Development and Pilot Testing of a Novel Electromechanical Device to Measure Wrist Rigidity in Parkinson's Disease.

Quantitative assessment of the muscle tone is important when studying patients with neurological disorders such as Parkinson's disease (PD). For the assessment of therapeutic progress, quantitative and objective outcome measures are needed. This article presents a novel electromechanical device to monitor the quantitative rigidity of the wrist joint against passive movement. The novel device is equipped with an electrical motor to move the wrist joint in a flexion-extension manner with different velocity profiles. The accuracy of the device was measured in terms of position, velocity and torque accuracy. The feasibility of the measurement procedure was tested in a pilot study with four PD patients and 12 healthy controls (HC), at velocities of 10 °/s,50 °/s, and 100 °/s. {The position and velocity of the developed device were (0.005 ± 0.105)° and (0.734 ±0.276) °/s, unloaded, and (0.003 ± 0.113) ° and (0.013 ± 0.038) °/s, loaded with a relaxed arm, respectively. The torque accuracy was (15.029 ± 2.235) mNm. The comparison of the median rigidity between the PD patients and HC showed significant differences at all tested velocities, during both flexion and extension movements. This device proved to have sufficient accuracy and sensitivity to precisely measure the interaction torque at the wrist joint and to differentiate PD rigidity from normal muscle tone. The device, thus provides a quantitative and objective measure of rigidity in PD.

Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study.

BACKGROUND: Tinnitus is an often disabling condition for which there is no effective therapy. Current research suggests that tinnitus may develop due to maladaptive plastic changes and altered activity in the auditory and prefrontal cortex. Transcranial direct current stimulation (tDCS) modulates brain activity and has been shown to transiently suppress tinnitus in trials. OBJECTIVE: To investigate the efficacy and safety of tDCS in the treatment of chronic subjective tinnitus. METHODS: In a randomized, parallel, double-blind, sham-controlled study, the efficacy and safety of cathodal tDCS to the auditory cortex with anode over the prefrontal cortex was investigated in five sessions over five consecutive days. Tinnitus was assessed after the last session on day 5, and at follow-up visits 1 and 3 months post stimulation using the Tinnitus Handicap Inventory (THI, primary outcome measure), Subjective Tinnitus Severity Scale, Hospital Anxiety and Depression scale, Visual Analogue Scale, and Clinical Global Impression scale. RESULTS: 42 patients were investigated, 21 received tDCS and 21 sham stimulation. There were no beneficial effects of tDCS on tinnitus as assessed by primary and secondary outcome measures. Effect size assessed with Cohen's d amounted to 0.08 (95% CI: -0.52 to 0.69) at 1 month and 0.18 (95% CI: -0.43 to 0.78) at 3 months for the THI. CONCLUSION: tDCS of the auditory and prefrontal cortices is safe, but does not improve tinnitus. Different tDCS protocols might be beneficial.

Transcranial direct current stimulation for the treatment of focal hand dystonia.

The treatment of writer's cramp, a task-specific focal hand dystonia, needs new approaches. A deficiency of inhibition in the motor cortex might cause writer's cramp. Transcranial direct current stimulation modulates cortical excitability and may provide a therapeutic alternative. In this randomized, double-blind, sham-controlled study, we investigated the efficacy of cathodal stimulation of the contralateral motor cortex in 3 sessions in 1 week. Assessment over a 2-week period included clinical scales, subjective ratings, kinematic handwriting analysis, and neurophysiological evaluation. Twelve patients with unilateral dystonic writer's cramp were investigated; 6 received transcranial direct current and 6 sham stimulation. Cathodal transcranial direct current stimulation had no favorable effects on clinical scales and failed to restore normal handwriting kinematics and cortical inhibition. Subjective worsening remained unexplained, leading to premature study termination. Repeated sessions of cathodal transcranial direct current stimulation of the motor cortex yielded no favorable results supporting a therapeutic potential in writer's cramp.