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Huang Y, Yao K, Zhang Q, Huang X, Chen Z, Zhou Y, Yu X. Bioelectronics for electrical stimulation: materials, devices and biomedical applications. Chem Soc Rev 2024; 53:8632-8712. [PMID: 39132912 DOI: 10.1039/d4cs00413b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Bioelectronics is a hot research topic, yet an important tool, as it facilitates the creation of advanced medical devices that interact with biological systems to effectively diagnose, monitor and treat a broad spectrum of health conditions. Electrical stimulation (ES) is a pivotal technique in bioelectronics, offering a precise, non-pharmacological means to modulate and control biological processes across molecular, cellular, tissue, and organ levels. This method holds the potential to restore or enhance physiological functions compromised by diseases or injuries by integrating sophisticated electrical signals, device interfaces, and designs tailored to specific biological mechanisms. This review explains the mechanisms by which ES influences cellular behaviors, introduces the essential stimulation principles, discusses the performance requirements for optimal ES systems, and highlights the representative applications. From this review, we can realize the potential of ES based bioelectronics in therapy, regenerative medicine and rehabilitation engineering technologies, ranging from tissue engineering to neurological technologies, and the modulation of cardiovascular and cognitive functions. This review underscores the versatility of ES in various biomedical contexts and emphasizes the need to adapt to complex biological and clinical landscapes it addresses.
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Affiliation(s)
- Ya Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Kuanming Yao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Qiang Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Xingcan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Zhenlin Chen
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Yu Zhou
- Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong, China.
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
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Pascual-Valdunciel A, Lopo-Martínez V, Beltrán-Carrero AJ, Sendra-Arranz R, González-Sánchez M, Pérez-Sánchez JR, Grandas F, Farina D, Pons JL, Oliveira Barroso F, Gutiérrez Á. Classification of Kinematic and Electromyographic Signals Associated with Pathological Tremor Using Machine and Deep Learning. ENTROPY (BASEL, SWITZERLAND) 2023; 25:114. [PMID: 36673255 PMCID: PMC9858124 DOI: 10.3390/e25010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Peripheral Electrical Stimulation (PES) of afferent pathways has received increased interest as a solution to reduce pathological tremors with minimal side effects. Closed-loop PES systems might present some advantages in reducing tremors, but further developments are required in order to reliably detect pathological tremors to accurately enable the stimulation only if a tremor is present. This study explores different machine learning (K-Nearest Neighbors, Random Forest and Support Vector Machines) and deep learning (Long Short-Term Memory neural networks) models in order to provide a binary (Tremor; No Tremor) classification of kinematic (angle displacement) and electromyography (EMG) signals recorded from patients diagnosed with essential tremors and healthy subjects. Three types of signal sequences without any feature extraction were used as inputs for the classifiers: kinematics (wrist flexion-extension angle), raw EMG and EMG envelopes from wrist flexor and extensor muscles. All the models showed high classification scores (Tremor vs. No Tremor) for the different input data modalities, ranging from 0.8 to 0.99 for the f1 score. The LSTM models achieved 0.98 f1 scores for the classification of raw EMG signals, showing high potential to detect tremors without any processed features or preliminary information. These models may be explored in real-time closed-loop PES strategies to detect tremors and enable stimulation with minimal signal processing steps.
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Affiliation(s)
- Alejandro Pascual-Valdunciel
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Víctor Lopo-Martínez
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rafael Sendra-Arranz
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel González-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Javier Ricardo Pérez-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Francisco Grandas
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - José L. Pons
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of PM&R, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
| | - Álvaro Gutiérrez
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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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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Meng L, Jin M, Zhu X, Ming D. Peripherical Electrical Stimulation for Parkinsonian Tremor: A Systematic Review. Front Aging Neurosci 2022; 14:795454. [PMID: 35197841 PMCID: PMC8859162 DOI: 10.3389/fnagi.2022.795454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinsonian tremor is one of the most common motor disorders in patients with Parkinson's disease (PD). Compared to oral medications and brain surgery, electrical stimulation approaches have emerged as effective and non-invasive methods for tremor reduction. The pathophysiology, detection and interventions of tremors have been introduced, however, a systematic review of peripherical electrical stimulation approaches, methodologies, experimental design and clinical outcomes for PD tremor suppression is still missing. Therefore, in this paper, we summarized recent studies on electrical stimulation for tremor suppression in PD patients and discussed stimulation protocols and effectiveness of different types of electrical stimulation approaches in detail. Twenty out of 528 papers published from 2010 to 2021 July were reviewed. The results show that electrical stimulation is an efficient intervention for tremor suppression. The methods fall into three main categories according to the mechanisms: namely functional electrical stimulation (FES), sensory electrical stimulation (SES) and transcutaneous electrical nerve stimulation (TENS). The outcomes of tremor suppression were varied due to various stimulation approaches, electrode locations and stimulation parameters. The FES method performed the best in tremor attenuation where the efficiency depends mainly by the control strategy and accuracy of tremor detection. However, the mechanism underlying tremor suppression with SES and TENS, is not well-known. Current electrical stimulation approaches may only work for a number of patients. The potential mechanism of tremor suppression still needs to be further explored.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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Pascual-Valdunciel A, Rajagopal A, Pons JL, Delp S. Non-invasive electrical stimulation of peripheral nerves for the management of tremor. J Neurol Sci 2022; 435:120195. [PMID: 35220113 PMCID: PMC9590374 DOI: 10.1016/j.jns.2022.120195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 12/22/2022]
Abstract
Pathological tremor in patients with essential tremor and Parkinsons disease is typically treated using medication or neurosurgical interventions. There is a widely recognized need for new treatments that avoid the side effects of current medications and do not carry the risks of surgical interventions. Building on decades of research and engineering development, non-invasive electrical stimulation of peripheral nerves has emerged as a safe and effective strategy for reducing pathologic tremor in essential tremor. This review surveys the peripheral electrical stimulation (PES) literature and summarizes effectiveness, safety, clinical translatability, and hypothesized tremor-reduction mechanisms of various PES approaches. The review also proposes guidelines for assessing tremor in the context of evaluating new therapies that combine the strengths of clinician assessments, patient evaluations, and novel motion sensing technology. The review concludes with a summary of future directions for PES, including expanding clinical access for patients with Parkinson's disease and leveraging large, at-home datasets to learn more about tremor physiology and treatment effect that will better characterize the state of tremor management and accelerate discovery of new therapies. Growing evidence suggests that non-invasive electrical stimulation of afferent neural pathways provides a viable new option for management of pathological tremor, with one specific PES therapy cleared for prescription and home use, suggesting that PES be considered along with medication and neurosurgical interventions for treatment of tremor. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
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Affiliation(s)
- Alejandro Pascual-Valdunciel
- Northwestern University, Evanston, IL, USA; E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Spain
| | | | - Jose L Pons
- Northwestern University, Evanston, IL, USA; Shirley Ryan AbilityLab, Chicago, IL, USA.
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Arruda BS, Reis C, Sermon JJ, Pogosyan A, Brown P, Cagnan H. Identifying and modulating distinct tremor states through peripheral nerve stimulation in Parkinsonian rest tremor. J Neuroeng Rehabil 2021; 18:179. [PMID: 34953492 PMCID: PMC8709974 DOI: 10.1186/s12984-021-00973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resting tremor is one of the most common symptoms of Parkinson's disease. Despite its high prevalence, resting tremor may not be as effectively treated with dopaminergic medication as other symptoms, and surgical treatments such as deep brain stimulation, which are effective in reducing tremor, have limited availability. Therefore, there is a clinical need for non-invasive interventions in order to provide tremor relief to a larger number of people with Parkinson's disease. Here, we explore whether peripheral nerve stimulation can modulate resting tremor, and under what circumstances this might lead to tremor suppression. METHODS We studied 10 people with Parkinson's disease and rest tremor, to whom we delivered brief electrical pulses non-invasively to the median nerve of the most tremulous hand. Stimulation was phase-locked to limb acceleration in the axis with the biggest tremor-related excursion. RESULTS We demonstrated that rest tremor in the hand could change from one pattern of oscillation to another in space. Median nerve stimulation was able to significantly reduce (- 36%) and amplify (117%) tremor when delivered at a certain phase. When the peripheral manifestation of tremor spontaneously changed, stimulation timing-dependent change in tremor severity could also alter during phase-locked peripheral nerve stimulation. CONCLUSIONS These results highlight that phase-locked peripheral nerve stimulation has the potential to reduce tremor. However, there can be multiple independent tremor oscillation patterns even within the same limb. Parameters of peripheral stimulation such as stimulation phase may need to be adjusted continuously in order to sustain systematic suppression of tremor amplitude.
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Affiliation(s)
- Beatriz S Arruda
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - Carolina Reis
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - James J Sermon
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - Hayriye Cagnan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK.
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Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12:700600. [PMID: 34434161 PMCID: PMC8380769 DOI: 10.3389/fneur.2021.700600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.
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Affiliation(s)
- Julio S. Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
- Ingeniería Electrónica, Universidad del Azuay, Cuenca, Ecuador
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
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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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Mo J, Priefer R. Medical Devices for Tremor Suppression: Current Status and Future Directions. BIOSENSORS-BASEL 2021; 11:bios11040099. [PMID: 33808056 PMCID: PMC8065649 DOI: 10.3390/bios11040099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 01/14/2023]
Abstract
Tremors are the most prevalent movement disorder that interferes with the patient’s daily living, and physical activities, ultimately leading to a reduced quality of life. Due to the pathophysiology of tremor, developing effective pharmacotherapies, which are only suboptimal in the management of tremor, has many challenges. Thus, a range of therapies are necessary in managing this progressive, aging-associated disorder. Surgical interventions such as deep brain stimulation are able to provide durable tremor control. However, due to high costs, patient and practitioner preference, and perceived high risks, their utilization is minimized. Medical devices are placed in a unique position to bridge this gap between lifestyle interventions, pharmacotherapies, and surgical treatments to provide safe and effective tremor suppression. Herein, we review the mechanisms of action, safety and efficacy profiles, and clinical applications of different medical devices that are currently available or have been previously investigated for tremor suppression. These devices are primarily noninvasive, which can be a beneficial addition to the patient’s existing pharmacotherapy and/or lifestyle intervention.
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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: 22] [Impact Index Per Article: 7.3] [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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11
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Hu Z, Xu S, Hao M, Xiao Q, Lan N. The impact of evoked cutaneous afferents on voluntary reaching movement in patients with Parkinson’s disease. J Neural Eng 2019; 16:036029. [DOI: 10.1088/1741-2552/ab186f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Hu Z, Hao M, Xu S, Xiao Q, Lan N. Evaluation of tremor interference with control of voluntary reaching movements in patients with Parkinson's disease. J Neuroeng Rehabil 2019; 16:38. [PMID: 30866977 PMCID: PMC6417201 DOI: 10.1186/s12984-019-0505-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/24/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A large population of patients with Parkinson's disease (PD) displays the symptom of resting tremor. However, the extent that resting tremor may affect the performance of movement control has not been evaluated specifically. This study aims at establishing methods to quantitatively evaluate motor performance in PD patients with tremor, and at analyzing the interfering effects of tremor on control of reaching movements. METHODS Ten PD patients with tremor and Ten healthy control subjects were recruited to participate in this study. All patients and healthy control subjects performed point-to-point reaching movements with their tremor affected arm or preferred arm. We verified that a smoothing model of minimum-jerk trajectory (MJT) can be used to extract voluntary movement trajectory from tremor-corrupted movement trajectory in the reaching tasks by the patients. Performance indices of reaction time (RT) and movement time (MT) of reaching movements by the PD subjects with tremor were evaluated using MJT trajectories. Differences of RT and MT between the recorded trajectories and MJT in PD and control subjects were calculated to investigate the extent that tremor may affect their motor performance. Linear mixed-effects model was used to identify the contributions of tremor, bradykinesia and rigidity to the performance indices of RT and MT based on UPDRS scores. The power spectrum densities (PSD) of tremor were also evaluated using hand velocities to represent tremor intensity and to analyze their correlations with RT and MT. RESULTS The MJT model demonstrated good fit to recorded trajectory with a more consistent estimation of motor performance for both PD and control subjects. The RT and MT of patients were found to be 43.4 and 79.5% longer respectively than those of healthy control subjects. Analysis of the linear mixed-effects model was not able to reveal that tremor, bradykinesia and rigidity each had a significant contribution to RT or MT in PD patients with tremor. However, the PSD of tremor was found to correlate significantly to RT, but not to MT, in both linear regression and linear mixed-effects model. CONCLUSIONS The minimum-jerk trajectory and power spectrum densities are effective quantitative tools for evaluating motor performance for PD patients with tremor. Resting tremor is one of the factors prolonging the initiation of voluntary reaching movement in these patients.
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Affiliation(s)
- Zixiang Hu
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China
| | - Manzhao Hao
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China
| | - Shaoqing Xu
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xiao
- Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ning Lan
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Hua Shan Road, Shanghai, 200030, China.
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