A neuroprosthesis for tremor management through the control of muscle co-contraction

[Background] Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering...

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Autores: Gallego, Juan Álvaro, Rocón, Eduardo, Belda-Lois, Juan Manuel, Pons Rovira, José Luis
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2013
País:España
Institución:Consejo Superior de Investigaciones Científicas (CSIC)
Repositorio:DIGITAL.CSIC. Repositorio Institucional del CSIC
OAI Identifier:oai:digital.csic.es:10261/76526
Acceso en línea:http://hdl.handle.net/10261/76526
Access Level:acceso abierto
Palabra clave:Tremor
Neuroprosthesis
Neurostimulation
Parkinson’s disease
Essential tremor
Adaptive filtering
Functional electrical stimulation
Human-Machine Interface
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spelling A neuroprosthesis for tremor management through the control of muscle co-contractionGallego, Juan ÁlvaroRocón, EduardoBelda-Lois, Juan ManuelPons Rovira, José LuisTremorNeuroprosthesisNeurostimulationParkinson’s diseaseEssential tremorAdaptive filteringFunctional electrical stimulationHuman-Machine Interface[Background] Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks.[Methods] We implemented a neuroprosthesis that regulated the level of muscle co-contraction by injecting current at a pair of antagonists through transcutaneous neurostimulation. Co-contraction was adapted to the instantaneous parameters of tremor, which were estimated from the raw recordings of a pair of solid state gyroscopes with a purposely designed adaptive algorithm. For the experimental validation, we enrolled six patients suffering from parkinsonian or essential tremor of different severity, and evaluated the effect of the neuroprosthesis during standard tasks employed for neurological examination.[Results] The neuroprosthesis attained significant attenuation of tremor (p < 0.001), and reduced its amplitude up to a 52.33±25.48%. Furthermore, it alleviated both essential and parkinsonian tremor in spite of their different etiology and symptomatology. Tremor severity was not a limiting factor on the performance of the neuroprosthesis, although there was a subtle trend towards larger attenuation of more severe tremors. Tremor frequency was not altered during neurostimulation, as expected from the central origin of Parkinson’s disease and essential tremor. All patients showed a good tolerance to neurostimulation in terms of comfort and absence of pain, and some spontaneously reported that they felt that tremor was reduced when the neuroprosthesis was activated.[Conclusions] The results presented herein demonstrate that the neuroprosthesis provides systematic attenuation of the two major types of tremor, irrespectively from their severity. This study sets the basis for the validation of the neuroprosthesis as an alternative, non-invasive means for tremor management.This work has been supported by the Commission of the European Union through grants ICT2007-224051 (TREMOR) and ICT-2011-287739 (NeuroTREMOR), by the Spanish Ministry of Science and Innovation through grants DPI2008-06772-C03-01 (REHABOT) and CSD2009-00067 (HYPER), and by the IMPIVA through grant IMDEEA/2011/91 (SISTR2).The authors also thank the Unit of Information Resources for Research (URICI-CSIC) for the co-financing of this publication in Open Access.Peer ReviewedBioMed Central20132013info:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_6501Publisher's versioninfo:eu-repo/semantics/publishedVersionhttp://hdl.handle.net/10261/76526reponame:DIGITAL.CSIC. Repositorio Institucional del CSICinstname:Consejo Superior de Investigaciones Científicas (CSIC)Inglés#PLACEHOLDER_PARENT_METADATA_VALUE##PLACEHOLDER_PARENT_METADATA_VALUE#info:eu-repo/grantAgreement/EC/FP7/224051info:eu-repo/grantAgreement/EC/FP7/287739http://dx.doi.org/10.1186/1743-0003-10-36info:eu-repo/semantics/openAccessoai:digital.csic.es:10261/765262026-05-22T06:33:51Z
dc.title.none.fl_str_mv A neuroprosthesis for tremor management through the control of muscle co-contraction
title A neuroprosthesis for tremor management through the control of muscle co-contraction
spellingShingle A neuroprosthesis for tremor management through the control of muscle co-contraction
Gallego, Juan Álvaro
Tremor
Neuroprosthesis
Neurostimulation
Parkinson’s disease
Essential tremor
Adaptive filtering
Functional electrical stimulation
Human-Machine Interface
title_short A neuroprosthesis for tremor management through the control of muscle co-contraction
title_full A neuroprosthesis for tremor management through the control of muscle co-contraction
title_fullStr A neuroprosthesis for tremor management through the control of muscle co-contraction
title_full_unstemmed A neuroprosthesis for tremor management through the control of muscle co-contraction
title_sort A neuroprosthesis for tremor management through the control of muscle co-contraction
dc.creator.none.fl_str_mv Gallego, Juan Álvaro
Rocón, Eduardo
Belda-Lois, Juan Manuel
Pons Rovira, José Luis
author Gallego, Juan Álvaro
author_facet Gallego, Juan Álvaro
Rocón, Eduardo
Belda-Lois, Juan Manuel
Pons Rovira, José Luis
author_role author
author2 Rocón, Eduardo
Belda-Lois, Juan Manuel
Pons Rovira, José Luis
author2_role author
author
author
dc.subject.none.fl_str_mv Tremor
Neuroprosthesis
Neurostimulation
Parkinson’s disease
Essential tremor
Adaptive filtering
Functional electrical stimulation
Human-Machine Interface
topic Tremor
Neuroprosthesis
Neurostimulation
Parkinson’s disease
Essential tremor
Adaptive filtering
Functional electrical stimulation
Human-Machine Interface
description [Background] Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks.
publishDate 2013
dc.date.none.fl_str_mv 2013
2013
dc.type.none.fl_str_mv info:eu-repo/semantics/article
http://purl.org/coar/resource_type/c_6501
Publisher's version
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10261/76526
url http://hdl.handle.net/10261/76526
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv #PLACEHOLDER_PARENT_METADATA_VALUE#
#PLACEHOLDER_PARENT_METADATA_VALUE#
info:eu-repo/grantAgreement/EC/FP7/224051
info:eu-repo/grantAgreement/EC/FP7/287739
http://dx.doi.org/10.1186/1743-0003-10-36
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:DIGITAL.CSIC. Repositorio Institucional del CSIC
instname:Consejo Superior de Investigaciones Científicas (CSIC)
instname_str Consejo Superior de Investigaciones Científicas (CSIC)
reponame_str DIGITAL.CSIC. Repositorio Institucional del CSIC
collection DIGITAL.CSIC. Repositorio Institucional del CSIC
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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