LiftLab's LiftWare products are recommended for those who have hand tremors. With clever ideas and implementation, LiftLabs have created a helpful product for tremor patients. Here are the details:

Through our research and conversations with people living with tremor, we know that forcibly suppressing a person’s tremor can cause pain and discomfort. We developed a uniquely effective and compact device that uses active tremor cancellation to 1) reduce the amount of force we need to counteract and 2) implement a control system that can quickly filter out unintentional tremor while preserving intentional hand movement.

Overcoming the forces generated by a trembling hand or arm typically requires large, awkward structures such as braces or weights. We were able to miniaturize LiftWare relative to other technologies by inventing a system that stabilizes only the bowl of the spoon, requiring much less force than a system that suppresses hand tremor. And by allowing the hand to tremor, using LiftWare feels natural and is comfortable to use.

Since we aren’t forcing the hand to be still, we needed a technology that could respond quickly to a person’s tremor, and also tell the difference between intentional motion (such as moving the spoon to your mouth) and unintentional tremor. Sensors embedded in the spoon detect motion, and a microcontroller uses sensor data to determine the best response. The microcontroller continuously directs motors in the handle of the device to move the spoon and cancel tremor both horizontally and vertically. Since we know that almost all Essential and Parkinsonian Tremor occurs between 4 and 7 cycles per second, we optimized our control system to only cancel motion in that range. As a result, food is kept steady in the bowl of the spoon through our active tremor cancellation technology.

The video clip shown below illustrates the effectiveness of a very early device working in the lab. The prototype is filled with granola while attached to an apparatus that simulates tremor. You can see that with the system turned off, the granola will immediately fly out of the bowl of the spoon, while turned on the granola is held indefinitely. We’ve come a long way since then, and are very proud of our final product.

Lift Labs, part of Lynx Design, is a group of
highly talented people who are working to create new technologies for the social benefit.

LiftLabs recently released a very useful free iPhone app for those with Essential Tremor and Parkinson’s Disease. Here are the details:

We’ve been listening to a lot of patients with Essential Tremor and Parkinson’s Disease these days, and it seems like a lot of people have a desire for a tremor measurement and monitoring app. Since many people have smart phones (and because of the computing power they now have), we thought it would be useful to create an app that can do just that.

Lift Pulse is a highly intuitive, yet powerful app that is calibrated to measure your tremor frequency and amplitude. To get a reading, hold your phone in your hand and press record. The gray bar will begin to fill as the recording begins. Once the bar is full (after about 10 seconds) the app will move to the analysis screen.

There, you can see a frequency spectrum. Your tremor measurement should appear as a peak between 5 and 10 Hz as shown in the figure above. The tremor measurement and monitoring app automatically finds this peak and integrates it to calculate your overall tremor amplitude in centimeters. The app senses tremor in all directions (x,y,z) of the phone and calculates your overall magnitude.

Lift Pulse allows you to compare your tremor to a pre-set baseline. To set your baseline (this could be on an average day for you), take a reading and then tap on the circle showing your amplitude in Cm. Any future tremor measurement and monitoring readings will be compared to this saved baseline and the circle showing your amplitude will change (from blue to red) depending on how much above or below the baseline you are.

The best news is that this tremor measurement and monitoring app is currently free! It is our hope to spread goodwill and generosity in order to support those in need of help. If you have any suggestions, please leave a comment or contact us at info@lynx-design.com.

Lift Labs, part of Lynx Design, is a group of highly talented people
who are working to create new technologies for the social benefit.

Parkinson’s is a disease that, in addition to causing neurological challenges, can affect your neuromuscular and skeletal system. So regardless of your stage of the disease, it’s important that you understand its potential effects and where the challenges may manifest themselves. If you’re experiencing some of the symptoms below, it would be helpful for your exercise program to incorporate exercises that will address these conditions. If you’re primarily symptom free, a comprehensive and intensive exercise program will help you postpone or minimize the effects.

Back Pain

Back pain is common in the unaffected population as well as those with PD. I have found much success in both communities with a systematic treatment which combines heat, exercise, stretching, massage, and ice. Consult your doctor and ask if any of these techniques are appropriate for you. Finding the right combination can be extremely pain-relieving as well as physiologically beneficial.

Degradation of Posture

Left alone, the individual with PD may begin to approach what is called the Parkinson’s posture, which is a slumped forward position with protracted shoulders and forward turned hands. This is very difficult on the spine and can cause tightness of muscles in the chest and shoulders as well as tightness in the hip flexors and neck. This contributes to shoulder and low back problems. Here, strengthening the muscles of the upper back and the postural muscles of the spine is key to preventing and correcting this condition. You will also want to stretch the anterior (front) muscles of the upper body: the chest and shoulder musculature (the doorway stretch is excellent for this). You will also want to improve the strength of the posterior muscles of the upper back: rhomboids, scapular stabilizers, trapezius, etc. The stretching of the chest and the strengthening of the back muscles will help pull the shoulders back, the head up, encouraging the body into a more proper posture position.

Tremor

Dyskenesia or involuntary movement can occur in the PD individual. This can be as subtle as a quiver of the lip to an extremely disrupting and frustrating shaking of a limb. Studies have shown that intense cardiovascular exercise performed on a consistent schedule can reduce the intensity of the symptom. The stationary bike is a wonderful and safe option, as is swimming, jogging, power walking, boxing, elliptical, water aerobics, and others. So dedicate yourself to 30–50 minutes of this exercise 3 to 5 times a week.

Muscle Stiffness

You may experience muscle stiffness with PD. You need to focus on getting oxygen to the muscles through exercise and implementing stretch and massage as much as possible. Dedicating 20–30 minutes a few times a week just to stretching and massage will make a difference. But always, always, always, begin this with a 10 minute warm up. There is no point in stretching a cold muscle. This puts undue stress not only on the muscle, but on the tendon that attaches the muscle to the bone. The type of stretch most of us have been taught is what is called a static stretch. This involves holding a stretch of the muscle from attachment point to insertion point. Another very useful type of stretching called myo facial release. Myo facial release stretching involves applying pressure to the belly of a muscle, while it is being stretched statically, or from end to end. This can be a great way of loosening up the soft tissues.

Reduction in Range of Motion

Joint stiffness and reduced activity will cause losses in functionality and reduction in range of motion. The best approach to improve this is through a combination of strength training, flexibility, and movement. You’ll want to improve the suppleness of the joints by keeping the ligaments, tendons and muscles soft and pliable. And you’ll want to improve the strength of the musculature around the joint so that the limbs can lift and rotate through the proper ranges of motion. Muscle stiffness and reduction in oxygen to the muscles of the core and postural musculature can create difficulty in trunk or torso rotation and contribute to poor posture. Chair rotation exercises involving hip stabilization and trunk rotations while attempting to maintain proper spinal alignment can be a wonderful way to open up the body and drive nutrients and oxygen to the muscles and soft tissues.

Balance Challenges

The ability to maintain balance requires muscle strength and proprioceptive awareness. When balance is lost, the individual must be able to react, correct, and stabilize. The components to work on to improve balance are muscle strength, proprioceptive awareness, and stepping drills that imitate common lower extremity movement patterns that will help correct and improve stability. PD can cause slowness of movement or problems with initiation of movement. Speed drills and exercises involving exaggerated movement can help. If you’re taking small and slow steps, push yourself to both exaggerate your movements and move quicker than you feel you’re able. You may be uncomfortable at first, but most likely, you’ll be moving at a safer and more appropriate speed.

Freezing

Freezing often is a symptom that can affect an individual with PD. There are tricks you can find that will get you beyond this point. Everyone is different and you must find the technique that works best for you. The first thing you should do is to stop, and reset. Take a moment to reset your posture. Take a deep breath and get a clean slate. Your feet may feel glued to the ground. If this is the case, one of the tricks is to focus your sight on a point beyond your destination and make that your target destination. Then begin shifting your weight from side to side, back and forth, as you gradually begin to lift your feet. When you feel you’re ready, take a big step forward and initiate your walk. Make it a big first step and stride forward with exaggerated movements. But always move with a focus on balance and safety.

Loss of Proprioceptive Awareness

As PD progresses there is a tendency to lose your awareness of where your limbs and body are positioned (1). In studies, the medications associated with PD such as Levodopa have shown to also interfere with this sense. Exercises such as open and closed eye balancing exercises have been shown to improve this awareness. A useful tool for improving this is the balance board or the Bosu ball or a foam pad. Always practice balance with a stabilizing object near by for safety because to improve this awareness, you must encounter moments of instability.

Difficulty with Eye Tracking

Testing of PD individuals has shown that there is a progressive difficulty of hand-eye coordination as well as a loss of the ability to track an object with the ocular muscles (the muscles that control the eyes). Training ocular muscles can be as simple as holding a thumb up and following it from left to right. Incorporate activities that involve hand eye coordination challenges into your exercise program. This can be both effective and fun.

References:

• Sponsor of study: Department of Veteran Affairs, Collaborator University of Iowa. Title: Effects of Aerobic Exercise in Parkinson’s Disease. (1) J Neurol Neurosurg Psychiatry 2001; 71:607–610
• Journal of Neurology, Neurosurgery & Psychiatry “Proprioception in Parkinson’s disease is acutely depressed by dopaminergic medications.

By Patrick LoSasso, Certified Personal Trainer, CSCS.

Patrick is on the Board of Directors of The American Parkinson’s Disease Association Los Angeles Chapter. Patrick has developed a specialization in working with individuals with Parkinson’s disease (PD) called ReGenerations-PD (Rejuvenating Exercises for the Generations living with Parkinson’s Disease). Above is an excerpt from his exercise manual The BrainBall-FX. If you have any questions you may email him atPatrick@PreventionThruFitness.com.

Both Essential Tremor and Parkinson's Disease are common movement disorders that affect many people around the world. Tremor can occur at rest (resting tremor), while holding objects (postural tremor) or during movement (action/intention tremor). Tremor can also effect the head (usually essential tremor) and/or the vocal cords (when isolated spasmodic dysphonia). Neither of these movement disorders can be diagnosed with blood tests or MRI/CT brain imaging technologies. However, brain scans can help rule out structural causes of some movement disorders.

Essential Tremor is the most common movement disorder in the world and is 25x more prevalent than Parkinson’s Disease. Since both Essential Tremor and Parkinson’s Disease patients have symptoms of tremor, it is extremely difficult to self diagnose. Both of these movement disorders can worsen with fatigue, mental or physical stress, anxiety, and too much caffeine (stimulants).

Both movement disorders can be caused by genetics. More than 60% of patients with Essential Tremor have had some sort of family history with the disorder. The ties between Parkinson’s Disease and genetics are much more subtle; only 2-5% of Parkinson’s Disease patients report strong family history. Scientists have recently begun researching the genes that cause both of these movement disorders with the intent of finding the best way to prevent and cure them.

Tremor disorders are difficult to diagnose even for neurologists who have several years treating patients with Essential Tremor and Parkinson’s Disease. Unfortunately, most patients are not referred to neurologists with fellowship training in movement disorders from an accredited neurology residency program — there are many patients who are only referred to fellowship trained movement disorder neurologists when their symptoms worsen significantly. Also there are many neurologists that call say they are movement disorder specialists but who have never done any specialized training. Medical boards and the American Academy of Neurology have not yet prevented neurologists in from falsely advertising their training qualifications to the public. Those neurologists that haven't done a fellowship and are at academic institutions in the movement disorder department have the equivalent of having done a fellowship. An accurate and early diagnoses is very important for correct treatment. If a patient isn’t diagnosed correctly, they can end up taking the wrong medications and go through unnecessary surgeries. For example, Deep Brain Stimulation (DBS) treats both Parkinson's Disease, Essential Tremor, but the surgery is performed in different locations in the brain.

Tremor

A “tremor” is defined as an involuntary and often rhythmic movement of an isolated body part. Essential Tremor is also known as a familiar or benign tremor. Tremors often start in the arms and move to different parts of the body. Essential Tremor can start at any age. The involuntary movements that happen with ET are more obvious during action and in good posture. In most cases, ET affects the hands and also commonly effects the head, face, vocal cords, legs, and torso. Alcohol is known to temporarily reduce the strength of muscle tremors. Patients with ET can normally walk without problems, but some feel unsteady during movement at times.

Parkinson’s Disease and Essential Tremor Pearls of Diagnosis

Parkinson’s Disease patients tend to have a shuffling gait, a bent posture, shorter strides, and a hard time turning quickly. Parkinson’s Disease is usually occurs after the age of 65, however, young onset Parkinson's can occur between age 21-40. PD also characterized by muscle rigidity, tremor, and Hypokinesia (slower movement). Parkinson’s Disease is known to have it’s tremors start in one arm and move to the other. Parkinson’s Disease tremors are usually more obvious when in a relaxed (resting) position.

The tremor in Parkinson's Disease is 4-6 Hz (cycles per second) and the tremor in Essential Tremor is faster 8-13 Hz.

 Parkinson’s Disease patients never have isolated vocal cord or head tremors.

 The slowing of physical movement (bradykinesia), rigidity and a masked or poker face occur in PD but not in ET.

In Essential Tremor walking is normal and most of the patients only have difficulty with heel to toe walking. Patients with ET do not develop any other physical signs except for progressive worsening of their tremor.

Also up to 70% of Essential Tremor patients report their tremor improved with alcohol and is not effective in Parkinson's Disease unless the alcohol is treating anxiety worsening the tremor.

Non-physical signs (3-15 years prior) of Parkinson’s Disease include:

• Decreased or complete lose of ones sense of smell
• Constipation
• Depression
• High risk: REM Behavior Sleep Disorder (RBD)

Secondary Parkinsonism (SPD) can be mistaken for Parkinson’s Disease because the symptoms look very similar. Secondary Parkinson's Disease is also called Parkinson's Plus or Atypical Parkinson's Disease. It can by caused by medications (drug induced Parkinson's disease), neurosyphilis, encephalitis, strokes (Vascular Parkinson's Disease). Physical signs and symptoms can mimic Idiopathic Parkinson’s Disease making it very difficult to diagnosis general neurologist and sometimes movement disorder neurologists. Parkinson’s Disease medications and Deep Brain Stimulation are not effective against Secondary Parkinson's Disease, so an accurate diagnosis is very important. Secondary Parkinson's Diseases do not or minimally respond (<30%) to carbidopa/levodopa (at least a 200-300 mg).

The more well known Secondary Parkinson's Diseases are Multiple System Atrophy (Striatonigral Degeneration, Shy Drager, Olivopontocerebellar Atrophy), Progressive Supranuclear Palsy, Corticobasal Ganglionic Degeneration, Diffuse Lewy Body Disease (Lewy Body Dementia).

Red Flags for Secondary Parkinson's Disease that indicate one does not have idopathic (typical) Parkinson's Disease are:

1. Early Dementia
2. Early Onset of Postural Instability
3. Early Onset of Hallucinations or Psychosis with low doses of Carbidopa/Levodopa (Sinemet) or Dopamine Agonists (Mirapex or Requip).
4. Paralysis or restricted eye movements in the up or down direction
5. Early Urinary Incontinence or more than a 20 point drop in the systolic blood pressure or pulse when going from a laying, sitting to standing position (orthostatic hypotension). This indicates early involvement in the autonomic nervous system.

Secondary Parkinson’s Disease can be also caused by, among other things:

• Medications- Depakote, Reglan, Haldol, Zyprexa, Abilify, Geodon, Risperdal, Phenergan, Amiodarone and other medications.
• Head trauma
• Normal Pressure Hydrocephalus

DATScan has been able to detect the difference between Essential Tremor & Parkinson's Disease in clinical trials.

GE Healthcare recently announced DATScan, ioflupane iodine–123 injection, a contrast agent for use with single-photon emission computed tomography (SPECT) for detecting dopamine transporters (DaT) in suspected parkinsonian syndromes.

The DaT visualization was created to help differentiate essential tremor and drug induced parkinsonism from tremor due to parkinsonian syndromes (including idiopathic Parkinson’s disease, multiple-system atrophy, and progressive supranuclear palsy, as an adjunct to other diagnostic modalities). These new SPECT scans show abnormal distribution of DaT in parkinsonian syndromes but are normal in other conditions, such as essential tremor and Alzheimer’s disease.

New Diagnostic Adjunct

Currently, movement disorders are diagnosed with clinical and laboratory tests as well as neuropsychological evaluations, "which are not conclusive and may lead to misdiagnosis.

FDA Advisory Panel

"This might make a real difference in 5% of patients seen by movement disorders specialists and 15% of patients seen by general practitioners, and that's an important number of patients," committee member Nathan Fountain, MD, associate professor of neurology at the University of Virginia, Charlottesville.

"There are many circumstances I can think of and imagine where this could be a benefit, and the risks are very low," said Karl Kierburtz, MD, MPH, committee member and professor of neurology and community and preventive medicine at the University of Rochester, New York.

Dr. Kierburtz noted that in many instances DaTscan could help improve the diagnostic accuracy by clinicians and decrease some of the problems associated with other means of differential diagnosis — such as medication challenges, which often work poorly in the elderly or patients with dementia.

Committee members emphasized that DaTscan was not suitable for screening or prognosis on its own. "We don't want to make this the gold standard for diagnosing Parkinson's disease.

Watch a promotional video for DATScan on GE Healthcare's website.

Safety Concerns and Practical Issues

Joel Perlmutter, MD, professor of neurology at Washington University School of Medicine, St. Louis, Missouri, said that after reviewing the scientific literature, he did not think that DaTscan was cost-effective. Between the cost of DaTscan ($1500 per scan) and a month’s trial of carbidopa or levodopa for a patient with possible PD ($150), the price can easily become unbearable. Joel said “it wouldn’t change how I would treat a patient.”

There are always issues with scans that require an active substance, such as iodine, into the body since some individuals have known sensitivities. GE Healthcare gave the following warning in their release notes: “To decrease thyroid accumulation of I–123, block the thyroid gland at least 1 hour before administration of DaTscan; failure to do so may increase the long term risk for thyroid neoplasia.”

GE has also stated that in clinical trials, adverse reactions such as headache, nausea, vertigo, dry mouth, and mild to moderate dizziness were reported. Hypersensitive and painful reactions in the injection site have also been documented.

Overall, the DATScan machine is promising. It’s new technology, but I believe it will soon be a valuable tool for diagnosing Parkinson’s Disease and Essential Tremor.

Learn more about DATscans at Medscape
Visit GE Healthcare to read/view DATScan promotional material