6 ms·

This is interesting, but IMHO, will not be as useful in most cases of Parkinson's disease. 1) Parkinsonian tremor is typically at rest or with distraction. Wh

by caycep 12y ago

This is interesting, but IMHO, will not be as useful in most cases of Parkinson's disease. 1) Parkinsonian tremor is typically at rest or with distraction. When you actually engage in purposeful action, such as using a spoon, the tremor usually dampens or goes away. 2) The main problem in Parkinson's is actually "bradykinesia" or slowness of movement. A more accurate term, in my opinion, is slowness of motor planning, that is, the brain systems cannot process the information require to, and then generate, a plan of movement for the limbs fast enough. The spoon won't fix that. 3) Parkinsonian and other forms of tremor do have relatively safe and effective treatments in medications or deep brain stimulation implantation. My thoughts are - this spoon, if it works and isn't a mechanical nightmare, would be useful in a limited subset of cases where the tremor resembles another condition known as essential tremor, where the tremor instead is an intention or action tremor, where purposeful activity amplifies the tremor. Even so, these would only be in those patients who cannot get deep brain stimulation surgery for some reason. The reason being that DBS, while brain surgery, once done, is the more elegant solution. I.e. your tremor goes away, rather than requiring a superficial "hack" like this spoon.

RhysU 12y ago
My father being an ET sufferer who has had a useless DBS device implanted that he now leaves disabled at all times, I concur with your assessment.
- caycep 12y ago
  I have seen the dark side to some of this. I think a lot of hospitals are rushing into implants without a lot of experience, and are either mis-implanting them or not selecting the candidates appropriately. IT's similar to another procedure like carotid endarterectomy in that it's very surgeon-dependent; you don't want it done by someone who does less than 25-30 cases a year.
  - RhysU 12y ago
    Most frustrating part for my father was the doctor claiming a historical 95% success rate and then never being willing to admit that my father'd drawn the lot of the 5%.
silencio 12y ago
I think there's still a market for this device for people with essential tremor explicitly as opposed to Parkinson's, in that is the opposite and worsens with movement. I have an ever so slight tremor that's worsened by the drugs I take but nowhere near bad enough for others to notice let alone be worth any treatment (so far) and I would occasionally kill for something like this to interact with my phone some days. Like this morning I was pinching and zooming up the wazoo to give my thumb a big enough target to hit without hitting things by accident while shaking around. Not sure it'd be that useful at the moment for fine tuned control but... (oh look I'm having a hard time hitting the reply button now...)
te_platt 12y ago
I have essential tremor not quite as bad as shown in the video but bad enough I'd be interested in such a spoon. I've tried Propranolol, a common tremor treating medication, but found the side effects (drowsiness) too unpleasant for frequent use. I have an anesthesiologist friend who reminds me of the surgery option every so often but brain surgery doesn't strike me as elegant as much as serious and invasive. My friend assures me it would be fun, but I think he means for him, not me.
- fossuser 12y ago
  Obviously something like brain surgery shouldn't be taken lightly, but I've had a family friend with tremors go through the process and the result is pretty amazing. Went from pretty severe tremors to appearing basically completely cured. This is a pretty good example: https://www.youtube.com/watch?v=uBh2LxTW0s0 https://www.youtube.com/watch?v=uBh2LxTW0s0
  - te_platt 12y ago
    I completely agree. How someone decides to treat a condition is a deeply personal choice and I certainly didn't mean for my comment to be a recommendation for anyone else. Just that this spoon looks like a great option for a lot of people, me in particular.
- caycep 12y ago
  It is a personal decision whether to go to surgery or not, but our group really believes in letting patients known all the options. The spoon only solves one problem - scooping up liquid food. One can argue that a fork or knife version could help with other food. It doesn't solve writing, playing instruments, typing. Shaving may be a little too delicate for something like this. DBS when done right solves all of this. The problem with DBS is that best practices for implantation can vary widely, and I've seen it done really poorly, either with surgical groups with crappy experience w/ a lot of infections or poorly targeted leads that are many millimeters off the intended brain target. Our group prides ourselves in being pretty accurate most of the time, and with a complication rate of < 1%; of which I can't recall anyone who had a serious hemorrhage or death from this. One thing to note, it's a stereotactic neurosurgical setup, which means our surgeon uses a skull mounted frame that inserts the implant in a 1 cm burr hole. It's not a typical open craniotomy where a large segment of the skull gets removed. So in a sense, yes, it is invasive, but no, it's not as invasive as full blown surgery. We make sure all our patients who are candidates are aware of the risks and what the surgery entails going forward - both the eager beavers raring at the bit and the reluctant folks who are afraid of it. Many of them choose it, some of them don't. Some of them don't qualify, and that's every bit their decision.
hansy 12y ago
For anyone interested in seeing the before/after effects of DBS treatment, this video is pretty powerful: http://www.youtube.com/watch?v=uBh2LxTW0s0 http://www.youtube.com/watch?v=uBh2LxTW0s0
chez17 12y ago
This is such an HN reply. Tear everything to shreds. Who cares if it "would be useful in a limited subset of cases where the tremor resembles another condition known as essential tremor"? Seriously, no one is forcing you to buy one. Be happy that people who are sick get the dignity of feeding themselves back. This is only positive. This can only get better. FFS...
- TeMPOraL 12y ago
  > Tear everything to shreds. That's also called "constructive feedback" or "having something useful to say". OP offered his thoughts on the best cases where this technology could be applied while explaining how Parkinson actually works and how this limits the usefulness of this solution. If this is "such an HN reply", then this is also the kind of reply for which I come back to this site.
  - gfosco 12y ago
    Lets just be clear... He recommended BRAIN SURGERY rather than a simple "hack" spoon.
    - Rayne 12y ago
      Well, so would I. The spoon doesn't cure the symptoms.
      - Kluny 12y ago
        I don't know the exact numbers, but I definitely feel like brain surgery carries a much higher risk with it than a new spoon. Some people might prefer not to take that risk, especially in cases of elderly people who may not be strong enough to survive surgery.
    - TeMPOraL 12y ago
      Well, so what? It seems to be a standard medical practice. It only sounds scary because it's new / we're used to have it sound scary in TV shows.
twistedgiblets 12y ago
It's primarily intended for Essential Tremor, and actually most people don't elect to get DBS, and most don't qualify. Brain surgery is a risky procedure, and most individuals at 60+ have complicating factors that disqualify them from DBS. That's why so few operations have been done relative to the patient population size. The device isn't a "hack", but a non-invasive way to deal with the problem.
stan_rogers 12y ago
I'm part of that small subset (there is intentional tremor, which actually made a Parkinsonism diagnosis a bit of a bitch). That's not a rebuttal; the device would be far more useful for essential tremor or Huntington's-like disease sufferer's than it would be for the ordinary Parkinson's sufferer. (For some value of "ordinary", which is hard to come by in the Parkinson's world. Among my peer group - people I've actually met through neurologists, support services, and so forth - there have been a relatively small number of people who have a textbook presentation. But intentional tremor is not a frequent symptom.) The spoon (and similar devices) would be absolutely transformative for some people's quality of life, but putting the "Parkinson's" label on it won't get it into the right hands.
rada 12y ago
Parkinsonian and other forms of tremor do have relatively safe and effective treatments in medications or deep brain stimulation implantation. (My father has PD, my father-in-law had PD, I am a webmaster for a PD news/events/support groups website, and we are on the board for Struther's Parkinson's Center in Minneapolis. Which is to say, I live and breathe PD daily, in a very personal way, through relatives and close friends, as well as doctors who have dedicated their entire lives to PD. I see first-hand what PD medications and DBS surgeries do to people, over a period of many years.) Your post is mind-boggingly misinformed and heartless. The "relatively safe and effective" medications you mention are not safe or very effective at all. They carry serious side effects for most patients and get less and less effective as time goes on. Even in the honeymoon years when the meds are still relatively effective, people still suffer in-between dosages, which is to say several times a day. The fact that people prefer being on them than being without them is a testament to how bad PD is, not how "safe" these meds are. Likewise, the DBS surgery is quite risky - so much so that you have to be relatively young and healthy to get it, e.g. very few people over 75 are even eligible. Moreover, the improvements are typically in the 40%-80% range, far from the 100% you so happily imagine, so MOST patients who undergo DBS still have to take medication. The risk of stroke from the surgery is 2% and the risk of infection requiring another surgery is super high at 4%, to name just two. If that's not enough for you, the risk of DEATH from DBS surgery is around 0.5%. Moreover, it is NOT a one-time procedure. The batteries implanted in the chest run out, and then you get to have another surgery. DBS, while brain surgery, is the more elegant solution. Your tremor goes away, rather than requiring a superficial "hack" like this spoon. What a bad, cruel joke.

by caycep 12y ago

RhysU 12y ago

My father being an ET sufferer who has had a useless DBS device implanted that he now leaves disabled at all times, I concur with your assessment.

caycep 12y ago
I have seen the dark side to some of this. I think a lot of hospitals are rushing into implants without a lot of experience, and are either mis-implanting them or not selecting the candidates appropriately. IT's similar to another procedure like carotid endarterectomy in that it's very surgeon-dependent; you don't want it done by someone who does less than 25-30 cases a year.
- RhysU 12y ago
  Most frustrating part for my father was the doctor claiming a historical 95% success rate and then never being willing to admit that my father'd drawn the lot of the 5%.

silencio 12y ago

I think there's still a market for this device for people with essential tremor explicitly as opposed to Parkinson's, in that is the opposite and worsens with movement. I have an ever so slight tremor that's worsened by the drugs I take but nowhere near bad enough for others to notice let alone be worth any treatment (so far) and I would occasionally kill for something like this to interact with my phone some days. Like this morning I was pinching and zooming up the wazoo to give my thumb a big enough target to hit without hitting things by accident while shaking around. Not sure it'd be that useful at the moment for fine tuned control but... (oh look I'm having a hard time hitting the reply button now...)

te_platt 12y ago

I have essential tremor not quite as bad as shown in the video but bad enough I'd be interested in such a spoon. I've tried Propranolol, a common tremor treating medication, but found the side effects (drowsiness) too unpleasant for frequent use. I have an anesthesiologist friend who reminds me of the surgery option every so often but brain surgery doesn't strike me as elegant as much as serious and invasive. My friend assures me it would be fun, but I think he means for him, not me.

fossuser 12y ago
Obviously something like brain surgery shouldn't be taken lightly, but I've had a family friend with tremors go through the process and the result is pretty amazing. Went from pretty severe tremors to appearing basically completely cured. This is a pretty good example: https://www.youtube.com/watch?v=uBh2LxTW0s0 https://www.youtube.com/watch?v=uBh2LxTW0s0
- te_platt 12y ago
  I completely agree. How someone decides to treat a condition is a deeply personal choice and I certainly didn't mean for my comment to be a recommendation for anyone else. Just that this spoon looks like a great option for a lot of people, me in particular.
caycep 12y ago
It is a personal decision whether to go to surgery or not, but our group really believes in letting patients known all the options. The spoon only solves one problem - scooping up liquid food. One can argue that a fork or knife version could help with other food. It doesn't solve writing, playing instruments, typing. Shaving may be a little too delicate for something like this. DBS when done right solves all of this. The problem with DBS is that best practices for implantation can vary widely, and I've seen it done really poorly, either with surgical groups with crappy experience w/ a lot of infections or poorly targeted leads that are many millimeters off the intended brain target. Our group prides ourselves in being pretty accurate most of the time, and with a complication rate of < 1%; of which I can't recall anyone who had a serious hemorrhage or death from this. One thing to note, it's a stereotactic neurosurgical setup, which means our surgeon uses a skull mounted frame that inserts the implant in a 1 cm burr hole. It's not a typical open craniotomy where a large segment of the skull gets removed. So in a sense, yes, it is invasive, but no, it's not as invasive as full blown surgery. We make sure all our patients who are candidates are aware of the risks and what the surgery entails going forward - both the eager beavers raring at the bit and the reluctant folks who are afraid of it. Many of them choose it, some of them don't. Some of them don't qualify, and that's every bit their decision.

hansy 12y ago

For anyone interested in seeing the before/after effects of DBS treatment, this video is pretty powerful: http://www.youtube.com/watch?v=uBh2LxTW0s0 http://www.youtube.com/watch?v=uBh2LxTW0s0

chez17 12y ago

This is such an HN reply. Tear everything to shreds. Who cares if it "would be useful in a limited subset of cases where the tremor resembles another condition known as essential tremor"? Seriously, no one is forcing you to buy one. Be happy that people who are sick get the dignity of feeding themselves back. This is only positive. This can only get better. FFS...

TeMPOraL 12y ago
> Tear everything to shreds. That's also called "constructive feedback" or "having something useful to say". OP offered his thoughts on the best cases where this technology could be applied while explaining how Parkinson actually works and how this limits the usefulness of this solution. If this is "such an HN reply", then this is also the kind of reply for which I come back to this site.
- gfosco 12y ago
  Lets just be clear... He recommended BRAIN SURGERY rather than a simple "hack" spoon.
  - Rayne 12y ago
    Well, so would I. The spoon doesn't cure the symptoms.
    - Kluny 12y ago
      I don't know the exact numbers, but I definitely feel like brain surgery carries a much higher risk with it than a new spoon. Some people might prefer not to take that risk, especially in cases of elderly people who may not be strong enough to survive surgery.
  - TeMPOraL 12y ago
    Well, so what? It seems to be a standard medical practice. It only sounds scary because it's new / we're used to have it sound scary in TV shows.

twistedgiblets 12y ago

It's primarily intended for Essential Tremor, and actually most people don't elect to get DBS, and most don't qualify. Brain surgery is a risky procedure, and most individuals at 60+ have complicating factors that disqualify them from DBS. That's why so few operations have been done relative to the patient population size. The device isn't a "hack", but a non-invasive way to deal with the problem.

stan_rogers 12y ago

I'm part of that small subset (there is intentional tremor, which actually made a Parkinsonism diagnosis a bit of a bitch). That's not a rebuttal; the device would be far more useful for essential tremor or Huntington's-like disease sufferer's than it would be for the ordinary Parkinson's sufferer. (For some value of "ordinary", which is hard to come by in the Parkinson's world. Among my peer group - people I've actually met through neurologists, support services, and so forth - there have been a relatively small number of people who have a textbook presentation. But intentional tremor is not a frequent symptom.) The spoon (and similar devices) would be absolutely transformative for some people's quality of life, but putting the "Parkinson's" label on it won't get it into the right hands.

rada 12y ago

Parkinsonian and other forms of tremor do have relatively safe and effective treatments in medications or deep brain stimulation implantation. (My father has PD, my father-in-law had PD, I am a webmaster for a PD news/events/support groups website, and we are on the board for Struther's Parkinson's Center in Minneapolis. Which is to say, I live and breathe PD daily, in a very personal way, through relatives and close friends, as well as doctors who have dedicated their entire lives to PD. I see first-hand what PD medications and DBS surgeries do to people, over a period of many years.) Your post is mind-boggingly misinformed and heartless. The "relatively safe and effective" medications you mention are not safe or very effective at all. They carry serious side effects for most patients and get less and less effective as time goes on. Even in the honeymoon years when the meds are still relatively effective, people still suffer in-between dosages, which is to say several times a day. The fact that people prefer being on them than being without them is a testament to how bad PD is, not how "safe" these meds are. Likewise, the DBS surgery is quite risky - so much so that you have to be relatively young and healthy to get it, e.g. very few people over 75 are even eligible. Moreover, the improvements are typically in the 40%-80% range, far from the 100% you so happily imagine, so MOST patients who undergo DBS still have to take medication. The risk of stroke from the surgery is 2% and the risk of infection requiring another surgery is super high at 4%, to name just two. If that's not enough for you, the risk of DEATH from DBS surgery is around 0.5%. Moreover, it is NOT a one-time procedure. The batteries implanted in the chest run out, and then you get to have another surgery. DBS, while brain surgery, is the more elegant solution. Your tremor goes away, rather than requiring a superficial "hack" like this spoon. What a bad, cruel joke.