Editing Tremor (section)

===Biomechanical loading===
As well as medication, rehabilitation programmes and surgical interventions, the application of biomechanical loading on tremor movement has been shown to be a technique that is able to suppress the effects of tremor on the human body. It has been established in the literature<ref>{{Cite journal |last1=Castrillo-Fraile |first1=Victoria |last2=Peña |first2=Elena Casas |last3=Galán |first3=José María Trejo Gabriel y |last4=Delgado-López |first4=Pedro David |last5=Collazo |first5=Carla |last6=Cubo |first6=Esther |date=2019-12-05 |title=Tremor Control Devices for Essential Tremor: A Systematic Literature Review |journal=[[Tremor and Other Hyperkinetic Movements]] |language=en |volume=9 |doi=10.5334/tohm.511 |pmid=31867136 |pmc=6898897 |issn=2160-8288 |doi-access=free }}</ref>  that most of the different types of tremor respond to biomechanical loading. In particular, it has been clinically tested that the increase of damping or inertia in the upper limb leads to a reduction of the tremorous motion. Biomechanical loading relies on an external device that either passively or actively acts mechanically in parallel to the upper limb to counteract tremor movement. This phenomenon gives rise to the possibility of an orthotic management of tremor.{{citation needed|date=June 2022}}

Starting from this principle, the development of upper-limb non-invasive ambulatory robotic exoskeletons is presented as a promising solution for patients who cannot benefit from medication to suppress the tremor. In this area robotic exoskeletons have emerged, in the form of [[orthotics|orthoses]], to provide motor assistance and functional compensation to disabled people. An orthosis is a wearable device that acts in parallel to the affected limb. In the case of tremor management, the orthosis must apply a damping or inertial load to a selected set of limb articulations.{{citation needed|date=June 2022}}

Recently, some studies demonstrated that exoskeletons could achieve a consistent 40% of tremor power reduction for all users, being able to attain a reduction ratio in the order of 80% tremor power in specific joints of users with severe tremor.<ref name="TNRSE2007">{{cite journal |vauthors=Rocon E, Belda-Lois JM, Ruiz AF, Manto M, Moreno JC, Pons JL | year = 2007 | title = Design and Validation of a Rehabilitation Robotic Exoskeleton for Tremor Assessment and Suppression | url = https://digital.csic.es/bitstream/10261/24774/1/getPDF.pdf| journal = IEEE Transactions on Neural Systems and Rehabilitation Engineering | volume = 15 | issue = 3| pages = 367–378 | doi=10.1109/tnsre.2007.903917| pmid = 17894269 | hdl = 10261/24774 | s2cid = 575199 | hdl-access = free }}</ref> In addition, the users reported that the exoskeleton did not affect their voluntary motion. These results indicate the feasibility of tremor suppression through biomechanical loading.

The main drawbacks of this mechanical management of tremor are (1) the resulting bulky solutions, (2) the inefficiency in transmitting loads from the exoskeleton to the human musculo-skeletal system and (3) technological limitations in terms of actuator technologies. In this regard, current trends in this field are focused on the evaluation of the concept of biomechanical loading of tremor through selective Functional Electrical Stimulation (FES) based on a (Brain-to-Computer Interaction) BCI-driven detection of involuntary (tremor) motor activity.<ref>{{Cite web|url=http://www.iai.csic.es/tremor/|archive-url=https://web.archive.org/web/20120213122301/http://www.iai.csic.es/tremor/|url-status=dead|title=Tremor project&nbsp;– ICT-2007-224051|archive-date=February 13, 2012|access-date=Jun 4, 2020}}</ref>