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Campbell AH, Barta K, Sawtelle M, Walters A. Progressive muscle relaxation, meditation, and mental practice-based interventions for the treatment of tremor after traumatic brain injury. Physiother Theory Pract 2024; 40:2441-2457. [PMID: 37551705 DOI: 10.1080/09593985.2023.2243504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND PURPOSE Individuals post traumatic brain injury (TBI) are likely to experience cognitive, sensory, and motor impairments. Tremor is a common movement disorder that can affect this patient population. The purpose of this case report was to describe the effects that progressive muscle relaxation, meditation, and mental practice-based interventions have on the treatment of chronic right upper extremity tremor in a patient post-TBI. CASE DESCRIPTION A 47-year-old male with a traumatic brain injury presented with a resting and postural tremor of the right wrist flexors and deficits in cognition, sensation, proprioception, balance, and motor function. The patient's primary goal for therapy was to decrease the tremor to improve his quality of life and ability to perform activities of daily living. METHODS Progressive muscle relaxation, breath-focused meditation, and mental practice-based intervention were administered to the patient. Active range of motion activities occurred during weekly in-person sessions and daily practice occurred at home. RESULTS The patient demonstrated improvements in quality of life, self-ratings of tremor severity, ratings of tremor impact on ADL's, gross motor object manipulation, frequency of tremor via surface electromyography, and visual inspection of a spirograph. CONCLUSION A combination of progressive muscle relaxation, meditation, and mental practice-based interventions appeared to positively impact tremor across physical and psychosocial domains in a patient with a chronic tremor. Further investigation is needed to verify these findings.
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Affiliation(s)
- Ashley Hall Campbell
- Department of Physical Therapy, College of Rehabilitation Sciences, University of St. Augustine for Health Sciences, Austin, TX, United States
| | - Kristen Barta
- School of Physical Therapy, South College, Knoxville, TN, United States
| | - Michelle Sawtelle
- Phoenix Doctor of Physical Therapy Program, Department of Rehabilitation Sciences, Tufts University, Phoenix, AZ, United States
| | - Amy Walters
- Department of Physical Therapy, College of Rehabilitation Sciences, University of St. Augustine for Health Sciences, Austin, TX, United States
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Zalyalova ZA, Katunina EA, Pokhabov DV, Munasipova SE, Ermakova MM. [Tremor-dominant form of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:28-35. [PMID: 38676674 DOI: 10.17116/jnevro202412404128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.
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Affiliation(s)
- Z A Zalyalova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center for Brain and Neurotechnology, Moscow, Russia
| | - D V Pokhabov
- Center for Innovative Neurology, Extrapyramidal Diseases and Botulinum Therapy, Krasnoyarsk, Russia
- Voino-Yasnevetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S E Munasipova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
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Richter B, Mace Z, Hays ME, Adhikari S, Pham HQ, Sclabassi RJ, Kolber B, Yerneni SS, Campbell P, Cheng B, Tomycz N, Whiting DM, Le TQ, Nelson TL, Averick S. Development and Characterization of Novel Conductive Sensing Fibers for In Vivo Nerve Stimulation. SENSORS (BASEL, SWITZERLAND) 2021; 21:7581. [PMID: 34833660 PMCID: PMC8619502 DOI: 10.3390/s21227581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
Advancements in electrode technologies to both stimulate and record the central nervous system's electrical activities are enabling significant improvements in both the understanding and treatment of different neurological diseases. However, the current neural recording and stimulating electrodes are metallic, requiring invasive and damaging methods to interface with neural tissue. These electrodes may also degrade, resulting in additional invasive procedures. Furthermore, metal electrodes may cause nerve damage due to their inherent rigidity. This paper demonstrates that novel electrically conductive organic fibers (ECFs) can be used for direct nerve stimulation. The ECFs were prepared using a standard polyester material as the structural base, with a carbon nanotube ink applied to the surface as the electrical conductor. We report on three experiments: the first one to characterize the conductive properties of the ECFs; the second one to investigate the fiber cytotoxic properties in vitro; and the third one to demonstrate the utility of the ECF for direct nerve stimulation in an in vivo rodent model.
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Affiliation(s)
- Bertram Richter
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Zachary Mace
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
- Computational Diagnostics, Inc., Pittsburgh, PA 15213, USA
| | - Megan E. Hays
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Santosh Adhikari
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Huy Q. Pham
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58102, USA;
| | - Robert J. Sclabassi
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
- Computational Diagnostics, Inc., Pittsburgh, PA 15213, USA
| | - Benedict Kolber
- Department of Neuroscience, University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Saigopalakrishna S. Yerneni
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15217, USA; (S.S.Y.); (P.C.)
| | - Phil Campbell
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15217, USA; (S.S.Y.); (P.C.)
| | - Boyle Cheng
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Nestor Tomycz
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Donald M. Whiting
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Trung Q. Le
- Department of Industrial and Manufacturing Engineering, North Dakota State University, Fargo, ND 58102, USA
| | - Toby L. Nelson
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Saadyah Averick
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
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Frey J, Hess CW, Kugler L, Wajid M, Wagle Shukla A. Transcranial Magnetic Stimulation in Tremor Syndromes: Pathophysiologic Insights and Therapeutic Role. Front Neurol 2021; 12:700026. [PMID: 34512517 PMCID: PMC8426899 DOI: 10.3389/fneur.2021.700026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a painless, non-invasive, and established brain stimulation technique to investigate human brain function. Over the last three decades, TMS has shed insight into the pathophysiology of many neurological disorders. Tremor is an involuntary, rhythmic oscillatory movement disorder commonly related to pathological oscillations propagated via the cerebello-thalamo-cortical pathway. Although tremor is the most common movement disorder and recent imaging studies have enhanced our understanding of the critical pathogenic networks, the underlying pathophysiology of different tremor syndromes is complex and still not fully understood. TMS has been used as a tool to further our understanding of tremor pathophysiology. In addition, repetitive TMS (rTMS) that can modulate brain functions through plasticity effects has been targeted to the tremor network to gain potential therapeutic benefits. However, evidence is available for only a few studies that included small patient samples with limited clinical follow-up. This review aims to discuss the role of TMS in advancing the pathophysiological understanding as well as emerging applications of rTMS for treating individual tremor syndromes. The review will focus on essential tremor, Parkinson's disease tremor, dystonic tremor syndrome, orthostatic tremor, and functional tremor.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Christopher W Hess
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Liam Kugler
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Manahil Wajid
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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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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Does non-invasive brain stimulation reduce essential tremor? A systematic review and meta-analysis. PLoS One 2017; 12:e0185462. [PMID: 28957367 PMCID: PMC5619788 DOI: 10.1371/journal.pone.0185462] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/13/2017] [Indexed: 12/16/2022] Open
Abstract
Essential tremor (ET) is the most common age-related disease leading to abnormal tremulous behaviors in the upper and lower extremities. Non-invasive brain stimulation (NIBS) may be an effective ET therapy by modulating the oscillating network of the brain. The current systematic review and meta-analysis examined the effects of NIBS interventions on tremor symptoms in ET patients. Our comprehensive search identified eight studies that used 1 Hz of rTMS, cTBS, or ctDCS protocols. Twenty total comparisons from the eight qualified studies were statistically synthesized, and the meta-analytic findings revealed that NIBS techniques reduced tremulous behaviors in individuals with ET. Moreover, the four moderator variable analyses demonstrated that the positive therapeutic effects of NIBS appeared across the following subgroups: (a) tremor assessment (clinical test vs. quantitative tremor assessment), (b) stimulation site (cerebellum vs. motor cortex), (c) session number (single session vs. multiple sessions), and (d) sustained positive treatment effect (posttest vs. retention test). This comprehensive systematic review and meta-analysis provided evidence that support positive treatment effects of NIBS techniques on ET motor therapy.
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Serrano JI, Romero JP, Castillo MDD, Rocon E, Louis ED, Benito-León J. A data mining approach using cortical thickness for diagnosis and characterization of essential tremor. Sci Rep 2017; 7:2190. [PMID: 28526878 PMCID: PMC5438396 DOI: 10.1038/s41598-017-02122-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/06/2017] [Indexed: 01/22/2023] Open
Abstract
Essential tremor (ET) is one of the most prevalent movement disorders. Being that it is a common disorder, its diagnosis is considered routine. However, misdiagnoses may occur regularly. Over the past decade, several studies have identified brain morphometric changes in ET, but these changes remain poorly understood. Here, we tested the informativeness of measuring cortical thickness for the purposes of ET diagnosis, applying feature selection and machine learning methods to a study sample of 18 patients with ET and 18 age- and sex-matched healthy control subjects. We found that cortical thickness features alone distinguished the two, ET from controls, with 81% diagnostic accuracy. More specifically, roughness (i.e., the standard deviation of cortical thickness) of the right inferior parietal and right fusiform areas was shown to play a key role in ET characterization. Moreover, these features allowed us to identify subgroups of ET patients as well as healthy subjects at risk for ET. Since treatment of tremors is disease specific, accurate and early diagnosis plays an important role in tremor management. Supporting the clinical diagnosis with novel computer approaches based on the objective evaluation of neuroimage data, like the one presented here, may represent a significant step in this direction.
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Affiliation(s)
- J Ignacio Serrano
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain.
| | - Juan P Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | - Ma Dolores Del Castillo
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | - Julián Benito-León
- Department of Neurology, Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), University Hospital 12 de Octubre, Madrid, Spain.
- Department of Medicine, Faculty of Medicine Complutense University, Madrid, Spain.
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