Essential Tremor

For this innovation project, students will research and analyze essential tremors and create a portable device to assist patients with fine motor skills in regards to eating with a utensil. Dr. Marc A. Marcum, father, husband, retired general surgeon and essential tremor patient, inspired students to create the ET Assist.
Essential tremor is a neurological movement disorder that causes involuntary, rhythmic sharking, especially in the hands (Johns Hopkins Medicine 2014). Essential tremor usually occurs with movements and can occur during many different types of activities such as, eating, drinking, or writing. Essential tremor often worsens when muscles are opposing gravity when hands are extended (Essential Tremor Handbook). It is usually

not present at rest. Although essential tremor affects the hands most severely, the arms, muscles of the trunk, face, head and neck may also display signs of a tremor. Head tremors may appear in a “yes-yes” or “no-no” fashion while the patient is seated or standing. Often times a patient’s voice is affected by the tremor. Essential tremor does not shorten the lifespan, however, it may interfere with fine motor skills such as using eating utensils, writing, shaving, applying makeup, and other daily activities (Mayo Clinic Staff). Essential tremor may be aggravated by several things including but not limited to emotional stress, anxiety, fatigue, hunger, caffeine, cigarette smoking and/or extreme temperatures.
Often times patients with essential tremor have similar signs and symptoms to a patient with Parkinson’s disease. Although the two disorders are similar, with Parkinson’s disease a patient’s hands continue to shake at rest. Similarly, with Parkinson’s patients often experience a stooped posture and slow movement. Essential tremor patients and Parkinson’s patients experience shaking and movement not only in the hands but the legs, chin and other body parts are also affected. Due to the similarities between both disorders, severe cases of essential tremor are often misdiagnosed as Parkinson’s disease (Genetics Home Reference).
In the United States, over 10 million people have essential tremor. This excludes cases that are so mild they are not brought to medical attention, or may not be detected in clinical exams. Researchers have yet to discover what causes essential tremor (Mayo Clinic Staff). However, some experts some environmental factors as well as several genes are likely to help determine an individual’s risk of developing this complex disorder. Essential tremor can be passed from generation to generation in families. In fact, about half of essential tremor cases are from a genetic mutation (Essential Tremor Handbook). It is unclear what causes essential tremor in people with a genetic mutation. This is an area of active research. In Dr. Marcum’s case, it is also unclear whether his history of Methicillin-resistant Staphylococcus Aureus (MRSA) infection has impacted his diagnosis.
Current test and treatment options involve exams, medication, non-medical therapies and surgery. Physicians often give patients a neurological exam, laboratory exams and performance tests. The most common performance test involves the patient using pen and paper to trace a simple spiral (Essential Tremor Handbook). The physician is able to track the progression or regression of the tremor based on the accuracy of the spiral. The patient’s decision to treat his or her tremor with medication depends on the side effects of said medication and if the patient is willing to take the risk. In other words, some medication may increase steadiness in one area, but may cause the voice to be weaker. In cases like these, doctors suggest that if both primidone and propranolol are not effective alone, a combination may provide better relief for selected patients (Johns Hopkins Medicine). The botulinum toxin injections are recommended for those with severe head tremor. Even though the head tremor does not affect most find motor skills, the embarrassment factor alone may cause patients to proceed with this form of treatment. The most common surgical option is deep brain stimulation, DBS, which stimulates the brain at high frequencies helping to nullify the signals that are sent to the hand and reduce the tremor (Mayo Clinic Staff). The advantage of DBS is that it is reversible and controllable, allowing the doctor to adjust the stimulator for maximum benefit and the least amount of side effects. The downside is that this treatment option is invasive and not all essential tremor patients are candidates for this procedure. There are however, non-surgical and non-medical therapy options. In some cases, weighting the limb to improve motor skills can reduce tremors (Essential Tremor Handbook). Due to anxiety and stress making the tremor worse in some patients, these non-medical therapy treatments can be effective and have fewer side effects.
This is where students feel there is a gap for a potential innovation to help patients with essential tremor to perform daily activities more easily than what is currently provided on the market. This problem exists for patients with essential tremor because the weighted utensils that are currently on the market are unattractive, embarrassing, difficult to assemble and not portable. The ET Assist, a weighted utensil pack designed by students, will provide a solution for these problems and ultimately help patients with fine motor skills like eating with a utensil. Figure 1 demonstrates the weighted writing utensil grip that is currently on the market to help patients reduce the tremor while writing. It provides a wide base grip and additional weight. However, at the end of the grip, there are at least three small screws that require patients to tighten with an allen wrench. This application process requires patients to ask for help before using the tool, another embarrassment factor. Another item that is currently on the market that aims to help patients is the weighted utensil (Figure 2). This item is unattractive, bulky, and inefficient particularly if a patient is eating anywhere else besides his or her home. The downside to the existing products is the inability to be portable, attractive and inconvenient.
Students use the Diffusion of Innovations Theory to create and evaluate the need for a product like the ET Assist.

Everett M. Rogers, creator of the theory, states “diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system,” (Rogers 1995). According to Rogers, the four main elements to diffuse the new idea are the innovation, communication channels, time and context. The characteristics an innovation needs to succeed are relative advantage, compatibility, complexity and trial-ability (Rogers 1995). The ET Assist is more likely to succeed if the communication channels are clear and open. Mass media channels like the Home Shopping Network or QVC are more effective in creating knowledge of the product. Interpersonal channels are more helpful when the attitude about the product needs to change, in turn influencing other patients and families to try the product. Rogers refers to this influential thought process as the innovation-decision process, “a mental process through which an individual passes from first knowledge of an innovation to forming an attitude toward the innovation, to a decision to adopt or reject, and to confirmation of this decision,” (Rogers 1995). In order for future buyers to become invested in this product Roger installed a five-step process to decrease uncertainty about an innovation’s expected lifespan. First, it is imperative for students to educate patients and families about

the ET Assist and how it functions. Without the proper knowledge, a patient will not become aware of the innovation and will not know how it works. Further information about the product can be found in subsequent paragraphs. Secondly, a person needs to be persuaded to purchase the ET Assist and create a favorable or unfavorable attitude toward the innovation. Next, a decision is made by the patient to adopt or reject the innovation. Ultimately, the patient implements the product in their therapy and every day life and finally confirms whether or not another product will be purchased. Depending on this confirmation, positive communication about the product will commence and the innovation will be marked as a success.
The first step in planning and executing the ET Assist is creating prototypes, launching pilot tests, adjusting the prototypes and garnering money to market and launch the product.

The purpose and idea behind the ET Assist is to create a portable, weighted grip that attaches to existing silverware. This allows the patient to go to restaurants, tailgates and dinner parties with the product to attach to utensils rather than carrying the embarrassing, existing product with them or being forced to eat without one. Prototypes will be developed that are dishwasher safe, available in packages of 3 utensils in attractive colors. The concept of being portable and attractive set the ET Assist apart from its competition. The materials, latches, and weights of the ET Assist have yet to be determined. Students have been advised to not share the technological ideas until a patent is filed. However, the prototypes will be pilot tested amongst patients and therapists, feedback will be taken into consideration and edits will be made. Students are open to the option of selling the patent and licensing the technology to an existing utensil or kitchenware company. Prices will be determined once the materials and manufacturing costs have been set. Students are not opposed to launching the ET Assist in a big-box retailer; however, it is a risky market for this type of medical

device.
Students will receive financial backing, knowledge and expertise from Greg Langdon, an angel investor from Louisville, Kentucky. Greg Langdon has a background in corporate and product strategy for technology businesses. He has experience in executive management, business development, marketing and public relations, acquisitions, product management, and software architecture and development (Pennington 2013).
In conclusion, there is a need for a product to help patients with essential tremor with fine motor skills. The existing products on the market are inefficient, embarrassing and lack knowledge of the essential tremor patient. Students will closely follow the Diffusion of Innovations theoretical framework to create a successful innovation that has the potential to reach 10 million Americans that suffer from essential tremor. By creating prototypes, testing amongst patients and generating a patent the ET Assist will be born. Students are recognizing a problem and are seeking a solution using innovation.