IP Requirement: Emory IP

Experience Requirement:

– Mechanical Design

– Rapid Prototyping

Deep brain stimulation (DBS) significantly improves symptoms for many patients with movement disorders who are unresponsive to medications. However, this invasive procedure has limitations, including potential side effects, high surgical costs and risks, limited access to care, patient or practitioner preferences, and high resource demands. Peripheral stimulation has emerged as a proposed alternative, involving external inputs—such as electrical pulses or vibratory stimulation—applied to peripheral nerves, muscles, or skin to regulate motor dysfunction. Non-invasive, wearable peripheral stimulators have gained attention due to their minimal risk and low cost. However, their efficacy remains inconsistent and varies across patients with movement disorders. Studies exploring peripheral stimulation differ substantially in stimulation parameters, including frequency, current amplitude, pulse width, and waveform patterns. These differences likely contribute to varying treatment outcomes. 

The only currently FDA-approved method for peripheral stimulation is transcutaneous electrical nerve stimulation (TENS), specifically employing a technique called transcutaneous afferent patterned stimulation (TAPS) [1]. TAPS involves bursts of non-invasive electrical stimulation alternating between the median and radial nerves at the wrist, with frequencies tuned to the individual patient’s tremor frequency. However, the reported effects are limited to a single implementation of TAPS, defined by specific waveform characteristics developed by single manufacturer (Cala Health). No comprehensive studies have compared TAPS to other TENS waveforms, nor have they clearly defined sham waveform parameters, leaving significant gaps in our understanding of its efficacy.

The objective of this project is to develop a TAPS system and evaluate its therapeutic benefits in comparison to non-TAPS and sham stimulation in a clinical setting. This will involve extending the hardware and software capabilities of a generic electrical stimulator currently available in the clinic. This approach aims to overcome the limitations of relying solely on the currently available commercial system with fixed parameters, offering the flexibility needed to test and optimize various stimulation paradigms. Such an approach will enable a more comprehensive investigation into the potential benefits of peripheral stimulation for patients with movement disorders. Students involved in this project will gain valuable hands-on experience in both engineering development and clinical assessment, fostering a multidisciplinary skill set. 

Reference

[1] Isaacson SH, Peckham E, Tse W, et al. Prospective home-use study on non-invasive neuromodulation therapy for essential tremor. Tremor and Other Hyperkinetic Movements. 2020;10(1):1-16. doi:10.5334/tohm.59