# Medical Devices for Tremor Suppression: Current Status and Future Directions
## 5 Assistive Feeding Devices  
The Neater Eater (Neater Solutions, Derbyshire, UK) was introduced by Michaelis in 1988 [127]. However, it was not available for use in the US until its registration with the FDA in 1993. This is a table-mounted device that involves internal spring-assisted lifting to support a clip-on utensil to enable eating. It relies on viscous damping to absorb tremors and fast movements via the flowing of a viscous fluid that dissipates the kinetic energy. A brief report interviewing 39 participants with various neuromuscular conditions found that the Neater Eater is associated with positive impacts in independence, self-confidence, and quality of life [128]. Follow-up and monitoring may be necessary to prevent fatigue and muscle build-up from using this device on a regular basis.  
Liftware Steady (Verily Life Sciences, South San Francisco, CA, USA), registered with the FDA in 2013, is a handheld device designed to help patients with ET or PD tremors eat. It consists of a motion-generating platform, capable of directing two DC motors to move the utensil opposite to the direction of the tremor. The patient's involuntary movements are detected by an accelerometer, which are then transmitted to a controller, providing control over the motion-generating platform. A pilot study involving 15 patients with ET demonstrated an improvement in tremor with the device, as measured by Fahn-Tolosa-Marin Tremor Rating Scale (TRS), while holding (\(p\) = 0.016), eating (\(p\) = 0.001), and transferring objects (\(p\) = 0.001) [129]. When using the device, patients expressed improved symptoms of ET while eating (\(p\) < 0.001) and transferring objects (\(p\) = 0.013) but not holding them (\(p\) = 0.14), as measured by the subject-rated Clinical Global Impression Scale (CGI-S) [129]. Data demonstrated a 73% tremor suppression across the three tasks [129]. Compared to other adaptive utensils in 22 patients with ET or PD tremor, Lifitware Steady was preferred [130].  
The Gyenno Spoon (GYENNO Technologies, Shenzhen, China), another handheld assistive feeding device, consists of a longitudinal motor and a transverse motor that are able to generate movements in two different directions opposite to the tremor direction [131]. Both motors are linked to a control module, which receives vibration data from multiple movement sensors within the device. Its ergonomic design and proposed efficacy led to its registration with the FDA in 2016 for use for patients with ET or PD tremors. While it claims ([[https://www.gyenno.com/spoon-en](https://www.gyenno.com/spoon-en)]([https://www.gyenno.com/spoon-en](https://www.gyenno.com/spoon-en)), accessed on 26 March 2021) to have an 85% tremor suppression, no clinical data has been published.  
Contrary to Lifitware Steady and the Gyenno Spoon, the Neater Eater requires no power supply and has the ability to automatically bring the spoon forward to the patient's mouth with an internal spring. However, both Lifitware Steady and the Gyenno Spoon enable data collection of the patient's tremor. This can be beneficial in allowing physicians to monitor their patients' tremor improvement or progression when Lifitware Steady or the Gyenno Spoon is supplemented with pharmacotherapy. Nonetheless, it is important to note that the functionality of these devices is limited to provide support in feeding only.