title: Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor.
abstract: BACKGROUND
  Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor.
  
  
  OBJECTIVE
  To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor.
  
  
  METHODS
  Ten patients with psychogenic tremor (5 women, mean age, 53.6 ± 12.8 years; mean disease duration 4.3 ± 2.7 years) were asked to participate in a pilot proof-of-concept study aimed at "retraining" their tremor frequency. Retrainment was facilitated by tactile and auditory external cueing and real-time visual feedback on a computer screen. The primary outcome measure was the Tremor subscale of the Rating Scale for Psychogenic Movement Disorders.
  
  
  RESULTS
  Tremor improved from 22.2 ± 13.39 to 4.3 ± 5.51 (p = 0.0019) at the end of retrainment. The benefits were maintained for at least 1 week and up to 6 months in 6 patients, with relapses occurring in 4 patients between 2 weeks and 6 months. Three subjects achieved tremor freedom.
  
  
  CONCLUSIONS
  Tremor retrainment may be an effective short-term treatment strategy in psychogenic tremor. Although blinded evaluations are not feasible, future studies should examine the long-term benefits of tremor retrainment as adjunctive to psychotherapy or specialized physical therapy.
authors.affiliation: James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA; UC Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: alberto.espay@uc.edu.
authors.forename: A J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: A. Avogadro University and Maggiore della Carità Hospital, Novara, Italy.
authors.forename: G D
authors.initials: GD
authors.lastname: Oggioni
authors.affiliation: Movement Disorders Clinic and The Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Phielipp
authors.affiliation: James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Cox
authors.affiliation: James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
authors.forename: H
authors.initials: H
authors.lastname: Gonzalez-Usigli
authors.affiliation: James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Pecina
authors.affiliation: Biomedical Research Division, Great Lakes NeuroTechnologies, Cleveland, OH, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Heldman
authors.affiliation: James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mishra
authors.affiliation: Movement Disorders Clinic and The Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: A E
authors.initials: AE
authors.lastname: Lang
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D003463:Cues; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D011602:Psychophysiologic Disorders / Q000503:physiopathology*; D016896:Treatment Outcome; D014202:Tremor / Q000523:psychology* / Q000534:rehabilitation*
keywords: Entrainment; Psychogenic movement disorders; Psychogenic tremor