Table 3.
Studies on the effect of intervention on Balance and Gait in Essential Tremor
| First Author, Year | ET (n) Control (n) | Age (Years) | Intervention | Assessment | Outcomes | Results |
|---|---|---|---|---|---|---|
| Ondo et al.53 | 13 ET | 72.8 | Thalamic stimulation | QP (sensory organization test) | 1. Time to onset of compensatory movements; 2. Amplitude of compensatory movements |
Performance on the sensory organization test was worse with DBS off and improved with DBS; |
| Fasano et al.51 | 11 ET 10 control |
69.8; 67.3 |
Bilateral thalamic stimulation | NE; QG (standard and tandem walk on treadmill) |
1.Tremor rating scale; 2. Intention tremor score; 3. Spiral score; 4. Postural tremor score; 5. Overground tandem gait velocity; 6. Overground tandem number missteps; 7. Ataxia score; 8. Swing duration CV; 9. Range of motion |
1. Total tremor score, intention tremor, postural tremor, and spiral tremor, was reduced with thalamic stimulation; 2. Supra therapeutic stimulation improved tremor except during upper limb spirals; 3. Number of missteps was reduced on thalamic stimulation, but was higher than healthy controls; 3. Supratherapeutic stimulation increased number of missteps; 4. With assisted tandem gait on treadmill lower limb kinematics were highly variable; 5. Thalamic stimulation improved ataxia ratio and variability |
| Fasano et al.52 | 11 ET 10 control |
69.8; 67.3 |
Bilateral thalamic stimulation | NE; QG (standard and tandem walk on treadmill) |
1. ICARS score; 2. Gait speed; 3. Stride length; 4. Swing duration; 5. Double support time; 6. Step width; 7. Step height; 8. Ataxia score; 9. Swing duration CV; 10. Range of motion |
1. Thalamic stimulation reduced intention and postural tremor; 2. Joint ROM in ET patients with normal kinematics was similar to controls; 3. ET patients with impaired kinematics (longer disease duration and greater intention tremor) had higher variability in joint movement; 4. Thalamic stimulation reduced joint variability in ET with impaired kinematics |
| Hwynn et al.56 | 38 ET | 67.1 | Thalamic stimulation (unilateral and bilateral) | NE; QG and falls assessment |
1. Fahn–Tolosa–Marin tremor rating scale; 2. Upper extremity scores (rest tremor, postural tremor, kinetic tremor, drawing spirals, pouring water into cup); 3. Gait and falls assessment |
1. About 70% of patients with unilateral thalamic stimulation and 55% with bilateral thalamic stimulation reported worsened gait; 2. Patients with worsened gait had poor baseline tremor scores |
| Earhart et al.24 | 13 ET; 13 control |
61.6; 63.2 |
Bilateral thalamic stimulation | NE; QG (preferred and tandem walk) |
1. ABC Scale; 2. Spatiotemporal gait measured with GAITRite mat; 3. BBS; 4. TUG |
1. ET patients demonstrated tremor reduction with stimulation; 2. During standard and tandem walk, ET patients walked with slower speed, lower cadence, and higher double support during ON and OFF stimulation compared with controls; 3. ET patients performed worse on clinical tests of balance compared with controls; 4. There were no differences with DBS on and off |
| Ulanowski et al.47 | 1 ET | 61 | Physical therapy (balance and functional movement training) for 14 sessions over 8 weeks | Standardized clinical assessment | 1. BBS; 2. FGA, 3. Five-times-sit-to-stand test 4.10-m walk test (10MWT). |
After 8 weeks of therapy, the patient had clinically meaningful changes in the five-times-sit-to-stand test, FGA, and BBS. The improvement reduced fall risk |
Abbreviations: ABC, Activities of Balance Confidence; BBS, Berg Balance Scale; CV, Coefficient of Variation; ET, Essential Tremor; FGA, Functional Gait Assessment; ICARS, International Cooperative Ataxia Rating Scale; NE, Neurological Examination; QG, Quantitative Gait; QP, Quantitative Posturography; TUG, Timed Up and Go.