Research Project
10291668
Project Summary Tremor is the most common movement disorder, estimated to affect at least 6-9% of persons aged 60 or older in the US. Most tremor disorders manifest as oscillations of the upper limbs at rest, while maintaining a posture, and/or while moving, making activities of daily living (eating, clothing, grooming, etc.) difficult or impossible. Medication and surgical interventions are only partially effective, and only in a subset of patients, leaving many patients without effective treatment options. Surprisingly, there are few tremor-suppressing devices available to patients. One might envision, for example, a wearable upper limb device (e.g. an orthosis) specifically designed to suppress (mechanically low-pass filter) tremor in ET patients. However, a significant obstacle to developing effective tremor-suppressing devices is that we do not currently know where (which muscles/joints) to intervene because we do not have a way of determining which muscles and joints are most responsible for a patient?s tremor. The purpose of this work is to develop validated, subject-specific models of tremor to 1) predict tremor, 2) understand how the neuromusculoskeletal system affects tremor, 3) determine which muscles and joints are most responsible for tremor at the hand, where it has the most impact on daily life, and ultimately 4) optimize tremor suppression. Although motivated in the context of the most common movement disorder (Essential Tremor), most of this work applies directly or indirectly to all types of tremor and tremor-suppression methods. By allowing one to target tremor-inducing muscles, a validated model may improve the efficacy of a variety of peripheral tremor- suppressing modalities, including wearable devices that filter out tremor, tremor ?cancellation? via antagonist muscle activation, sensory stimulation to disrupt feedback loops involved in tremor, and injection of botulinum toxin.
