Title: Assessing and Suppressing Upper Limb Tremor to Enable Independence
Funder: Department of Health (England)

Abstract: Background Upper limb kinetic and intention tremor is complex, difficult to measure and very disabling as it occurs when movement is attempted. Tremor and ataxia affect about 50% of multiple sclerosis (MS) patients and can occur following head injury, stroke and CNS acquired or inherited conditions. It seriously affects quality of life, capacity to work and social function; at worst it robs people of independence and dignity. Drawing on experience in multidimensional upper limb movement measurement, the development of a first iteration lab. prototype orthosis with the capacity to add damping of movement (i4i grant 11-FS-0190-11081) has been achieved. The applicants now wish to develop a lightweight arm orthosis able to control tremor during movement using intelligent feedback control. Aims Using lightweight orthotic design, advanced sensors and mathematical modelling, the team aims to deliver and test a pre-commercial prototype intelligent tremor control device. We will carry out trials to quantify the benefits of the orthosis and to obtain qualitative information on its usability with a representative group of patients. In addition, further refinement of the measurement system will provide accessible clinical data in the form of a workstation that will enable clinicians to assess tremor and its treatment in a wider patient population. As part of this we will develop two measures that clinicians can use: tremor amplitude related to arm position and the expended effort in performing a goal-oriented task. Plan of Investigation The work is divided into three workpackages. WP1 will develop the measurement system to provide accessible clinical data. It will also allow the theoretical assessment and optimisation of the tremor reduction orthosis. WP2 will develop the low-power passive variable damper and controller for the feedback controlled tremor suppressing orthosis. This work will be influenced by patient feedback (from WP3) and the evaluation of performance data (using WP1). WP3 involves patient testing. The clinical team will ensure all regulatory procedures are in place, recruit suitable patients and carry out the clinical tests. These will be based on clinical measures of tremor, simple recorded reach-retrieve movement activities and qualitative evaluation of patient experience when using the orthosis. Potential Impact Individuals with kinetic and/or intention tremor describe it as one of their worst symptoms It imposes serious economic and personal cost, often being the main cause of loss of employment and ability to participate in family life. To date there is no effective treatment and neurosurgical approaches may have significant unwanted consequences. Everyday tasks like keypad/keyboard use, eating, drinking, grooming, etc. often require constant help, risking social isolation and loss of independence. The development of a simple to use, effective tremor control device that can be delivered through normal rehabilitation channels will have considerable impact on a group of patients for whom no other source of symptom management currently exists. About 100,000 patients in the UK could benefit.


Research activity codes: 6.3 MEDICAL DEVICES;5.3 MEDICAL DEVICES
Health categories: NEUROLOGICAL