Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review.
Nicolas Philip Fromme, Martin Camenzind, Robert Riener and 1 others
PMID 31319893WHAT IT FOUND
Existing upper-limb tremor orthoses suppress tremor by 63% on average in patients, matching medication, but are bulky and heavy.
They add about 20% weight to the arm, causing fatigue and rejection. Current designs fail ergonomics despite decent mechanical suppression.
Key findings
01Tremor suppression efficacy in patients averaged 63% across methods, which is in the range of medication efficacy (39-68% for ET) but was often supplementary to ongoing medication.
02Most orthoses are rigid and heavy, adding approximately 20% to the arm's weight, which leads to muscle fatigue and low user acceptance.
03Only 5 of the 21 identified orthoses were soft or non-rigid, highlighting a gap in comfortable, wearable designs.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review includes many small studies, often with single subjects, meaning efficacy data is not statistically robust. There is significant heterogeneity in tremor types (ET, PD, MS) and evaluation methods (PSD, RMS, AA), making direct comparison difficult. Test bench results, which show high efficacy, do not reflect real-world performance due to soft tissue interaction. The review focuses on mechanical and ergonomic properties but does not deeply analyse clinical outcomes like quality of life or long-term adherence beyond user reports.
Declared interests
The authors declare no competing interests. The study was not funded by a commercial entity selling the devices reviewed.
The easy way to misread this
Do not interpret the 63% average suppression efficacy as a recommendation to prescribe these devices. This figure is an average across heterogeneous studies with small sample sizes, and the devices are described as bulky and heavy, leading to user rejection. The efficacy is often supplementary to medication, not a replacement.