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Newer MRI Approaches May Allow Tremor To Be Treated Without Surgery

MRI techniques

New magnetic resonance imaging (MRI) techniques capable of zeroing in on a pea-size region of the brain responsible for movement control may allow physicians to treat patients with Parkinson’s disease or essential tremor without having to resort to invasive brain surgery.

These methods were described in the study, “Advanced MRI techniques for transcranial high intensity focused ultrasound targeting,” published in the journal Brain.

Parkinson’s disease and essential tremor are neurological disorders characterized by lack of movement control that is thought to stem from defects in a small region of the thalamus, called the intermediate nucleus, in the brain.

Although first-line treatment for involuntary tremors consists on a combination of medications, this is not effective in about a third of all patients.

In the late 1990s, deep brain stimulation (DBS) — a surgical treatment that involves implanting a device to activate specific brain regions with electrical signals generated by a battery — started being used in non-responsive patients.

More recently, magnetic resonance guided high intensity focused ultrasound (MR-HIFU) — a non-invasive, image-guided therapy that allows physicians to burn (ablate) small pieces of tissue with precision using ultrasound heat waves — started being used to destroy the small region, the  intermediate nucleus, causing tremors in these people.

Unlike DBS, MR-HIFU does not require surgery to open the skull and implant a device, and can be performed without anesthesia while patients are awake.

The main challenge has been locating the exact region within the thalamus where the intermediate nucleus is located.

Although conventional computed tomography (CT) and MRI scans allow surgeons to identify regions that ought to be removed, both methods lack the resolution necessary to visualize the intermediate nucleus, a tiny pea-size region, for MR-HIFU targeting.

Researchers at UT Southwestern and colleagues described three new MRI techniques that allow doctors to spot and eliminate this region, without damaging nearby areas and risking permanent walking impairments and slurred speech.

“The benefit [of using these techniques] for patients is that we will be better able to target the brain structures that we want. And because we’re not hitting the wrong target, we’ll have fewer adverse effects,” Bhavya R. Shah, MD, an assistant professor of radiology and neurological surgery at UT Southwestern’s Peter O’Donnell Jr. Brain Institute, and the study’s first author, said in a press release.

Diffusion tractography, the most widely studied, is possibly the most promising of these three. It generates high-resolution 3D images based on the natural movement of water inside brain tissue.

“Currently, diffusion tractography is the technique that has demonstrated the most promise with multiple studies showing its clinical utility” for both DBS and MR-HIFU, the researchers wrote.

The second method, known as quantitative susceptibility mapping, is able to create high-contrast images of the brain due to its ability to pick up distortions in the magnetic field caused by the presence of certain substances in tissues, like blood or iron.

Fast gray matter acquisition TI inversion recovery, the third approach, enables doctors to visualize gray matter brain structures with high detail by turning white matter regions dark and gray matter regions white.

Gray matter refers to areas made up of neuron cell bodies, and white matter to areas made up of myelinated nerve segments (axons) that connect gray matter areas and are responsible for  transmitting nerve signals.

All three MRI techniques have already been approved by the U.S. Food and Drug Administration for use with people. Physicians at UT Southwestern are planning to start using them with patients when the Center’s Neuro High Intensity Focused Ultrasound Program opens in the fall.

“Bilateral MRgHIFU [MR-HIFU] thalamotomy clinical trials, now underway, will rely on improved targeting methodologies to reduce adverse effects and improve patient outcomes,” the research team added.

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Discovery May Lead to Better Treatments for Tremor, Other Movement Disorders

tremor research

Two distinct proteins previously known to play key roles in the development of tremor associated with neurodegenerative diseases now have been found to interact directly, a discovery that might lead to new therapies for tremor-related movement disorders, including Parkinson’s disease.

The study with that finding, “LINGO1 is a regulatory subunit of large conductance, Ca2+-activated potassium channels”, was published in Proceedings of the National Academy of Sciences of the United States of America (PNAS).

Parkinson’s hallmark motor symptoms include tremor, slowness of movement (bradykinesia), stiffness (rigidity), uncontrolled movements (dyskinesia) and poor balance.

These symptoms are a consequence of damage to neurons (nerve cells) in the brain’s cerebellum — an area that plays a key role in motor coordination and body balance.

People with Parkinson’s and essential tremor — a progressive movement disorder that causes involuntary shaking and is many times misdiagnosed as Parkinson’s — have higher amounts of a protein known as LINGO1, which has been implicated in movement control. People who have an extra copy of the LINGO1 gene also exhibit tremor, which further supports the idea that increased levels of the LINGO1 protein could play a key role in tremor.

Additionally, individuals with Parkinson’s and essential tremor have low levels of large conductance calcium-activated potassium (BK) ion channels within cerebellar neurons. These channels are present in the membrane of nerve cells and control the activation of neurons and smooth muscle — the tissue that lines the inside of blood vessels, internal organs and the digestive system.

Blocking or genetically deleting BK channels in mice has been found to induce tremor and movement disorders.

Now, researchers have used postmortem (autopsy) cerebellum samples of Parkinson’s patients and age-matched healthy controls to investigate the role and connection between LINGO1 and BK channels.

Researchers found that LINGO1 interacted with BK channels in the human cerebellum causing them to become inactive. This protein also reduced the expression of BK channels in the cell membrane of cells grown in the lab. However, BK channel protein expression was not altered in Parkinson’s patients’ cerebellar samples.

“Unfortunately, we were unable to ascertain if tremor was present in these deceased PD patients, and it therefore remains a possibility that the LINGO1 levels recorded in these patients were insufficient to down-regulate BK expression,” the researchers stated.

Importantly, the team found that, in cerebellar tissues from both Parkinson’s patients and age-matched controls, LINGO1 served as a regulatory subunit of BK channels.

“[T]hese two findings [referring to LINGO1 and BK’s role in the molecular mechanism of tremor] were previously thought to be unrelated. We put these two findings together and showed that LINGO1 inhibits the activity of BK channels, LINGO1 also reduces the expression of BK channels, the brains of Parkinson’s disease patients have higher levels of LINGO1, and LINGO1 is assembled with BK channels in the brains of Parkinson’s disease patients,” study author Brian Perrino, PhD, said in a press release. Perrino is associate professor, department of physiology and cell biology at the University of Nevada, Reno School of Medicine.

These results add to scientists’ understanding of the molecular mechanisms involved in neurodegenerative diseases associated with tremor. Importantly, they open the door for the development of new therapies that can block LINGO1’s interaction with BK channels and may potentially lessen motor symptoms associated with these disorders and improve patients’ quality of life.

“By bringing together an international team with complementary skills, this multi-disciplinary study promises to advance research and reveal new ways to help reduce the motor disorders associated with major disorders of the human brain,” said study author Mark Hollywood, PhD, professor, molecular physiology at the Dundalk Institute of Technology in Ireland.

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Daily Use of Cala Trio Device Effectively Eases Hand Tremors, Trial Reports

hand tremor

Using Cala Health’s non-invasive therapeutic device Cala Trio for 40 minutes twice daily effectively helped to reduce hand tremors within three months, results from a clinical study show.

The results, “Study Design, Baseline Demographics, and Interim Results from the Prospective Study for Symptomatic Relief of Essential Tremor with Cala Therapy (PROSPECT) Trial” (LBA No. 9), were presented at the International Congress of Parkinson’s Disease and Movement Disorders in Nice, France.   

Cala Trio is a wrist-worn device that delivers neuromodulation therapy, calibrated to individual needs, through the skin to provide symptomatic relief of hand tremors. The device gently stimulates the nerves responsible for the tremor, interrupting nerve circuits to allow for better control of movement.

“We are thrilled with the results of the PROSPECT trial. It is tremendously exciting to see the relief our non-invasive neuromodulation therapy brings to patients with essential tremor, without surgery or drugs,” Kate Rosenbluth, founder and chief scientific officer at Cala Health, said in a news release. “We are deeply grateful to the patients and investigators who participated in this study.”

The PROSPECT trial (NCT03597100) claims to be largest study conducted in patients with essential tremor, a benign neurological condition that is characterized by uncontrolled, rhythmic shaking, typically in the limbs. The trial enrolled 263 people at 26 U.S. sites; all had essential tremor symptoms for an average of more than 25 years (median age at study, 69.6).

Essential tremor — often misdiagnosed as Parkinson’s disease — is a progressive movement disorder most common in people ages 40 and older. It mainly affects the hands and arms, but head, voice, and leg tremors are also known.

Unlike Parkinson’s, which is associated with motor symptoms such as slow movement and muscle stiffness, essential tremor does not cause other health problems, although unsteady gait may be observed. Parkinson’s patients also typically experience tremors when their hands are at rest, while essential tremor is evident when people are using their hands.

Trial data showed that, for a majority of these people, using Cala Trio in 40-minute sessions twice daily for three months effectively reduced hand tremor severity. The average symptom relief lasted 96.7 minutes after each stimulation session — done at least two hours apart — in patients reporting benefits.

In total, 62% of participants improved from severe or moderate tremors to mild or slight tremors, according to the physician-reported Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS); 68% said their tremors went from severe or moderate before treatment to mild after Cala Trio use, according to results of the self-reported Bain and Findley Activities of Daily Living (ADL) scale.

Overall, 54% of patients reported a greater than 50% reduction in tremor power after finishing the study’s three months of treatment, and 25% experienced a 70% easing in tremor power, the study reports.

Participants also reported significant improvement in Quality of Life in Essential Tremor Questionnaire (QUEST) scores by study end.

“For patients living with ET [essential tremor], this means that they can now more easily complete daily tasks such as handwriting, drinking from a glass, and using a soup spoon — tasks that were otherwise much more difficult,” said Stuart Isaacson, MD, director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton in Florida.

“Treatment with Cala Trio represents a novel approach to improving tremor in people living with essential tremor and provides a safe and effective therapeutic option.”

Transient device-related adverse events were reported in 18% of participants, which included wrist discomfort, skin irritation, and pain. None required medical intervention.

Cala Trio has been cleared by the U.S. Food and Drug Administration to treat essential tremor, and is currently available by prescription in select U.S. markets.

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Alpha-synuclein in Blood Serum May Be Early Parkinson’s Biomarker, Study Suggests

biomarker, alpha-synuclein

Measuring the amount of alpha-synuclein in tiny vesicles collected from blood serum may help diagnose early Parkinson’s and identify patients with different types of this disease.

The study with that finding, “Central Nervous System-Derived Exosomal Alpha-Synuclein in Serum May Be a Biomarker in Parkinson’s Disease,” was published recently in the journal Neuroscience.

As both resting and posture tremor may occur in the early stages of Parkinson’s, patients may be misdiagnosed with essential tremor. Similar to Parkinson’s, essential tremor is a progressive movement disorder, and it predominantly affects hands and arms.

Alpha-synuclein is the main component of Lewy bodies, characteristic protein aggregates that accumulate in brain cells of Parkinson’s patients.

Compared to unaffected individuals, Parkinson’s patients typically have lower levels of alpha-synuclein in their cerebrospinal fluid — the liquid surrounding the brain and spinal cord — which correlates with prognosis. However, measuring alpha-synuclein in the clinic has been precluded by the invasive nature of spinal tap and by the inconsistent results of plasma or serum samples.

Exosomes are tiny vesicles released by neurons and other cells, and have been implicated in the transmission of misfolded proteins, including alpha-synuclein in people with Parkinson’s. As such, researchers hypothesized that exosomes derived from the central nervous system (CNS) could be a peripheral biomarker of Parkinson’s disease.

The scientists recruited 38 newly diagnosed, untreated patients with early Parkinson’s divided into tremor-dominant (TD, 22 patients, mean age 62.7 years) and non-tremor-dominant (NTD, 16 patients, 62.1 years), who were compared to 21 patients with essential tremor (62 years) and 18 healthy controls.

Among the patients with Parkinson’s, those with TD had a shorter disease duration than the people with the NTD subtype (19.2 vs. 35.8 months). The age at disease onset did not differ in these two groups – 61.1 years in TD and 59.1 years in NTS patients.

The results revealed that Parkinson’s patients had lower levels of alpha-synuclein in CNS-derived serum exosomes than those with essential tremor or controls. Importantly, within Parkinson’s patients, those with the NTD type — which has been associated with more frequent depression, lack of motivation and impairment in activities of daily life — had lower amounts than those in the TD subset.

A subsequent analysis found that exosomal alpha-synuclein had a moderate potential to diagnose Parkinson’s disease and a great potential to diagnose non-tremor-dominant patients.

Of note, the amount of CNS-derived alpha-synuclein in exosomes was not significantly associated with disease duration or severity.

Overall, “CNS-derived exosomal [alpha]-synuclein in the serum may be regarded as a biomarker to identify [early Parkinson’s],” the scientists wrote.

Cautioning that studies with larger groups of patients and those with longitudinal monitoring are needed, the team further commented that assessing alpha-synuclein in serum exosomes also may help identify different Parkinson’s types.

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My DaTscan Results Made My PD Diagnosis ‘Real’

DaTscan

When I was first diagnosed with Parkinson’s disease (PD) in 2015, I asked the neurologist if there was a definitive test to confirm a PD diagnosis. I mentioned a DaTscan, but he said the test is not entirely conclusive. He also indicated that DaTscan results likely would not change his prescribed course of treatment for me.

His view was that the best way to confirm a PD diagnosis is to give a patient the medication levodopa to see if PD symptoms disappeared. Other neurologists I consulted for second opinions concurred with his assessment.

What is a DaTscan?

DaTscan is a medication that is injected into the bloodstream to assess dopamine-containing neurons that are involved in controlling movement. The contrast agent ioflupane (123I) is distributed around the body in the bloodstream and accumulates in the area of the brain called the striatum, where it attaches to the structures that transport dopamine. The patient then has a single-photon emission computed tomography (SPECT) scan.

The DaTscan test was designed to differentiate parkinsonian syndromes from essential tremor. PD is the most common form of parkinsonian syndromes, but there are other forms, including multiple system atrophy and progressive supranuclear palsy.

My DaTscan

A comparison between a normal and an abnormal DaTscan can be viewed here. A normal DaTscan will show two distinct comma-like or crescent shapes. An abnormal DaTscan will have two period-like or oval shapes, or a combination of period and comma shapes, indicating a reduced uptake of DaTscan in certain areas of the brain. Parts of the image that are “lit up,” indicate more surviving brain cells. Dark areas could mean either PD or parkinsonism.

My DaTscan image showed that the right side of my brain is less “lit up” than the left side. The right hemisphere of the brain coordinates the left side of the body. The left side of my body is the one most affected by PD, so it makes sense that my right side brain is less “lit up.”

Am I convinced that I have PD?

Three years after my diagnosis, I am still struggling to find relief from my symptoms and slow the progression of this disease. I exercise, eating a mostly vegan and gluten-free diet, take Sinemet (carbidopa-levodopa), and use the Neupro transdermal patch. I am working with my current neurologist to fine-tune my medication “cocktail.”

I had wondered whether I did have PD since I’ve never had an “aha” moment in which I feel somewhat normal after taking medications. People tell me I look fine and they don’t observe any external signs of the disease. However, my tremors are internal and I feel horrible and constantly fatigued.

Why now?

I am subjecting my body to what I believe are toxic medications to treat a disease that I feel has been subjectively diagnosed. My symptoms have not been completely alleviated with my current exercise, diet, and prescription medication regimen. I wanted more concrete evidence that I have PD, so my neurologist prescribed a DaTscan. Much to my dismay, the results were abnormal and compatible with Parkinson’s syndrome.

Seeing my brain image with areas not “lit up” where they should be, when contrasted with a normal DaTScan, made my diagnosis very real for me. I have a form of parkinsonian syndrome — most likely PD.

Would I still have gotten a DaTscan?

It was important for me to have confirmation other than my symptoms of abnormalities in my brain. I think this scan can be used as a baseline to follow my disease progression.

So, yes, I would have still gotten this test, although the $2,000 out-of-pocket cost upfront may have given me pause.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Focused-ultrasound Lesion Surgery Can Treat Tremors and Improve Life Quality, Study Says

tremors and surgery

Treating tremor in Parkinson’s patients using non-invasive and focused-ultrasound lesion surgery is associated with better quality of life when compared to deep brain stimulation, although both approaches are equally effective in easing this disease symptom, a review study reports.

The study, “Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-analysis,” was published in the journal World Neurosurgery.

At least 50 percent of people with Parkinson’s, essential tremor (ET) or multiple sclerosis (MS) given oral medications as a first-line treatment for tremor — defined as an involuntary, uncontrollable muscle contraction; most commonly in the hands — do not tolerate these medications over the long term.

Current alternatives include deep brain stimulation (DBS) and lesion surgery (LS), which induces lesions on targeted areas using a heated electrode or focused ultrasound. Prior comparisons have shown that while the two techniques are equally effective in suppressing tremor, DBS led to a greater improvement in function.

But LS with focused ultrasound is gaining in popularity, and one study suggested that it may significantly improve tremor and quality of life.

Researchers at Harvard Medical School conduced a systematic review and a meta-analysis — a type of statistical study that combines the results of various studies — to determine which strategy is most effective in diminishing tremor severity and improving life quality and function in people with Parkinson’s, ET, or MS.

Three online databases were searched for results of randomized clinical trials published up to Jan. 1, 2018, and that included adults treated with either LS or DBS, or serving as controls. Both DBS and LS studies targeted unilateral or bilateral thalamus, pallidum or subthalamic nucleus, all of which are implicated in motor function.

Thirteen Parkinson’s trials were among the 15 included in this study, and the primary outcome for all but one was change in upper limb tremor severity, as assessed with the unified Parkinson’s disease rating scale (UPDRS) part III. Changes in quality of life, cognitive function and neuropsychiatric function were also assessed with variable measures.

A total of 1, 508 patients (mean age range, 48.4 to 70.8) were included, and in addition to the 13 studies involving only Parkinson’s patients, one study looked at people with Parkinson’s, ET and MS, while the remaining study was in people with severe ET.

Four of the 15 trials — involving 125 patients — directly compared DBS to LS. The others compared either LS or DBS with controls.

Results showed that DBS and LS were not significantly different across all analyzed outcomes, which is in line with current guidelines, the researchers noted. All but one trial showed both these types of surgery eased tremor severity. Quality of life findings showed variability in outcomes, which was driven by disease duration. Specifically, longer disease duration correlated with a greater likelihood of surgery and better quality of life.

A subgroup analysis that looked specifically at LS using focused ultrasound revealed that this approach was associated with a significant improvement in quality of life compared to DNS, although changes in tremor severity were similar.

“Policy makers, healthcare providers, and patients could therefore consider focused-ultrasound [LS] as a potential choice for tremor control, based on currently available evidence,” the researchers wrote.

However, results from more studies directly comparing DBS with focused-ultrasound LS are needed, they advised.

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Xeomin Eases Tremor Severity, Improves Hand Function in People with Essential Tremor, Phase 2 Trial Shows

essential tremor, Xeomin

Intramuscular treatment with Xeomin (incobotulinumtoxinA) decreases tremor severity and improves hand function in patients with essential tremor of the upper limbs, according to Phase 2 trial results.

Results of the trial, titled “Efficacy and safety of incobotulinumtoxinA for upper-limb essential tremor in a randomised, double-blind, placebo-controlled trial using kinematics-guided clinical decision support,” was presented at the recent 2018 World Congress on Parkinson’s Disease and Related Disorders in Lyon, France.

Essential tremor — often misdiagnosed as Parkinson’s disease — is a progressive movement disorder, found in more people ages 40 and older. It mainly affects the hands and arms, but head, voice, and leg tremors may also occur.

Unlike Parkinson’s, which is associated with motor symptoms such as slow movement and muscle stiffness, essential tremor does not cause other health problems, although unsteady gait may be observed. Also, while patients with Parkinson’s typically experience tremors when their hands are at rest, those with essential tremor have them when using their hands.

Researchers conducted a randomized, double-blind Phase 2 clinical trial (NCT02207946) — sponsored by Merz Pharma, Xeomin’s developer — to evaluate the effectiveness and safety of a single, kinematics (motion)-guided intramuscular injection of Xeomin in adults with moderate to marked essential tremor in their upper limbs. The trial was conducted in the U.S. and Canada.

A total of 30 patients were included — 19 of whom were randomized to receive Xeomin, at a total dose of up to 195 Units, and 11 received a placebo. The participants all got an injection in the wrist, with optional injections into the shoulder and/or elbow. Muscle selection was based on each patient’s patterns of tremor, while doses per muscle were based on a kinematics-guided TremorTek analysis, which uses a combination of wearable movement sensors and computer software.

Differences between Xeomin and placebo were assessed at weeks four and eight for maximum wrist-tremor amplitude and motor performance, measured by the Fahn-Tolosa-Marin (FTM) Part B score. Analyses of tremor severity, with the FTM tremor scale, and grip strength were conducted over 24 weeks.

Treatment with Xeomin induced a trend toward decreased wrist-tremor amplitude, compared with placebo, at week four, and showed a significant improvement at week eight. Persistent anti-tremor effects were seen by motion measurements up to 24 weeks after a single injection of Xeomin.

The data further demonstrated that Xeomin significantly improved motor performance at both the fourth and eighth weeks. Maximum grip strength in the treated arm decreased by 20%, with no notable change in those on placebo. Although two patients receiving Xeomin reported localized finger-muscle weakness, none of the participants discontinued treatment due to muscle weakness.

“Kinematics-guided incobotulinumtoxinA (Xeomin) administration significantly decreased tremor severity and improved hand motor function versus placebo in patients with ET of the upper limb,” the researchers wrote.

Xeomin was recently approved by the U.S. Food and Drug Administration to treat adults with chronic sialorrhea, or excessive drooling, a common condition in Parkinson’s patients. It has also been approved for the treatment of adults with abnormal head position and neck pain due to involuntary contraction of neck muscles, abnormal spasm of the eyelids (blepharospasm) in patients previously treated with Botox (onabotulinumtoxinA), and to reduce muscle stiffness of the upper limbs.

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Source: Parkinson's News Today

New AI Model May Improve Use of Touchscreens by Patients with Parkinson’s, Other Disabilities

user interface

Finnish and Japanese researchers have developed a new algorithmic approach to user interface optimization that takes individual differences into account. This approach could be beneficial for patients with Parkinson’s disease or other disabilities.

The research, “Ability-Based Optimization of Touchscreen Interactions,” was published in the journal IEEE Pervasive Computing.

Among the limitations presented by users with disabilities are essential tremors, characterized by involuntary and rhythmic shaking, most often when using the hands for simple tasks, dyslexia, which impairs the ability to read words of the interface, and dementia.

Strategies to overcome these limitations could involve increasing the size of user interface elements and grouping functions together, reducing the amount of text in the screen and making sure it is correct,  creating designs that require as little previous knowledge as possible, and prioritizing frequent tasks.

“The majority of available user interfaces are targeted at average users. This ‘one size fits all’ thinking does not consider individual differences in abilities — the aging and disabled users have a lot of problems with daily technology use, and often these are very specific to their abilities and the circumstances,” Jussi Jokinen, one of the study’s co-authors, said in a press release.

Approaches to improve the user interface require an accurate model of the user, Jokinen observed. “Previously, designers did not have detailed models that are based on psychological research and can be used to predict how different individuals perform in interactive tasks,” he said.

The scientists developed a new model of interaction, which combines psychological research on finger pointing and eye movements to predict limitations in text entry speed, typing, and proofreading.

By simulating a user with essential tremors, the researchers predicted that using the common Qwerty keyboard is almost impossible, because more than half of all typed keys are typos. “We chose to simulate and optimize for essential tremor, because it makes text entry very difficult,” Jokinen said.

“We connected the text entry model to an optimizer, which iterates through thousands of different user interface designs. No real user could of course try out all these designs. For this reason it is important that we could automatize the evaluation with our computational model,” he added.

This resulted in an interface predicted to be superior for individuals with essential tremors; the simulated user did not make any entry errors. The optimized layout was then tested with a person with essential tremors, who was able to type almost error-free messages.

“This is of course just a prototype interface, and not intended for consumer market,” Jokinen said. “I hope that designers pick up from here and with the help of our model and optimizer create individually targeted, polished interfaces.”

“While more empirical work is needed to evaluate the results, the first evidence acquired in this paper is promising,” the researchers wrote. Future work should test the design for dyslexics, they said.

Beyond the confirmed validity of the model in essential tremor and text entry, scientists also may use it for other disabilities and tasks. “For example, we have models for simulating how being a novice or an expert with an interface impacts users’ performance,” Jokinen said.

The effects of memory impairment in learning and everyday use of interfaces also may be addressed, he added.

“The important point is that no matter the ability or disability, there must be a psychologically valid theory behind modeling it. This makes the predictions of the model believable, and the optimization is targeted correctly,” Jokinen said.

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Source: Parkinson's News Today

New Lithuanian Technology Reduces Hand Tremor, May Be Useful for Parkinson’s

essential tremor invention

A new technology that reduces “shaky hands” in people with essential tremor (ET) may benefit those with Parkinson’s disease.

People with essential tremor, a condition that has overlapping motor features with Parkinson’s disease, have a significant reduction in their quality of life, as everyday tasks such as drinking from a glass or tying shoelaces become challenging.

Estimates from 2012 indicate the disease affects around 2 percent of Americans. Its prevalence increases with advanced age, as the incidence in people over age 40 is approximately 23.7 per 100,000 per year.

ET, which is often misdiagnosed as Parkinson’s, is a progressive neurological disorder causing involuntary and rhythmic shaking, mainly in the hands. However, unlike Parkinson’s, which typically presents hand tremor at rest, hand tremor in ET often occurs when the hands are being used.

“My grandfather had this problem. Seeing a close person suffering from the condition, it becomes clear that any device which could reduce the symptoms would be of great assistance,” Mantas Venslauskas, CEO of the Lithuanian startup company Fidens and a scientist at Kaunas University of Technology (KTU), said in a press release.

ViLim Ball, developed by Fidens, is an advanced version of a vibro trainer. Venslauskas said he knows of only one similar technology to alleviate hand tremor, which is currently available in the U.S. The ViLim Ball technology may also improve hand stiffness in the morning, a typical manifestation of rheumatoid arthritis.

In addition to ViLim Ball, the researchers at KTU’s Biomechanics Laboratory have also been working on a technology to improve circulation in body extremities, which is relevant for rheumatoid arthritis patients. This work has been done in collaboration with scientists at the Lithuanian University of Health Sciences (LSMU).

In their joint effort with LSMU researchers, “we found out that the technology can also be used for tremor diminishing. Therefore, at Fidens we have created a thoroughly new technology and concept of a device for reducing hand tremor and stiffness,” Venslauskas said.

Tests of the ViLim Ball showed that it effectively reduces symptoms in seven out of 10 ET cases, and in nine out of 10 rheumatoid arthritis cases. The technology’s impact on physiological parameters is currently being evaluated, Venslauskas added.

In January 2018, Fidens released a beta version of ViLim Ball into the Lithuanian market with a price of 195 euros (about $238 U.S). Customer feedback will be critical toward improving the product. After additional testing and optimization, Fidens plans to sell the ViLim Ball in the U.S.

The company is also developing a wearable technology to decrease hand tremor in real time, a device that would be particularly relevant for Parkinson’s patients.

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Source: Parkinson's News Today