Improving functional disability in patients with tremor: A clinical perspective of the efficacies, considerations, and challenges of assistive technology

Abstract

Despite advances in treatments for tremor disorders, many patients are still left with functional disability affecting both basic and complex tasks needed for independent living, reflecting a significant gap in the current management of tremor disorders. Assistive devices present a possible solution to bridge the gap between symptom burden and current therapies, offering safe and effective tremor suppression. Although not yet considered as an option in most therapeutic guidelines for tremor disorders, assistive technologies (AT) offer a unique opportunity as adjunctive interventions utilising new portable technologies at lower cost, with minimal adverse effects. Here, the clinical concept of Human Activity Assistive Technology model via two groups of AT (limb weights and handheld devices; orthoses and exoskeletons) in patients with tremor is reviewed, supported by clinical evidence on reduction of tremor severity or improved functional performance. Although most devices are prototypes with limited clinical evidence, many are approved as medical devices and are commercially available. However, despite increased availability of these devices, there are still barriers to their adoption, mostly influenced by perceptions on privacy, trust, and functionality/added value. Long-term adherence to these devices is also unknown. In order to promote accessibility and usability of AT for tremor, an evaluation consensus by an interdisciplinary team (users, prescribers, and technicians) is required to identify those in need and to offer device recommendations. Future developments of AT for tremor should improve user comfort by incorporating softer, lightweight materials and explore new mechanisms to enhance wearability and long-term efficacies. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.

Keywords: Accessibility; Essential tremor; Limb weights; Orthoses, exoskeletons; Parkinson's disease; Tremors; Usability.