Innovative Orthotic Helps Calm Hand Tremors

LENDING A HAND
Innovative Orthotic Helps Calm Hand Tremors 
By Margo Pierce

Originally published in Healthcare Journal Baton Rouge,
​March/April 2015

​Read the full article here:

http://www.healthcarejournalbr.com/the-journal/hjbr-contents-index/features/1919-lending-a-hand

After being diagnosed with Parkinson’s disease in 2012, Sara Hart did everything she could to prevent her symptoms from getting worse. She found a neurologist who specializes in the disease, participated in physical therapy, watched her diet – but her hands still shook. She had to all but give up quilting because she couldn’t thread a needle or use a pair of scissors. 

“A lot of the tremor has to do with your anxiety level,” Hart says. “If you’re in a really stressful, anxious situation – when you go out to dinner and you sit down to eat – sometimes you can pick up your fork and it’s not so bad. But other times you pick up the fork and try to eat and you’d be throwing salad everywhere. That’s an anxious moment.”

Frustrated but determined, she started working with Krista Madere, an occupational therapist with the NeuroMedical Center Clinic in Baton Rouge. They discussed the benefits of Google Liftware, an eating utensil with an electronic handle that senses and counterbalances hand tremors. An attractive alternative to weighted forks, the cost ($300) and limited use (eating only) made it clear this high-tech solution wasn’t going to help much.

That’s when Hart and Madere started experimenting and created a low-tech solution – the “Readi Steadi” glove.

From batteries to fishing lures

Madere spoke with some engineers about the problem of steadying shaking hands. The discussions circled around weights, lift, and balance, which made her think that some extra weight on the top of Hart’s hands might help settle the tremors. Dr. Gerald J. Calegan, Hart’s neurologist, says the approach makes sense. “We know that with any type of tremor disorder, weights decrease amplitude of movement. When patients lose weight, tremors increase. Instead of encouraging people to gain weight, selectively placing weights in key locations counterbalances movement,” he says.

The first step was to test Hart’s fine motor skills so that Madere could watch the tremors as they occurred. Based on that evaluation, Madere added a small amount of weight strapped to the back of Hart’s hands.

“Krista started out with putting two packages of batteries on my hands, six AAA batteries in each one,” Hart says. “I wore that from Monday until I came back to see her on Wednesday. I told her I did feel as though it did help slow down the tremor.”

Hart was happy to be part of the trial-and-error process because she hadn’t been able to find any existing products that would help control the shaking in her hands. Like most people with any kind of tremor, Hart was aware of her “good” days and “bad” days – how her hands shook and the intensity of the movement. That was essential in Madere’s experiments.

“Miss Sara’s tremors change day to day, so we didn’t want to place something too heavy on her hand (because) she might not need that much weight every single day,” Madere says. “I came up with weights that are low-profile and they’re in two-ounce increments. She can place as little as two ounces on her hand or as much as 12 ounces. Also, we noted that strategically placing the weight made a difference. For example, she benefits the most when the weight is placed on the back of her hand right proximal to her knuckles. Other days she does better when the weight is placed closer to her thumb.”

The first weights were fishing lures. The small size made it easier for Madere to easily control the placement and amount of weight. But she needed something to attach the weights to, something that would be easy for Hart to adjust. So Madere chose molded plastic normally used to create a splint to customize a cover for the back of Hart’s hand but not cross the knuckles or wrist. Then she put Velcro on the plastic as well as the weights.

Just as the batteries weren’t an attractive accessory, the weights were unsightly. So Madere used a nylon, nude-colored, arthritis compression glove to cover the orthotic. 

“I wanted something that the patient wasn’t embarrassed to wear in public … and wouldn’t restrict their range of motions,” she says. “Once you start restricting wrist and finger range of motion, then you’re at risk for joint stiffness and other problems. This doesn’t cross the joints. It can if needed.”

Hart wore the new orthotics daily and regularly met with Madere to fine-tune the device. Hart adjusts the weights first thing in the morning, slips on the gloves and gets on with her day. She can use regular eating utensils, write without the aid of a special pen, and perform other tasks she thought she’d given up for good.

The only limitation she has is not being able to get her hands wet. Even though the nylon is washable and the weights are plastic coated, Madere says she needs to develop gloves from a waterproof material. An added benefit, according to Hart, is that she’s had “to give up doing dishes.”

Gloves, not surgery

Recognizing that the results of one test are hardly conclusive, Madere wanted to see what the neurologists at her facility thought of the device. So she arranged for Hart to demonstrate with a before/after test of fine motor skills. Calegan is one of the group who watched the demonstration. He was impressed and sees potential benefits for other patients.

“It was exciting because all the neurologists saw the transformation right before our eyes,” he says. “This device has the potential to spare patients from taking medication (for tremors) which can be costly and have side effects. Some patients with tremor see great results with Deep Brain Stimulation, but this hand orthotic could keep individuals from having brain surgery. This device has the potential to allow patients … to have a better quality of life in a non-invasive manner and relatively inexpensive way.”

He believes future testing will show this device can help people with “any disorder that can cause tremor—dystonia, cerebellar disorder, Parkinson’s, and essential tremor.”

Madere expects to see more patients in the coming months now that the neurologists are referring qualified patients. And she couldn’t be happier.

“It’s my job to help my patients to be as independent as possible,” she says. “Creating a custom device specifically for a neurological patient with tremors has been really rewarding.