Abstract
Pathological tremor is manifested as an involuntary oscillation of one or more body parts. Tremor greatly decreases the quality of life and often prevents the patient from performing daily activities. We hypothesized that sensors-driven multichannel electrical stimulation could stabilize affected joints by activating the antagonistic muscles during involuntary activation of agonist muscles and vice versa (out-of-phase stimulation). Here, we present the new system (hardware and software) and the testing of its operation. The hardware consists of a multichannel stimulator and inertial sensors for feedback. The software implements adaptive sensors-driven control for the out-of-phase stimulation. The system was initially applied to healthy persons at the wrist and elbow joints to test the efficiency of the hardware and software solutions. Predefined rhythmic stimulation resulted in tremulous movement, which subjects could not prevent; yet, they were still able to functionally use their hand. The system was then applied to seven patients with Parkinson’s disease and essential tremor for minimization of the wrist joint tremor. In six patients, the adaptive out-of-phase stimulation resulted in a significant decrease in the amplitude of tremor (67 ± 13%). In one patient, the stimulation did not result in the expected reduction of tremor.
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References
Anouti A, Koller WC (1995) Tremor disorders—diagnosis and management. West J Med 162(6):510–513
Benazzouz A, Hallett M (2000) Mechanism of action of deep brain stimulation. Neurology 55(12 Suppl 6):S13–S16
Bo APL, Poignet P, Widjaja F, Ang WT (2008) Online pathological tremor characterization using extended Kalman filtering. Proceedings of the 30th international conference of the IEEE engineering in medicine and biology society, Vancouver, Canada, pp 1753–1756
Deuschl G, Bain P, Brin M (1998) Consensus statement of the movement disorder society on tremor. Mov Disord 13(S3):2–23
Grimaldi G, Manto M (2008) Tremor: from pathogenesis to treatment. Synth Lect Biomed Eng 3(1):1–212
Javidan M, Elek J, Prochazka A (1992) Attenuation of pathological tremors by functional electrical stimulation II: clinical evaluation. Ann Biomed Eng 20(2):225–236
Malešević N, Popović L, Bijelić G, Kvaščev G (2010) Muscle twitch responses for shaping the multi-pad electrode for functional electrical stimulation. J Autom Control 20(1):53–58
Malešević N, Popović L, Schwirtlich L, Popović DB (2010) Distributed low frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation. Muscle Nerve 42(4):556–562
Popović L, Malešević N (2009) Muscle fatigue of quadriceps in paraplegics: comparison between single vs. multi-pad electrode surface stimulation. Proceedings of IEEE EMBC, Minneapolis, MN, pp 6785–6788
Popović DB, Popović MB (2009) Automatic determination of the optimal shape of a surface electrode: Selective stimulation. J Neurosci Methods 178(1):174–181
Popović LZ, Malešević NM, Popović MB (2009) Optimization of multi-pad surface electrode: selective stimulation of wrist. Proceedings of the IEEE region 8 Eurocon conference, St. Petersburg, Russia, pp 142–145
Popović LZ, Šekara T, Popović MB (2010) Adaptive band-pass filter (ABPF) for tremor extraction from inertial sensor data. Comput Methods Programs Biomed 99(3):298–305
Popović LZ, Malešević N, Petrović I, Popović MB (2010) Semi-closed loop tremor attenuation with FES. Proceedings of the 10th Vienna international workshop on functional electrical stimulation and 15th IFESS annual conference, Vienna, Austria, Sept 8–12, pp 65–67. Printed as abstract in Artificial Organs, 34(8):A31
Popović-Bijelić A, Bijelić G, Jorgovanović N, Bojanić D, Popović MB, Popović DB (2005) Multi-field surface electrode for selective electrical stimulation. Artif Organs 29(6):448–452
Prochazka A, Elek J, Javidan M (1992) Attenuation of pathological tremors by functional electrical stimulation. I. Method. Ann Biomed Eng 20(2):205–224
Rocon E, Manto M, Pons J, Camut S, Belda JM (2007) Mechanical suppression of essential tremor. Cerebellum 6(1):73–78
Rocon E, Belda-Lois JM, Ruiz AF, Manto M, Moreno JC, Pons JL (2007) Design and validation of a rehabilitation robotic exoskeleton for tremor assessment and suppression. IEEE Trans Neural Syst Rehabil Eng 15(3):367–378
Rocon E, Gallego JA, Barrios L, Victoria AR, Ibanez J, Farina D, Negro F, Dideriksen JL, Conforto S, D’Alessio T, Severini G, Belda-Lois JM, Popovic LZ, Grimaldi G, Manto M, Pons JL (2010) Multimodal BCI-mediated FES suppression of pathological tremor. 32nd Annual international conference of the IEEE EMBS, Buenos Aires, Argentina, Aug 31–Sept 4, pp 3337–3340. doi:10.1109/IEMBS.2010.5627914
Widjaja F, Shee CY, Au WL, Poignet P, Ang WT (2008) An extended Kalman filtering of accelerometer and surface electromyography data for attenuation of pathological tremor. Proceedings of the 2nd IEEE/RAS-EMBS international conference on biomedical robotics and biomechatronics, pp 193–198
Zhang D, Ang WT (2007) Reciprocal EMG controlled FES for pathological tremor suppression of forearm. Proceedings of the 29th international conference of the IEEE engineering in medicine and biology society, Lyon, France, pp 4810–4813
Acknowledgment
This project has been funded in part by the European Commission (IST STREP Project TREMOR No. 224051), Ministry of Science and Technological development of Republic of Serbia (research grant #175016), and Ministerio de Ciencia e Innovación, Spain (CONSOLIDER-INGENIO Hyper).
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Popović Maneski, L., Jorgovanović, N., Ilić, V. et al. Electrical stimulation for the suppression of pathological tremor. Med Biol Eng Comput 49, 1187–1193 (2011). https://doi.org/10.1007/s11517-011-0803-6
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DOI: https://doi.org/10.1007/s11517-011-0803-6