Abstract
IntroductionTremor is the most common movement disorder, affecting 5.6% of the population with Parkinson’s disease or essential tremor over the age of 65. Conventionally, tremor diseases like Parkinson’s are treated with medication. An alternative non-invasive symptom treatment is the mechanical suppression of the oscillation movement. The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments.MethodA systematic literature search was conducted by performing a keyword combination search of the title, abstract and keyword sections in the four databases Web of Science, MedLine, Scopus, and ProQuest. Initially, the retrieved articles were selected by title and abstract using selection criteria. The same criteria were then applied to the full publication text. After the selection process, relevant information on the retrieved orthoses was isolated, sorted and analysed systematically.ResultsForty-six papers, representing 21 orthoses, were identified and analysed according to the mechanical and ergonomic properties. The identified orthoses can be divided into 5 concepts and 16 functional prototypes, then subdivided further based upon their use of passive, semi-active, or active suppression mechanisms. Most of the orthoses concentrate on the wrist and elbow flexion and extension. They mainly rely on rigid structures and actuators while having tremor-suppression efficacies for tremorous subjects from 30 to 98% using power spectral density or other methods.ConclusionThe comparison of tremor-suppression orthoses considered and mapped their various mechanical and ergonomic properties, including the degrees of freedom, weight, suppression characteristics, and efficacies. This review shows that most of the orthoses are bulky and heavy, with a non-adapted human-machine interface which can cause rejection by the user. The main challenge of the design of an effective, minimally intrusive and portable tremor-suppressing orthosis is the integration of compact, powerful, lightweight, and non-cumbersome suppression mechanisms. None of the existing prototypes combine all the desired characteristics. Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance.
Highlights
Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson’s disease or essential tremor over the age of 65
Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance
Purpose of review paper The purpose of this review is to identify the scope for improvement of past wearable tremor-suppression orthoses for the upper limb in order to improve future orthoses
Summary
Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson’s disease or essential tremor over the age of 65. Of the two most prevalent conditions causing tremor in the upper limb, the disease essential tremor (ET) is prevalent with 4.6% of the population aged 65 or over and 21% older than 95, whilst Parkinson’s disease (PD) is known to develop in 2% of all people older than 65 [3,4,5,6,7]. For those who develop PD, tremor manifests in 50% of those afflicted with the condition, whereas symptomatic tremor is ubiquitous in ET [7]. 48% of the PD patients and 34% of the ET patients are at least mildly depressed due to their lack of performance in activities of daily living [11]
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