Development of a closed-loop system for tremor suppression in patients with Parkinson's disease
Abstract
More than 70% of patients suffering Parkinson's disease (PD) exhibit resting tremor in their extremities, hampering their ability to perform daily activities. Based on our earlier studies on corticospinal transmission of tremor signals [10,11], we hypothesize that cutaneous afferents evoked by surface stimulation can produce an inhibitory effect on propriospinal neurons (PN), which in turn will suppress tremor signals passing through the PN. This paper presents the development of a closed-loop system for tremor suppression by transcutaneous electrical nerve stimulation (TENS) of sensory fibers beneath the skin. The closed-loop system senses EMGs of forearm muscles, and detects rhythmic bursting in the EMG signal. When a tremor is detected by the system, a command signal triggers a stimulator to output a train of bi-phasic, current regulated pulses to a pair of surface electrodes. The stimulation electrode is placed on the dorsal hand skin near the metacarpophalangeal joint of index finger, which is innervated by the superficial radial nerve that projects an inhibitory afferent to PNs of forearm muscles. We tested the closed-loop system in 3 normal subjects to verify the algorithm and in 2 tremor dominated PD subjects for feasibility of tremor detecting and suppression. Preliminary results indicate that the closed-loop system can detect tremor in all subjects, and tremor in PD patients was suppressed significantly by electrical stimulation of cutaneous afferents.
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Hao et al.'s surface electrical stimulation on the dorsal hand in eight PD patients reduced average peak spectral amplitude by 61.6 ± 8.9% and average EMG activity by 47.9 ± 25.8%.
“Although tremulous movements and EMG signals seemed to be increased in some trials due to the stimulation, both metrics decreased their severity in most cases, resulting in an average peak spectral amplitude reduction of 61.6 ± 8.9% and an average EMG activity reduction of 47.9 ± 25.8%.”
From A Review on Wearable Technologies for Tremor Suppression (2021) · cites this paper as [80]
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- Authors
- Xu, F. L., Hao, M. Z., Xu, S. Q., Hu, Z. X., Xiao, Q., & Lan, N.
- Affiliations
- Shanghai Jiao Tong University (CN)
- Venue
- 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)
- Publisher
- IEEE
- Published
- 2016-08
- Volume
- 2016
- Pages
- 1782-1785
- ISSN
- 2375-7477 (ISSN-L)
- OpenAlex
- W2532054287
- Cited by
- 18
- References
- 13
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 2
- FWCI
- 5.06
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
- Keywords
- Parkinson's disease, resting tremor, tremor suppression, closed-loop stimulation, transcutaneous electrical nerve stimulation, cutaneous afferents, propriospinal neurons, superficial radial nerve, sensory feedback
- MeSH terms
- Electric Stimulation, Electromyography, Forearm, Humans, Parkinson Disease, Tremor, Muscle, Skeletal
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