Objective: To present a case of a post-stroke rubral tremor which benefited from compression therapy to the affected arm, improving medication-refractory tremor.

Background: Rubral and ataxic tremor remains a difficult condition to treat with medications often unsuccessfully controlling symptoms.  Compressive therapies have been reported with some success in treating multiple sclerosis related tremors [3], and we evaluate one case of response in stroke-induced rubral tremor.

Method: A 67 year old right handed lady presented with an acute right superior cerebellar ischemic stroke, with ipsilateral ataxia. 4 months later, she developed right arm tremor with posture, action and rest, which was disruptive in her rehabilitation and daily living. She also noted a milder tremor in the right leg as well in times of rest and action. She was diagnosed with rubral tremor and medications were tried including clonazepam, but were limited by sedation. She developed mild spasticity in the right arm, and received botulinum toxin injections 6 months after her stroke to the proximal right upper extremity with very mild benefit without side effect, but her tremor remained disruptive to her activities of daily living.

Results: Placing an elastic bandage wrap around the patient’s affected arm was noted to improve tremor at rest, as well as with activity. Tremor was also slightly improved on intention of finger-to-nose testing, but was still present to moderate degree. The patient was videotaped before and after placing compression sleeve, highlighting the benefit using this device .

Conclusion: This case demonstrates a successful treatment of a medically-refractory rubral tremor post-stroke. The mechanism in this particular instance highlights the suspected pathophysiology of cerebellar or ataxic tremors. Some evidence describes that cerebellar tremor is modulated through muscle stretch reflex oscillations as a result of dysfunction of feed-forward loops within the central nervous system [1]. Through proprioception feedback with a mild compression device, there may be stability of the affected limb which results in improvement of tremor. Previous studies have demonstrated benefit using compressive sleeves in hemiplegic strokes and tremor in multiple sclerosis [2,3]. Further studies are needed to see if this may benefit patients in the setting of post-stroke rubral tremor.

References: 1. Deuschl, G., Raethjen, J., Lindemann, M., & Krack, P. (2001). The pathophysiology of tremor. Muscle & nerve, 24(6), 716-735. 2. Gracies, J. M., Marosszeky, J. E., Renton, R., Sandanam, J., Gandevia, S. C., & Burke, D. (2000). Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients. Archives of Physical Medicine and Rehabilitation, 81(12), 1547-1555. 3. Miller, L., Wijck, F. van, Lamont, L., Preston, J., & Hair, M. (2016). Sensory dynamic orthoses in mild to moderate upper limb tremor in multiple sclerosis: a mixed methods feasibility study. Clinical Rehabilitation, 30(11), 1060–1073. Video references will be shown on a tablet with example of patient before and after intervention. Per discussion with MDS, video posters are not available for presentation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/compression-therapy-a-treatment-of-rubral-tremor/