Online Tremor Suppression Using Electromyography and Low-Level Electrical Stimulation

• Published in: IEEE transactions on neural systems and rehabilitation engineering Vol. 23; no. 3; pp. 385 - 395
• Main Authors: Dosen, Strahinja, Muceli, Silvia, Dideriksen, Jakob Lund, Romero, Juan Pablo, Rocon, Eduardo, Pons, Jose, Farina, Dario
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.05.2015; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Afferent stimulation; Aged; Electric Stimulation Therapy - instrumentation; Electric Stimulation Therapy - methods; Electrical stimulation; Electrodes; Electromyography; Electromyography - instrumentation; Electromyography - methods; Essential Tremor - physiopathology; Essential Tremor - rehabilitation; Female; Fingers; Humans; Joints; Male; Middle Aged; Motors; Muscle Fatigue; Muscle, Skeletal - physiopathology; Muscles; neuromodulation; Online Systems; Parkinson Disease - physiopathology; Parkinson Disease - rehabilitation; Patients; Reduction; Sensory stimulation; Sensory Thresholds; Stimulation; Thresholds; Treatment Outcome; Tremor - physiopathology; Tremor - rehabilitation; tremor demodulation; tremor suppression; Tremors; Wrist
• ISSN: 1534-4320; 1558-0210; 1558-0210
• DOI: 10.1109/TNSRE.2014.2328296

Tremor is one of the most prevalent movement disorders. There is a large proportion of patients (around 25%) in whom current treatments do not attain a significant tremor reduction. This paper proposes a tremor suppression strategy that detects tremor from the electromyographic signals of the muscles from which tremor originates and counteracts it by delivering electrical stimulation to the antagonist muscles in an out of phase manner. The detection was based on the iterative Hilbert transform and stimulation was delivered above the motor threshold (motor stimulation) and below the motor threshold (sensory stimulation). The system was tested on six patients with predominant wrist flexion/extension tremor (four with Parkinson disease and two with Essential tremor) and led to an average tremor reduction in the range of 46%-81% and 35%-48% across five patients when using the motor and sensory stimulation, respectively. In one patient, the system did not attenuate tremor. These results demonstrate that tremor attenuation might be achieved by delivering electrical stimulation below the motor threshold, preventing muscle fatigue and discomfort for the patients, which sets the basis for the development of an alternative treatment for tremor.