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Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor.


ABSTRACT: Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor.To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor.Ten patients with psychogenic tremor (5 women, mean age, 53.6 ± 12.8 years; mean disease duration 4.3 ± 2.7 years) were asked to participate in a pilot proof-of-concept study aimed at "retraining" their tremor frequency. Retrainment was facilitated by tactile and auditory external cueing and real-time visual feedback on a computer screen. The primary outcome measure was the Tremor subscale of the Rating Scale for Psychogenic Movement Disorders.Tremor improved from 22.2 ± 13.39 to 4.3 ± 5.51 (p = 0.0019) at the end of retrainment. The benefits were maintained for at least 1 week and up to 6 months in 6 patients, with relapses occurring in 4 patients between 2 weeks and 6 months. Three subjects achieved tremor freedom.Tremor retrainment may be an effective short-term treatment strategy in psychogenic tremor. Although blinded evaluations are not feasible, future studies should examine the long-term benefits of tremor retrainment as adjunctive to psychotherapy or specialized physical therapy.

SUBMITTER: Espay AJ 

PROVIDER: S-EPMC4028378 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor.

Espay A J AJ   Edwards M J MJ   Oggioni G D GD   Phielipp N N   Cox B B   Gonzalez-Usigli H H   Pecina C C   Heldman D A DA   Mishra J J   Lang A E AE  

Parkinsonism & related disorders 20140320 6


<h4>Background</h4>Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor.<h4>Objective</h4>To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor.<h4>Methods</h4>Ten patients with psychogenic tremor (5 women, mean age, 53.6 ± 12.8 years; mean disease duration 4.3 ± 2.7 years) were asked to partici  ...[more]

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