The Effect of Vibrotactile Stimulation on Parkinson's Tremor

The Effect of Vibrotractile Stimulation on Parkinson's Tremor - an Explorative Study

Tremor in Parkinson's disease is a common and highly burdensome symptom. Recent evidence shows that areas in the brain that are underlying Parkinson's tremor overlap with those that respond to somatosensory stimulation. Applying such stimulation to the tremulous limb might therefore influence tremor-related brain activity and thereby potentially reduce tremor. In this study, the investigators explore this possibility and investigate whether tremor specific vibrotactile stimulation at the wrist of the most affected arm influences tremor severity.

Study Overview

• Status: Completed
• Conditions: Parkinson Disease; Tremor
• Intervention / Treatment: Device: Vibrotactile stimulation at tremor frequency; Device: Vibrotactile stimulation at tremor frequency*1.5; Device: Vibrotactile stimulation at continuous stimulation; Device: Vibrotactile stimulation 10% below and above step frequency

Detailed Description

Parkinson's disease (PD) is the second most common neurodegenerative disease, of which tremor is a common and highly burdensome symptom. The pathophysiology of tremor involves a cerebral network that consists of basal ganglia and a cerebello-thalamo-cortical motor circuit. Emerging evidence suggests that somatosensory input from the tremulous limb to the brain may influence this network. Specifically, tremor-related activity was observed in primary and secondary somatosensory cortex, and thalamic cells involved in tremor appear to be responsive to somatosensory stimulation as well. Somatosensory afferents may thus play a role in tremor pathophysiology and could therefore be used as treatment target. Here, the investigators will test this hypothesis by investigating the effect of modulating somatosensory input (with vibrotactile stimulation) on tremor severity.

The primary objectives are 1) to test whether rhythmic somatosensory input (vibrotactile stimulation) at tremor frequency reduces tremor power of Parkinson's tremor as compared to vibrotactile stimulation at 1.5 times tremor frequency and 2) whether continuous 80Hz vibrotactile stimulation reduces tremor power as compared to sham stimulation. As secondary objectives, the investigators will test whether the effect of vibrotactile stimulation on tremor power depends on the context in which tremor occurs (rest, cognitive coactivation, posture), whether stimulation at tremor frequency reduces tremor power as compared to sham stimulation, and whether vibrotactile stimulation has an effect on two other common PD symptoms: impaired gait and bradykinesia. The investigators will include 27 patients with Parkinson's disease and rest as well as postural tremor. The intervention involves subtle mechanical vibrations on the wrist or ankles. This is a non-invasive and painless way to provide somatosensory stimuli, in a continuous (80Hz) or rhythmic fashion (brief bursts of 80 Hz at tremor or step frequency).

The investigators expect that this study will provide mechanistic insights into if and how somatosensory (vibro-tactile) afferents influence the cerebral tremor circuit in Parkinson's disease, and may provide a solid basis for designing further clinical treatment studies.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Netherlands
  • Gelderland
    • Nijmegen, Gelderland, Netherlands, 6500HB
      • Donders Centre for Cognitive Neuroimaging

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 18-80 years old and able to provide informed consent
• Have a diagnosis of idiopathic PD made by a movement disorders specialist
• Medically optimized without planned medication changes for the duration of the study • Resting tremor subscore >/= 2 of the most-affected arm on the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) item 2.10
• Postural tremor subscore >/= 1 of the most-affected arm on the MDS-UPDRS item 3.15
• Signed informed consent

Exclusion Criteria:

• The presence of additional neurologic diseases that might confound testing or the coexistence of PD and essential tremor together (action tremor that was present prior to the development of parkinsonism)
• Moderate to severe peripheral neuropathy (reduced vibratory sensation) at the upper extremities, quantified with a graduated tuning fork
• Montreal cognitive assessment (MoCA) score < 20 or previously documented dementia
• Unable to walk without walking aid

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Vibrotactile stimulation atdifferent settings; All participants receive vibrotactile stimulation at three different stimulation settings as well as one sham condition. Specifically, stimulation is applied at (1) brief bursts of 80Hz that occur at the individual tremor frequency, (2) 80Hz bursts at tremor frequency*1.5, and (3) continuous stimulation at 80Hz. The sham condition does not involve any stimulation. All of the stimulations will be applied under three different contextual manipulations: during rest, posture and cognitive coactivation (serial subtraction task). Within each context, stimulation/sham conditions are applied in random order.

Device: Vibrotactile stimulation at tremor frequency; Mechanical vibrations are applied at brief bursts of 80Hz that occur at the individual tremor frequency. Vibrations are delivered via a small device, which is worn on the wrist of the most-affected arm.; Device: Vibrotactile stimulation at tremor frequency*1.5; Mechanical vibrations are applied at 80Hz bursts at individual tremor frequency*1.5. Vibrations are delivered via a small device, which is worn on the wrist of the most-affected arm.; Device: Vibrotactile stimulation at continuous stimulation; Continuous 80Hz stimulation is applied via a small device worn on the wrist of the most-affected arm.; Device: Vibrotactile stimulation 10% below and above step frequency; This intervention is applied during assessment of gait. Two devices are worn on both ankles which allows alternating stimulation of both ankles with brief bursts of 80 HZ at the individual step frequency plus or minus 10%.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The effect of vibrotactile stimulation at tremor frequency on tremor severity with active control	The investigators will investigate the effect of frequency specific stimulation compared to an active control condition, averaged across three different contexts (rest/posture/cognitive coactivation). Specifically, we will test the change in log transformed tremor power from baseline to stimulation, as a function of stimulation setting (bursts at tremor frequency vs. bursts at 1.5 times tremor frequency).	25 minutes
The effect of continuous vibrotactile stimulation on tremor severity	The investigators will investigate the effect of continuous stimulation compared to sham stimulation, averaged across three different contexts (rest/posture/cognitive coactivation). Specifically, we will test the change in log transformed tremor power from baseline to stimulation, as a function of stimulation setting (continuous 80Hz stimulation vs. sham). For the two primary outcomes measures, Bonferroni correction will be applied to correct for multiple comparisons.	25 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The effect of vibrotactile stimulation at tremor frequency on tremor severity with passive control	The investigators will explore the change in log transformed tremor power from baseline to stimulation, as a function of stimulation setting (bursts at tremor frequency vs. sham).	25 minutes
The effect of continuous vibrotactile stimulation on bradykinesia	The average button presses per second in the keyboard finger tapping test during continuous 80Hz stimulation versus sham will be investigated.	10 minutes
The effect of vibrotactile stimulation on gait	Time to complete the timed up and go task will be investigated, comparing stimulation 10% above step frequency/10% below step frequency/sham	10 minutes
The effect of vibrotactile stimulation on freezing	Number of freezing episodes during the timed up and go task will be investigated, comparing stimulation 10% above step frequency/10% below step frequency/sham	10 minutes
Investigating the effect of vibrotactile stimulation at tremor frequency on tremor severity in 3 different contexts	The investigators will explore the change in log transformed tremor power from baseline to stimulation as a function of stimulation setting (bursts at tremor frequency/bursts at 1.5 times tremor frequency) and context (rest/posture/cognitive coactivation).	25 minutes
Investigating the effect of continuous stimulation on tremor severity in 3 different contexts	The investigators will explore the change in log transformed tremor power from baseline to stimulation, as a function of stimulation setting (continuous 80Hz stimulation vs. sham) and context (rest/posture/cognitive coactivation).	25 minutes

Collaborators and Investigators

• Sponsor: Donders Centre for Cognitive Neuroimaging
• Collaborators: Parkinson's Foundation

Study record dates

Study Major Dates

• Study Start (Actual): November 30, 2021
• Primary Completion (Actual): May 19, 2022
• Study Completion (Actual): May 19, 2022

Study Registration Dates

• First Submitted: November 25, 2021
• First Submitted That Met QC Criteria: December 7, 2021
• First Posted (Actual): December 10, 2021

Study Record Updates

• Last Update Posted (Actual): February 15, 2023
• Last Update Submitted That Met QC Criteria: February 14, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: Parkinson disease; Tremor; Vibrotactile stimulation
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Dyskinesias; Parkinson Disease; Tremor
• Other Study ID Numbers: NL77202.091.21; 2021-12968 (Other Identifier: Commissie Mensgebonden Onderzoek)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No