Development and Pilot Testing of the Tremor Retrainer Smartphone Application for the Treatment of Functional Tremor

Tremor Other Hyperkinet Mov (N Y). 2023 Dec 19:13:45. doi: 10.5334/tohm.823. eCollection 2023.

Abstract

Background: Functional tremor is a common and disabling condition with limited treatment options. A prior proof-of-concept pilot study sought to translate entrainment, a key diagnostic feature of functional tremor, into a treatment strategy.

Methods: The Tremor Retrainer smartphone application was developed though a collaboration between neurologists and a software engineer. It analyzes data from smartphone accelerometers to measure baseline tremor frequency, then provides auditory cues at a lower frequency for the patient to match with flexion-extension movements at the wrist. The application provides continuous biofeedback on performance via a visual gauge. Patients with functional tremor underwent a one-week treatment protocol with the Tremor Retrainer application and provided feedback on usability and acceptability to guide software programming.

Results: Three pediatric patients completed the one-week protocol and their feedback was used to modify the software. All patients felt that the application was easy to use and could be effective in treating functional tremor.

Discussion: The Tremor Retrainer smartphone application uses auditory cues and a visual gauge to provide a personalized and widely accessible entrainment-based intervention. Pilot testing in pediatric patients provided key feedback for application design.

Highlights: The Tremor Retrainer smartphone application modulates functional tremor frequency by providing pulsed auditory cues for a patient to match with wrist flexion-extension movements while receiving continuous biofeedback via a visual gauge. This adaption of the diagnostic sign of entrainment has potential as an accessible treatment for patients with functional tremor.

Keywords: entrainment; functional; smartphone; treatment; tremor.

MeSH terms

  • Child
  • Humans
  • Mobile Applications*
  • Movement
  • Pilot Projects
  • Smartphone
  • Tremor* / diagnosis
  • Tremor* / therapy

Grants and funding

This project was funded by the University of Virginia Department of Neurology. JG and GB authors report no commercial associations relevant to this work. The University of Virginia Patent Foundation filed a provisional patent application on November 16, 2023. Dr. Espay has received grant support from the NIH and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Neuroderm, Amneal, Acadia, Avion Pharmaceuticals, Acorda, Kyowa Kirin, Supernus (formerly, USWorldMeds), and Herantis Pharma; personal honoraria for speakership for Avion, Amneal, and Supernus; and publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer. He cofounded REGAIN Therapeutics and is co-inventor of the patent “Compositions and methods for treatment and/or prophylaxis of proteinopathies.”