The effect of contraction type and intensity, mass loading and visual feedback on wrist tremor in individuals with essential tremor
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Objectives: Determine the effect of contraction type and intensity, inertial loading, and visual feedback on various measures of hand tremor in subjects with essential tremor. Methods: Study 1. Twenty-three ET subjects and 22 controls held their hand in an outstretched position while supporting various submaximal loads (no-load, 5%, 15% and 25% 1-repetition maximum). Hand postural tremor and wrist extensor neuromuscular activity (EMG) were recorded. Study 2. Twenty-one ET subjects and 22 controls applied isometric wrist extension contractions with and without visual feedback. Various submaximal contraction intensities were evaluated (5%, 10%, 20% and 30% MVC). Force production and EMG were recorded. Study 3. Twenty-one ET subjects and 22 healthy controls performed slow wrist extension-flexion movements while supporting various submaximal loads (no-load, 5%, 15% and 25% 1-repetition maximum). Angular displacement and EMG were recorded. Results: Study 1. Inertial loading resulted in a reduction in postural tremor in ET subjects. The largest reduction in tremor amplitude occurred at the 15% load, which was associated with spectral separation of the mechanical reflex and central tremor component. Despite an increase in overall neuromuscular activity with inertial loading, EMG tremor power did not increase with loading. Study 2. Higher contraction intensities were associated with larger amplitude force fluctuations and greater EMG amplitudes. Tremor spectral power of force and EMG remained constant at all target intensities, resulting in a reduction in relative tremor power at higher contraction intensities. Visual feedback affected subjects in the control and ET groups similarly. Study 3. Subjects with more pronounced tremor spectral peaks had larger amplitude kinetic tremor, which was reduced with inertial loading. Despite an increase in overall neuromuscular activity with inertial loading, EMG tremor spectral power was only slightly increased with loading, which resulted in a large reduction in relative EMG tremor power. Conclusions: The effect of inertial loading on postural and kinetic tremor amplitude appears to be mediated in large part by its effect on the interaction between the mechanical reflex and central tremor components. The level of motor unit entrainment remains relatively constant in subjects with ET despite increasing contraction intensities.