Objective: To assess the effect of 9-week vibrotactile stimulation with cueing on static and dynamic balance, anxiety and fatigue in people with Primary Orthostatic Tremor (POT).

Background: POT is a rare hyperkinetic movement disorder marked by unsteadiness during standing, often associated with anxiety and fatigue[1]. It can lead to significant disability, including wheelchair dependence, and reduced quality of life (QoL)[2]. Pharmacological treatments are limited[3], and invasive surgeries like deep brain or spinal cord stimulation carry high risks[4]. A recent pilot study showed that vibrotactile stimulation with cueing through a non-invasive device was safe and potentially effective for Parkinson’s motor and non-motor symptoms[5], but its impact on POT remains unknown.

Method: This unblinded pilot study evaluated baseline measurements and compared immediate effects after a 20-minute acclimatization period with a vibrotactile cueing device, as well as cumulative effects after 9 weeks of daily 8-hour use. Outcomes included maximal stance time (MST) with feet together (FT) and apart (FA), MST during tandem stance, tandem walk (number of steps), heel raise hold (HRH), and Timed Up and Go (TUG) with and without a numeracy dual task. Patient-reported outcomes included the Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), and Patient Global Impression of Change (PGIC). All outcomes were exploratory, with Bonferroni correction for multiple comparisons (p≤0.005 for 10 tests).

Results: Eleven people with POT (27% male, 73% female; age: 58-88; disease duration: 1-30 years) were recruited. Immediate improvement trends were observed in MST FA (112.69±165.80 vs. 136.59±201.30, p=.028), TUG (11.06±3.06 vs. 9.48±2.22, p=.013), tandem stance (4.13±6.18 vs. 7.25±8.80, p=.015), tandem steps (2.73±4.00 vs. 4.36±3.69, p=.027), and HRH (4.68±4.42 vs. 6.93±5.43, p=.013) (Table 2). After 9 weeks, improvement trends were seen in TUG (11.06±3.06 vs. 8.48±1.69, p=.016), TUG with dual task (18.22±17.42 vs. 10.65±3.07, p=.026), tandem stance (4.13±6.18 vs. 12.96±15.55, p=.017), FSS (46.45±13.77 vs. 39.45±14.75, p=.021), and PGIC (2.50±1.08 vs. 3.55±1.51, p=.018). No adverse events were reported, with 100% compliance.

Conclusion: Vibrotactile cueing treatment shows potential in improving balance, reducing fatigue, and enhancing mobility in POT. Larger, controlled clinical trials are needed to assess long-term effects.

References: [1] Benito-León J, Domingo-Santos Á. Orthostatic Tremor: An Update on a Rare Entity. Tremor Other Hyperkinet Mov (N Y). 2016;6:411. Published 2016 Sep 22. doi:10.7916/D81N81BT
[2] Maugest L, McGovern EM, Mazalovic K, et al. Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor. Front Neurol. 2018;8:747. Published 2018 Jan 15. doi:10.3389/fneur.2017.00747
[3] Hassan A, Ahlskog JE, Matsumoto JY, Milber JM, Bower JH, Wilkinson JR. Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients. Neurology. 2016 Feb 2;86(5):458-64. doi: 10.1212/WNL.0000000000002328. Epub 2016 Jan 8. PMID: 26747880.
[4] Boogers A, Billet A, Vandenberghe W, et al. Deep brain stimulation and spinal cord stimulation for orthostatic tremor: A systematic review. Parkinsonism Relat Disord. 2022;104:115-120. doi:10.1016/j.parkreldis.2022.10.001
[5] Azoidou V, Rowsell K, Camboe E, Dey KC, Zirra A, Quah C, Boyle T, Gallagher D, Noyce AJ, Simonet C. A pilot interventional study on feasibility and effectiveness of the CUE1 device in Parkinson’s disease. Parkinsonism Relat Disord. 2025;133:107349.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vibrotactile-stimulation-with-cueing-as-promising-therapeutic-approach-in-orthostatic-tremor/