuntary tremor causes negative side effects. This study examines the ability of passive vibration absorbers in reducing the amplitude of postural tremor (PT) type of involuntary tremors. An inertial measurement unit (IMU) is used to record PT signals at the forearm and hand of a patient. IMU signal is used as the active excitation input of an upper limb system modeled to represent the flexion-extension vibrational motion at the joints. Equations of motion are solved numerically to obtain a simulated response that fits the measured tremor signal. passive tuned mass damper (TMD) is modeled as a thin lightweight cantilever beam with a screw located at the position reflecting its operating frequency. Natural frequency of the TMD is derived for different screw positions and validated numerically and experimentally. Modal damping ratio of the TMD for each screw position is also estimated. Optimization of screw position and damping coefficient of the TMD depends on the minimization of the angular displacement amplitude at the wrist joint. A lightweight optimized three-TMD system of 28.64 g total effective mass, simulated using its estimated modal damping ratios, shows its effectiveness compared to the literature, in reducing 65-83% of the amplitudes at the joints. An experimental arm is prepared for further experimental validation before the design of a wearable anti-vibration bracelet.
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Affiliation(s)
- Sarah Gebai
- Lab Navier, Univ Gustave Eiffel, ENPC, CNRS, F-77447 Marne-la-Vallée, France; SDM & LIBRA Research Groups, Department of Mechanical Engineering, International University of Beirut, 146404, Mazraa, Beirut, Lebanon
| | - Gwendal Cumunel
- Lab Navier, Univ Gustave Eiffel, ENPC, CNRS, F-77447 Marne-la-Vallée, France
| | - Mohammad Hammoud
- SDM & LIBRA Research Group, Department of Mechanical Engineering, International University of Beirut, Beirut, 146404, Mazraa, Lebanon, and School of Engineering, Lebanese International University LIU, Bekaa, Lebanon
| | - Gilles Foret
- Lab Navier, Univ Gustave Eiffel, ENPC, CNRS, F-77447 Marne-la-Vallée, France
| | - Emmanuel Roze
- Faculté de Médecine de Sorbonne Université, UMR S 1127, Inserm U 1127, and UMR CNRS 7225, and Institut du Cerveau et de la Moëlle épinière, F-75013, Paris, France, and Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Elodie Hainque
- Faculté de Médecine de Sorbonne Université, UMR S 1127, Inserm U 1127, and UMR CNRS 7225, and Institut du Cerveau et de la Moëlle épinière, F-75013, Paris, France, and Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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Karamesinis A, Sillitoe RV, Kouzani AZ. Wearable Peripheral Electrical Stimulation Devices for the Reduction of Essential Tremor: A Review. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:80066-80076. [PMID: 34178561 PMCID: PMC8224473 DOI: 10.1109/access.2021.3084819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Essential tremor is the most common pathological tremor, with a prevalence of 6.3% in people over 65 years of age. This disorder interferes with a patient's ability to carry out activities of daily living independently, and treatment with medical and surgical interventions is often insufficient or contraindicated. Mechanical orthoses have not been widely adopted by patients due to discomfort and lack of discretion. Over the past 30 years, peripheral electrical stimulation has been investigated as a possible treatment for patients who have not found other treatment options to be satisfactory, with wearable devices revolutionizing this emerging approach in recent years. In this paper, an overview of essential tremor and its current medical and surgical treatment options are presented. Following this, tremor detection, measurement and characterization methods are explored with a focus on the measurement options that can be incorporated into wearable devices. Then, novel interventions for essential tremor are described, with a detailed review of open and closed-loop peripheral electrical stimulation methods. Finally, discussion of the need for wearable closed-loop peripheral electrical stimulation devices for essential tremor, approaches in their implementation, and gaps in the literature for further research are presented.
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Affiliation(s)
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong, VIC 3216, Australia
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Pascual-Valdunciel A, Gonzalez-Sanchez M, Muceli S, Adan-Barrientos B, Escobar-Segura V, Perez-Sanchez JR, Jung MK, Schneider A, Hoffmann KP, Moreno JC, Grandas F, Farina D, Pons JL, Barroso FO. Intramuscular Stimulation of Muscle Afferents Attains Prolonged Tremor Reduction in Essential Tremor Patients. IEEE Trans Biomed Eng 2021; 68:1768-1776. [PMID: 32813648 DOI: 10.1109/tbme.2020.3015572] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study proposes and clinically tests intramuscular electrical stimulation below motor threshold to achieve prolonged reduction of wrist flexion/extension tremor in Essential Tremor (ET) patients. The developed system consisted of an intramuscular thin-film electrode structure that included both stimulation and electromyography (EMG) recording electrodes, and a control algorithm for the timing of intramuscular stimulation based on EMG (closed-loop stimulation). Data were recorded from nine ET patients with wrist flexion/extension tremor recruited from the Gregorio Marañón Hospital (Madrid, Spain). Patients participated in two experimental sessions comprising: 1) sensory stimulation of wrist flexors/extensors via thin-film multichannel intramuscular electrodes; and 2) surface stimulation of the nerves innervating the same target muscles. For each session, four of these patients underwent random 60-s trials of two stimulation strategies for each target muscle: 1) selective and adaptive timely stimulation (SATS) - based on EMG of the antagonist muscle; and 2) continuous stimulation (CON) of target muscles. Two patients underwent SATS stimulation trials alone while the other three underwent CON stimulation trials alone in each session. Kinematics of wrist, elbow, and shoulder, together with clinical scales, were used to assess tremor before, right after, and 24 h after each session. Intramuscular SATS achieved, on average, 32% acute (during stimulation) tremor reduction on each trial, while continuous stimulation augmented tremorgenic activity. Furthermore, tremor reduction was significantly higher using intramuscular than surface stimulation. Prolonged reduction of tremor amplitude (24 h after the experiment) was observed in four patients. These results showed acute and prolonged (24 h) tremor reduction using a minimally invasive neurostimulation technology based on SATS of primary sensory afferents of wrist muscles. This strategy might open the possibility of an alternative therapeutic approach for ET patients.
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Pascual-Valdunciel A, Hoo GW, Avrillon S, Barroso FO, Goldman JG, Hernandez-Pavon JC, Pons JL. Peripheral electrical stimulation to reduce pathological tremor: a review. J Neuroeng Rehabil 2021; 18:33. [PMID: 33588841 PMCID: PMC7885254 DOI: 10.1186/s12984-021-00811-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/11/2021] [Indexed: 01/02/2023] Open
Abstract
Interventions to reduce tremor in essential tremor (ET) and Parkinson’s disease (PD) clinical populations often utilize pharmacological or surgical therapies. However, there can be significant side effects, decline in effectiveness over time, or clinical contraindications for these interventions. Therefore, alternative approaches must be considered and developed. Some non-pharmacological strategies include assistive devices, orthoses and mechanical loading of the tremorgenic limb, while others propose peripheral electrical stimulation. Specifically, peripheral electrical stimulation encompasses strategies that activate motor and sensory pathways to evoke muscle contractions and impact sensorimotor function. Numerous studies report the efficacy of peripheral electrical stimulation to alter tremor generation, thereby opening new perspectives for both short- and long-term tremor reduction. Therefore, it is timely to explore this promising modality in a comprehensive review. In this review, we analyzed 27 studies that reported the use of peripheral electrical stimulation to reduce tremor and discuss various considerations regarding peripheral electrical stimulation: the stimulation strategies and parameters, electrodes, experimental designs, results, and mechanisms hypothesized to reduce tremor. From our review, we identified a high degree of disparity across studies with regard to stimulation patterns, experimental designs and methods of assessing tremor. Having standardized experimental methodology is a critical step in the field and is needed in order to accurately compare results across studies. With this review, we explore peripheral electrical stimulation as an intervention for tremor reduction, identify the limitations and benefits of the current state-of-the-art studies, and provide ideas to guide the development of novel approaches based on the neural circuitries and mechanical properties implied in tremor generation.
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Affiliation(s)
- Alejandro Pascual-Valdunciel
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Grace W Hoo
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Simon Avrillon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Jennifer G Goldman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julio C Hernandez-Pavon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - José L Pons
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
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Pigg AC, Thompson-Westra J, Mente K, Maurer CW, Haubenberger D, Hallett M, Charles SK. Distribution of tremor among the major degrees of freedom of the upper limb in subjects with Essential Tremor. Clin Neurophysiol 2020; 131:2700-2712. [PMID: 33010725 DOI: 10.1016/j.clinph.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 07/06/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Although Essential Tremor is one of the most common movement disorders, we do not currently know which muscles are most responsible for tremor. Determining this requires multiple steps, one of which is characterizing the distribution of tremor among the degrees of freedom (DOF) of the upper limb. METHODS Upper-limb motion was recorded while 22 subjects with ET performed postural and kinetic tasks involving a variety of limb configurations. We calculated the mean distribution of tremor among the seven DOF from the shoulder to the wrist, as well as the effect of limb configuration, repetition, and subject characteristics (sex, tremor onset, duration, and severity) on the distribution. RESULTS On average, kinetic tremor was greatest in forearm pronation-supination and wrist flexion-extension, intermediate in shoulder internal-external rotation and wrist radial-ulnar deviation and then shoulder flexion-extension and elbow flexion-extension, and least in shoulder abduction-adduction. The average distribution of postural tremor was similar except for forearm pronation-supination, which played a smaller role than in kinetic tremor. Limb configuration and subject characteristics did significantly affect tremor, but practically only in forearm pronation-supination and wrist flexion-extension. There were no significant differences between repetitions, indicating that the distribution was consistent over the duration of the experiment. CONCLUSIONS This paper presents a thorough characterization of tremor distribution from the shoulder to the wrist. SIGNIFICANCE Understanding which DOF exhibit the most tremor may lead to more targeted peripheral tremor suppression.
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Affiliation(s)
- Adam C Pigg
- Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA
| | - Johanna Thompson-Westra
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Karin Mente
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Carine W Maurer
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Steven K Charles
- Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; Neuroscience, Brigham Young University, Provo, UT 84602, USA.
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