A noninvasive handheld assistive device to accommodate essential tremor: A pilot study

Background We explored whether a noninvasive handheld device using Active Cancellation of Tremor (ACT) technology could stabilize tremor‐induced motion of a spoon in individuals with essential tremor (ET). Methods Fifteen ET subjects (9 men, 6 women) performed 3 tasks with the ACT device turned on and off. Tremor severity was rated with the Fahn‐Tolosa‐Marin Tremor Rating Scale (TRS). Subjective improvement was rated by subjects with the Clinical Global Impression Scale (CGI‐S). Tremor amplitude was measured using device‐embedded accelerometers in 11 subjects. Results TRS scores improved with ACT on (versus off) in all 3 tasks: holding (1.00 ± 0.76 vs. 0.27 ± 0.70; P  = 0.016), eating (1.47 ± 1.06 vs. 0.13 ± 0.64; P  = 0.001), and transferring (1.33 ± 0.82 vs. 0.27 ± 0.59; P  = 0.001). CGI‐S improved with eating and transferring, but not the holding task. Accelerometer measurements demonstrated 71% to 76% reduction in tremor with the ACT device on. Conclusions This noninvasive handheld ACT device can reduce tremor amplitude and severity for eating and transferring tasks in individuals with ET. © 2013 International Parkinson and Movement Disorder SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106922/1/mds25796.pd

Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games

Background: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. Materials: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. Methods: Ten users with CP participated in the study. Whereas the control group (n=5) followed traditional therapies, the experimental group (n=5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. Results: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p<0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. Conclusions:Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n=10) additional studies are needed to corroborate this hypothesis

Biomechanical Loading as an Alternative Treatment for Tremor: A Review of Two Approaches

Background: Tremor is the most common movement disorder and strongly increases in incidence and prevalence with aging. Although not life threatening, upper-limb tremors hamper the independence of 65% of people suffering from them affected persons, greatly impacting their quality of life. Current treatments include pharmacotherapy and surgery (thalamotomy and deep brain stimulation). However, these options are not sufficient for approximately 25% of patients. Therefore, further research and new therapeutic options are required to effectively manage pathological tremor. Methods: This paper presents findings of two research projects in which two different wearable robots for tremor management were developed based on force loading and validated. The first consisted of a robotic exoskeleton that applied forces to tremulous limbs and consistently attenuated mild and severe tremors. The second was a neuroprosthesis based on transcutaneous neurostimulation. A total of 22 patients suffering from parkinsonian or essential tremor (ET) of different severities were recruited for experimental validation, and both systems were evaluated using standard tasks employed for neurological examination. The inclusion criterion was a postural and/or kinetic pathological upper-limb tremor resistant to medication. Results: The results demonstrate that both approaches effectively suppressed tremor in most patients, although further research is required. The work presented here is based on clinical evidence from a small number of patients (n = 10 for robotic exoskeleton and n = 12 for the neuroprosthesis), but most had a positive response to the approaches. In summary, biomechanical loading is non-invasive and painless. It may be effective in patients who are insufficiently responsive (or have adverse reactions) to drugs or in whom surgery is contraindicated. Discussion: This paper identifies and evaluates biomechanical loading approaches to tremor management and discusses their potential

Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor

Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.This work has been supported by the Commission of the European Union through the grant ICT-2011-287739 (NeuroTREMOR).Peer reviewedPeer Reviewe

Head movement assessment of cerebral palsy users with severe motor disorders when they control a computer thought eye movements

[Abstract] Eye tracking is currently a promising technology to access computers for people who suffer severe motor disorders, like cerebral palsy. However, there is a lack of usability assessment procedures and concrete value to describe the user’s motor capabilities in this specific scenario of computer control. This paper presents a methodology, based on two head movement assessment metrics and the ISO-9241, for the quantitative motor description of users with severe motor disorders, when they control the computer thought their eyes. Seven participants with CP and three people without motor disabilities were recruited for the evaluation of the proposed procedure. Results evidence for the first time how users with CP control their head while they access a computer with their eyes.Ministerio de Economía, Industria y Competitividad; RTC-2015-3967-1Ministerio de Economía, Industria y Competitividad; DPI2015-68664-C4-1-RMinisterio de Economía, Industria y Competitividad; RTC-2015-4327-

Real-Time Estimation of Pathological Tremor Parameters from Gyroscope Data

This paper presents a two stage algorithm for real-time estimation of instantaneous tremor parameters from gyroscope recordings. Gyroscopes possess the advantage of providing directly joint rotational speed, overcoming the limitations of traditional tremor recording based on accelerometers. The proposed algorithm first extracts tremor patterns from raw angular data, and afterwards estimates its instantaneous amplitude and frequency. Real-time separation of voluntary and tremorous motion relies on their different frequency contents, whereas tremor modelling is based on an adaptive LMS algorithm and a Kalman filter. Tremor parameters will be employed to drive a neuroprosthesis for tremor suppression based on biomechanical loading

Wearable Robots in Rehabilitation Engineering Tremor Suppression

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Covid 19, Políticas Neoliberais e Saúde Pública no Brasil: rebatimentos interseccionais sobre raça, gênero e sexualidade

Neste ensaio problematizamos as desigualdades com as quais a pandemia de Covid-19 tem atingido mulheres, negros(as) e LGBTs brasileiras(os) em meio a investida neoliberal sobre o Sistema Único de Saúde e o desmonte do Estado Brasileiro. Encerramos analisando que pensar o covid-19 como um vírus que, democrático, revelaria uma suposta ideia de igualde dentre a população brasileira pode ser efeito da não percepção, dos que assim pensam, da condição de privilégio vivida em uma sociedade organizada por opressões cisheteropatriarcal branca e de base europeia. &nbsp