How often and duration of the Tass gloves? - Cure Parkinson's

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How often and duration of the Tass gloves?

Furch profile image
74 Replies

Just completed the build. Wife used first time for 2 hrs with improved gait was able to walk in house without walker. Used walking sticks just due to fear of falling. Hand printing improved. However today after 2 hrs she said she felt very jittery, kind of like a residual feeling of vibratio So she insisted that it was on too long. Said felt great at the one hour mark but the last 1/2 hr of the 2hr session she was "miserable ". So I am . Wondering the usual routine that most of the Tass DIY are following ?. Is there a standard protocol? Thanks.

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Manypony profile image
Manypony

I’ve been involved in a trial where it was suggested 2 hrs/ 2x daily. I did okay during the placebo phase ( go figure) but the effective protocol definitely made me anxious. I am using them 2 hours 3x /week now. It’s all experimental at this point.

WinnieThePoo profile image
WinnieThePoo in reply to Manypony

Do you know for sure which was the placebo and which was the active phase?

Manypony profile image
Manypony in reply to WinnieThePoo

Yes, at the end of my 4 month commitment (2 months placebo 2 months “effective”)the gloves were returned to me “effective” as I suspected it was the program that I had just completed. I use the “effective” program 3x weekly now. Feeling pretty good actually. I wanted WAY more motor improvement, I’d like to stop limping and be rid of the associated pain, but most of my improvement is cognitive (I think 😂) and honestly I’m doing better with daily mundane tasks. Bathing, cooking, cleaning,washing dishes , folding laundry, etc. I want my strength back and my anxiety to leave. But any improvement is welcome 🙏🙏

Squarepusher profile image
Squarepusher in reply to Manypony

What is the time gap between doses in one day?

Manypony profile image
Manypony in reply to Squarepusher

For the Synergic trial it was recommended at least 2 hours in between sessions. I mostly did it early morning and late afternoon. Now, after the 2 months of 2 hrs twice daily I’m doing 2 hours MWF mornings only

Squarepusher profile image
Squarepusher in reply to Manypony

Do you find that you need more medication in the later part of the day on the MWF treatment days? Do you find that you require more hydration on treatment days?

Manypony profile image
Manypony in reply to Squarepusher

I use a small amount of mucuna early morning and about an hour after lunch and don’t vary the dose. I take water everywhere I go and drink about the same every day. No, I walked sometimes with the gloves but I’m hyperactive so I used the 2 hours to rest most often. Eating is impossible with the gloves 😂 one prepares as well as possible before donning them.

Squarepusher profile image
Squarepusher in reply to Manypony

Thank you. Where on the fingertip do you feel the stimulation: closer to the nail, closer to where the skin folds, or half-way in between. And how intense is the vibratory sensation on a scale of one to ten. one being you barely notice each impulse and ten being almost like a shock of energy? Thanks for being so generous with your answers.

Manypony profile image
Manypony in reply to Squarepusher

Halfway between tip and fold on pad. I’m going to say 6 because it’s pretty focused but not alarming

WinnieThePoo profile image
WinnieThePoo in reply to Manypony

Yes, that's definitely way too loud

Manypony profile image
Manypony in reply to WinnieThePoo

If it weren’t for your posts of the Tass science we would only have these subjective conversations. We all need to bear in mind even Dr Tass has tested gloves on very few Parkinson’s patients

WinnieThePoo profile image
WinnieThePoo in reply to Manypony

My personal direct experience is that lower amplitude makes a huge difference. Peter Tass, and we are only interested in this because of him, is quite clear on this point.

In a first-in-human study, five idiopathic PD patients received vCR fingertip stimulation for 4 h per day on 3 consecutive days (Syrkin−Nikolau et al., 2018). Kinematic assessments revealed improved gait and bradykinesia during stimulation and after 1 month poststimulation. However, blinded video Unified Parkinson’s Disease Rating Scale (UPDRS) III scores (excluding items for rigidity and speech due to video constraints) did not show a significant change. As known from CR-DBS, a third of the pulse amplitude used for conventional high-frequency DBS caused significantly greater therapeutic effects (Tass et al., 2012), as CR requires separate stimulation of neuronal subpopulations (Tass, 2003; Tass and Majtanik, 2006). Accordingly, in the present studies, we used smaller vibration peak amplitudes (Adamchic et al., 2014) (0.06–0.10 mm) rather than the higher vibrational amplitude used in the first-in-human vCR study (0.35 mm; Syrkin−Nikolau et al., 2018).

There have only been 2 published trials so far and the first one failed. You are in the middle of another, and your results have been disappointing. If the gloves retail at $8000 would you buy a pair?

Manypony profile image
Manypony in reply to WinnieThePoo

I can only hope that the gloves I’m trialing are programmed according to Dr Tass’ instructions. I’m grateful to be part of the trial and that I don’t have to pay $8000. I also admire people for building gloves for PWP

Squarepusher profile image
Squarepusher in reply to Manypony

And how much setup is there before a treatment? Do they train you to calibrate the compressive force on your skin before initiation, or check the distance of some sort of set screw/caliper, do you measure anything or just wear the gloves and run the program? I think it is great that you hydrate the same way each day: the tensile strength of skin is related to hydration from what I hear

Manypony profile image
Manypony in reply to Squarepusher

The gloves are designed to be adjusted by the team and have been very consistent throughout the trial. I’m not advised to adjust anything nor have felt something needs adjusting. There’s no set up besides charging it

Squarepusher profile image
Squarepusher in reply to Manypony

Thanks

Squarepusher profile image
Squarepusher in reply to Manypony

How large is the part of the vibrating element that makes contact with your finger pads: like a needle, like a dull pencil, like the end of an pencil eraser, like a penny or between which two of these?

Squarepusher profile image
Squarepusher in reply to Manypony

Did they tell you not to do any activity while being treated: no exercise, no walking, no eating etc etc?

WinnieThePoo profile image
WinnieThePoo

It's not easy. Peter Tass and Stanford have published open label trial results for 8 patients. They have maybe treated a double handful more than that on a compassionate use basis - they couldn't just "have a go" with regular PD patients. This probably means most were fairly advanced cases, eligible for DBS and by definition poor responders to medication

The "norm" at Stanford appears to be 4 hours a day for 4 months followed by a maintenance treatment of maybe 2 hours , 2 or 3 times week. But there have been plenty of exceptions even in the tiny group treated by Stanford. The 4 hours a day is 2 sessions of 2 hours at least 1 hour apart.

And Dr Tass emphasises that they usually reduce significantly conventional medication, and where they are unable to do that, they reduce glove time initially. So there is very little available qualified expertise

For DIY its a nightmare scenario of legend and rumour and very little unambiguous data. My own experiences have been quite confusing, and I could see a strong case for use being under medical supervision. I am fortunate that my GP, and both neuros are "on-side" and supportive - but they know nothing about the gloves really.

Broadly, there are 2 types of DIY gloves. The vast majority use a "vibrating coin" type actuator (PD Buzzboard, bHaptics etc). These create vibrations using one of the Tass patterns, but do not meet his design criteria of

1) stimulation perpendicular to the skin

2) 0.5mm precompression of the skin

3) -30db (ref 1mm) peak to peak amplitude

4) 250 Hz stimulation frequency

5) Rapid rise and decay times (max 5ms)

The other type (which includes mine) try to meet these specifications as closely as possible. Generally, my impression is that most of the vibrating coin type use them less than 4 hours a day.

I have now been using my mk4 glove for 4 hours a day for 3 months. Prior to that I had used less comfortable, less accurate gloves for maybe 4 months, much less regularly. I am therefore having to make it up as I go along, but I am cutting to 2 hours a day now until the end of November, and then 2 hours twice a week after that, and see how i get on.

Ethin profile image
Ethin in reply to WinnieThePoo

Wondering about your plan to reduce glove time: is it mainly because of diminishing returns, or because of increasing side effects?

WinnieThePoo profile image
WinnieThePoo in reply to Ethin

More an endurance issue. I had always intended to do 4 months then switch to twice a week. Although I have only done 3 months on the new gloves, I'm close to 7 months in total. So I am due to see how I get on at this maintenance level. And there must be the possibility I am "over-cooked". It would be nice if I maintain the improvements, and reduce the side effects

The key will be to stay dystonia free. I experimented yesterday with "un de plus" sinemet when I felt pain and tension in my biceps at 11 and at 4- and boy did I prove to myself over-medication is not nice. Not the most painful episode I've had, but plenty painful enough. Today, with only one sinemet and no gloves last night, is really rather nice 🙂

Ethin profile image
Ethin in reply to WinnieThePoo

Makes sense -- fingers crossed for finding the right balance!

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Are you able to measure the compression of your vibrating element contacting your finger in psi? Not on, in pre-compression ready mode

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

No. I'm afraid not. Although I quote Peter Tass measurements I think it is the message behind them that is key.

"low amplitude, small area contact point, peripheral shielding, stable contact location, very fast rise&fall, light skin compression at rest"

The closer you can get to that, in my experience, the better the result. It is worth being aware of -18db (the difference between 0.35mm and 0.03mm), but the actual physical measures relate to the equipment used at Stanford. And its physical characteristics are different to the equipment I use. Peter Tass has several times emphasised that this can be implemented with simple mechanical devices and not a unique specialist device - but the implementation needs to follow the rules. Be aware of the context for the various parameters.

I recently changed my design a bit, based on information kindly supplied by users of the equipment used at Stanford. And I think it has made an important difference. It made me realise that some measurements must be specific to the C2 and CRM LRA's. And what a coincidence that the first "in-human" trial, which failed with 0.35mm amplitude used equipment to which the same physical measurements were relevant. So I read the trial paperwork. Although his name wasn't listed on the summary, Peter Tass was part of the team! No wonder he knew such details about it

WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

I'm writing this wearing the gloves, whose clumsiness often results in me losing long posts - so breaking this into less-long posts. The new design involves replacing the 8mm diameter contact screw with a 7mm hex bolt with a 2mm bumb in the middle of it. Now the bump is the contact point, which naturally pre-compresses the skin, and the bolt surface is resting paralell to the skin, lightly contacting it but not compressing it.

The threaded screw/bolt was to facilitate height adjustment of the contact surface, without shimming. The switch from bladed srewdriver to hex spanner was due to the problem 3D printing the bump with a screwdriver slot through the middle of it

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Thank you

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

"It made me realise that some measurements must be specific to the C2 and CRM LRA's. And what a coincidence that the first "in-human" trial, which failed with 0.35mm amplitude used equipment to which the same physical measurements were relevant."

Can you say a little more about this. I'm not clear on what is being inferred here. I'll look up what C2 and CRM mean, but if you don't mind a quick explainer that would help

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

These are specialist LRAs manufacturered by Engineering acoustics for research purposes and used by Peter Tass. They are an unusual open frame (no cover) design.

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Yes, thank you, I see the image on their website.

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

They have a resonant frequency of 250 hz, and won't take much power to drive at that frequency. They will also be quite stiff compared with the exciters I use. But critically, compared with a normal LRA with a closed front, they will be efficiently damped by contact with the skin. So they have a small contact area and high force

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

I wonder if you could help me with the following based on your deeper read of the recent Tass literature: what is a 100ms pulse - from the beginning of the left tail to the end of the right tail, from the middle of rise to the end of steady state, etc, etc what do you understand is meaning of pulse. Similarly what is 67ms silence? From the end of the fall period to the onset of the next pulse, from the end of steady state amplitude to the next pulse onset, etc, etc. Please let me know if my questions are not clear as I'm not in a good part of my C/L cycle

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

I'm not sure it's that precise. I think Tass uses the term "burst" instead of "pulse" - but they both mean a very short time of precise stimulation. I have seen nothing other than it meaning duration of stimulus (ie from "switch on" to "switch off" - the implication being a rapid rise and fall - effectively cliff-edge. They say a picture is worth 1000 words. I have added one that shows the intention

As I have said before, 67ms is a function of a 1.5Hz cycle and 4 channels and 100ms bursts. 1.5Hz equates to 667ms per cycle which leaves 267/4 "silence" between bursts

100ms was chosen to achieve sufficient vibratory “loudness” (Green, 1976; Gescheider et al., 1999), while avoiding adaptation potentially caused by unnecessarily long vibratory bursts

As I said before, the important elements are the cycle frequency and "not crossing the streams"

100ms burst at 250Hz
WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

This is the other (famous) picture which illustrates the concept

The Tass glove pattern
Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Thank you, that's very helpful

House2 profile image
House2

My understanding of the concept behind the Tass gloves is that it uses something called "spike timing dependent plasticity" which simply put, means providing optimally timed input (the vibration sequence) for the purpose of changing / creating new or stronger synapses (connections between nerve cells) between malfunctioning nerve cells in the Parkinson's brain. So phase one builds / strengthens these new connections (which requires more stimulation), whereas phase 2, is like a booster stimulation (much less time) to maintain these newly established connections. I'm not sure Tass himself, knows the optimal time required for each phase (1 and 2), which is, in part, what the current research hopes to determine. I suspect (but who am I?) that eventually the stimulation protocols will be adjusted based on each individual patient's response to the stimulation (kinda like our medications).

Ethin profile image
Ethin in reply to House2

I think you are right that, eventually, CR will be adjusted individually for each patient based on behavioral measures or biomarkers such a spectra of neural responses.

However, in many ways CR is quite unlike STDP in that it aims to weaken neural connections rather than to strengthen them, via decorrelated sensory input. The connections are thought to be the basis of pathological neural synchronization in PD and other diseases, and their weakening is hoped to reduce these synchronization phenomena and the symptoms to which they contribute.

(Notice the cautious phrasing here, as there are still many question marks in this field of research. 🙂)

House2 profile image
House2 in reply to Ethin

My understand is/was it desynchronized oscillations by strengthening brain maps individually of the thumb, index finger, etc, This forms the sequenced pattern of stimulation.

For example the thumb receives stimulation while the index finger does not.

Which would decouple synchronized oscillations between thumb and index finger. Using the same concept to break down synchronized oscillations for all 5 digits of the hand. Am I off target?

House2 profile image
House2

Several things I have not been able to get my head around: how long (duration)does the vibration last before the pattern (fingers stimulated) changes?

Is the pattern change random or is there an ideal sequence of change?

Do you have a handle on these variables? What parameters are you using, if you don't mind sharing them?

I know vibration frequency and amplitude are near optimal (278hz if I remember correctly) for activating mechanoreceptors in the soft tissue of the hand.

I often wondered if you could use light, sound, smell, and vibration in a similarly patterned sequence to decouple the occipital, temporal, frontal and parietal lobes of the brain respectively?

This is fascinating stuff :)

Gioc profile image
Gioc in reply to House2

Actually P Tass wrote all the informations.

What you need to do is study this research , define all the technical terms you find and everything will be much simpler.

Here you will find the fundamentals, the basic theory on how it works and the CORRECT parameters of how to build a pair of vibrating gloves..

The only thing not guaranteed is the result. ncbi.nlm.nih.gov/pmc/articl... 25

Furch profile image
Furch in reply to House2

Very interesting. My wife did the trans cranial thermal thing neuromodulation device when in the study at Winston Salem. The device also had alternating patterns of hot and cold. That's one of reasons I got on the neuromodulation bandwagon,since she responded so well. Perhaps she may be that type of PD patient thst responds to neuromodulation?

WinnieThePoo profile image
WinnieThePoo in reply to House2

Assuming we are confining the discussion to the gloves actually built by Peter Tass, and used in his published trial

The vibrations are 100ms bursts (1/10th of a second). They are in a period which lasts 667ms (which is a 1.5Hz CR frequency - 3 periods every 2 seconds). In each period each finger is stimulated once and only once for 100ms with no overlap between fingers. This results in 4 bursts of 100ms stimulus, and 4 67ms silences. The stimulus period (100ms) was chosen to ensure sufficient "loudness" while avoiding adaptation potentially caused by unnecessarily long vibratory bursts . The rest periods are a function of the CR frequency and the stimulus period (4*(100+67)=667 and 1/667ms = 1.5Hz)

(That arrangement can be varied by jitter - lets not complicate things for now)

The sequence of fingers in a period is chosen at random (RVS = Rapidly Varying Sequence) or after several repeats (SVS = Slow Varying Sequence)

RVS , with and without jitter, was used in the published trial. Moreover a further pattern exists where each group of 3 stimulus periods, is followed by 2 rest periods.

Personally, I am using RVS with 23% jitter, mirrored to both hands. Which was used in the trials.

"Activating mechano-receptors in the hand". There are 4 different ones. They respond best to different frequencies. The 250Hz used by Peter Tass (and me) is ideal for FA2 Pacinian Corpuscles. The rest of the glove design and parameters used are optimised for these PC's in the hope of keeping a focussed stimulus without "Noise" from the other mechanoreceptors. Hence perpendicular stimulation, 0.5mm preloading, -30db amplitude, and "instant" rise and fall times.

House2 profile image
House2 in reply to WinnieThePoo

Winnie, what microprocessor are you using to drive the actuators? Do you think a smart phone could be used with blue tooth to drive the actuators?

WinnieThePoo profile image
WinnieThePoo in reply to House2

I use audio exciters as actuators. Mounted in finger pods which meet peter tass design brief for a fixed contact at 0.5mm compression. I drive those with a 4 channel audio amplifier. The exciters are rated at 3w..I think 1w would suffice.But not the output from a mobile phone

House2 profile image
House2 in reply to WinnieThePoo

Hi Winnie, from the text you posted " In each period each finger is stimulated once and only once for 100ms with no overlap between fingers. " So if my understanding is correct, if the thumb for example receives stimulation, fingers 2-5 are not. Next pass, the thumb stimulation stops, and 1 of the remaining fingers is stimulated. This loop continues until each of the individuals digits has been stimulated in isolation? Is there a set sequence of finger stimulation or does each pass create a unique pattern (order) of finger stimulation? Or am I completely out in left field?

WinnieThePoo profile image
WinnieThePoo in reply to House2

The diagram Ethin posted covers this. But, except the thumbs aren't used, the pattern might be 100 ms finger 1.then 67ms silenceThen 100ms finger 4. 67ms silence

100ms finger 2 67ms silence

100ms finger 3.67 ms silence

Then 4231

Then 3142

2 complete rests 2x667ms

Then a new block of 5

House2 profile image
House2 in reply to WinnieThePoo

Great TY

Ethin profile image
Ethin in reply to House2

Figure 1 from this paper frontiersin.org/articles/10... summarizes the CR paradigm.

Mind that the second phase of three ON cycles is mostly shown to demonstrate that the sequence of burst stimulations during the ON cycles is not repetitive, but random. I.e., the whole routine proceeds as 3 ON - 2 OFF - 3 ON - 2 OFF- ... etc.

Personally, I also use this kind of routine with 23% temporal jitter, randomized (not-mirrored) between the hands, as I am mildly concerned that a hand-mirrored routine could induce some interhemispheric synchronization effects. But that's probably not a big deal. More important seems to be to titrate the stimulation intensity to a low setting, such that the vibrations are clearly but barely felt. (I have also experimented with a random intensity setting, which means that you would occassionally miss individual stimuli altogether. Theoretical work of Peter Tass suggested that this may be particularly effective, but that still needs to be confirmed experimentally.)

Coordinated Reset stimulation with temporal jitter (4 channels = 1 hand)
WinnieThePoo profile image
WinnieThePoo in reply to Ethin

I'se just copying - imitation not innovation

"For bilateral application of noisy vCR in PD patients, we used a mirrored delivery such that right and left fingers 2–5 were coincidently activated, respectively. This was done to avoid bilateral masking-like interference (Craig, 1985; Craig and Qian, 1997)."

Ethin profile image
Ethin in reply to WinnieThePoo

I know. 🙂

I just think the evidence for this "bilateral masking-like interference" is not particularly strong, while the induction of inter-hemispheric synchronization has also been demonstrated (e.g., pubmed.ncbi.nlm.nih.gov/255... ). In any case, as Peter Tass has also stated that the stimulation of the hands can be done independently, I don't think he is much concerned about this aspect, and it may not be crucial.

WinnieThePoo profile image
WinnieThePoo in reply to Ethin

I know 🙂

As for the independent stimulation of the hands - that's without jitter

"In contrast, regular vCR was delivered to both hands in a non-mirrored manner, such that vibratory stimulus administration times were identical for both hands, but stimulus delivery was not coincident for fingers 2–5 of both hands. This mode was chosen to increase the spatial randomization, hypothesized to be more favorable to induce long-term synaptic decoupling (Kromer and Tass, 2020)"

I confess I am a bit puzzled by this one, since he has also stated it is possible to stimulate just one hand and affect both sides of the brain (they have done this with DBS CR)

I'm a bear of very little brain, and so my objective is to copy as closely as possible the method of the good doctor's success, and not to challenge his research, or tell him how he could have done better

Imitation not innovation. A point the Italian peacock struggles to grasp

Ethin profile image
Ethin in reply to WinnieThePoo

Yeah, I don't think I can tell him how to do better, though if the overall goal is desynchronization and randomization of synaptic weights, including as much randomization as possible (of the stimulation sequence, plus temporal jitter, between the hands, of the stimulation intensity) should be in line with the overall concept.

As for how to stimulate one side of the brain and affect both sides, that opens another whole box of questions about the pathways along which vCR may operate. Does it only affect the cortical sensory-motor representations, unlike DBS?- unlikely. If it also affects basal ganglia circuitry, then via which projections? And how does that lead to cortical desynchronization in turn? Lots of known unknowns, and probably a couple of unknown unknowns as well.

Gioc profile image
Gioc in reply to WinnieThePoo

AH AH I have always liked the male peacock, a client of mine had some beautiful ones WTP, but my favorite was the "bird with crystal plumage" or Balearica pavonina, he had a pair of them, a very delicate species. There was an old nursery rhyme that said “… Reflected mirror, whatever you say, you know you are.”

but if your goal is to imitate why you changed the parameters and I quote:

A month ago you wrote: ".6 they make a vibration of very small amplitude. I find that the best results occur with peak-to-peak vibrations close to 0.03 mm(-30 db). “

then above you wrote: “

3) -30 dB (ref. 1 mm) peak-to-peak amplitude”.

Then changed again above:" Hence perpendicular stimulation, 0.5mm preloading, -30db amplitude, and "instant" rise and fall times.

quote from Tass:

“Figure 3

Vibratory burst at 250 Hz.

The vibration signal, that is the position of the stimulation contact surface, perpendicular to the skin displays a low-amplitude oscillation (with peak to peak amplitude of 0.03 mm) around the constant indentation of 0.5 mm.”

You know this point well,It's not the same. You altered it not imitated!

In my opinion it is an inapplicable point for over-precision for a vibrating actuator applied to a finger.

but is it an important point?

I think it is for you since you're saying that all the other models don't work with out this parameter.

Maybe you've seen results, maybe you're simply very confident in your creation, but surely all this makes you feel better, and gives you hope,

but also for others is the same !

Hope is important because otherwise we can fall into a deep apathy that will kill us and our loved ones.

Don't think that I ever intended to disrespect you and then we are colleagues in the search for treatment at the PD.

Greetings

en.m.wikipedia.org/wiki/Bla....

WinnieThePoo profile image
WinnieThePoo in reply to Gioc

Gio

I normally just ignore you because you get so much wrong. I realise English is not your first language - but wrong is wrong. I'm going to call out your bullshit once and only once because you are thread crapping again. then I'm going to go back to ignoring you, You are just acting the "first lady"

"Don't think I ever intended to disrespect you" - you need a new google translate sunshine

"No WTP, definitely not your field. Forget it, you look like "the blind leading the blind"

"The blind leading the blind", but the bad thing comes when he thinks he sees more than the other.

And the rest.

So, I'm not really sure what point you were trying to make. I think it was that I was being inconsistent over time. Which only serves to make the point that you dont understand the subject. My glove paramaters are unchanged from the beginning. I achieve them better now.

And Peter Tass parameters are unchanged over the period I have been making gloves.

And my objective was to copy Peter Tass as closely as possible. Not to out-smart him or challenge him. Just copy him. That said, he has published some explanations of why these criteria are important. If others ask, I may expand on that

So, in 2017 Peter Tass published the document you linked to earlier, discussing some of the factors relevant to a vibrotactile approach to Coordinated Reset (CR) in PD, and identifying 3 different options.

He picked the first option for his gloves. in 2021, 4 years later, he published this

ncbi.nlm.nih.gov/pmc/articl...

which describes the state of the actual device he designed and used and the relevant parameters. Particularly in the data sheet pdf in the supplementary materials

4 years after the concept discussion document you said "has all you need"

Lets look at the pdf

Our design approach was to configure our tactors to have a “contactor” (C) that oscillates perpendicularly to the skin, surrounded by a housing (H) and radial gap. The moving “contactor” was lightly preloaded against the skin (Zvc), as well as the housing (ZvH). When an electrical signal was applied (producing a force F), the “contactor” oscillated with a velocity (Vc) perpendicular to the skin, while the surrounding skin area was “shielded” with a passive housing

The fingertips are most sensitive to vibration at frequencies between about 200 to 300 Hz. These frequencies excite primarily the Pacinian corpuscles which are rapidly adapting (RA) receptors.

Reasonable technical requirements for the vibrotactile actuator for vCR would therefore be an operating frequency of approximately 250 Hz, a displacement output that exceeds 40 dB (Re 1μm) above the threshold for sensitivity for the fingers (to achieve salience), and a rise time of less than 2ms.

Now the main text of document,

In a first-in-human study, five idiopathic PD patients received vCR fingertip stimulation for 4 h per day on 3 consecutive days (Syrkin−Nikolau et al., 2018). Kinematic assessments revealed improved gait and bradykinesia during stimulation and after 1 month poststimulation. However, blinded video Unified Parkinson’s Disease Rating Scale (UPDRS) III scores (excluding items for rigidity and speech due to video constraints) did not show a significant change. As known from CR-DBS, a third of the pulse amplitude used for conventional high-frequency DBS caused significantly greater therapeutic effects (Tass et al., 2012), as CR requires separate stimulation of neuronal subpopulations (Tass, 2003; Tass and Majtanik, 2006). Accordingly, in the present studies, we used smaller vibration peak amplitudes (Adamchic et al., 2014) (0.06–0.10 mm) rather than the higher vibrational amplitude used in the first-in-human vCR study (0.35 mm; Syrkin−Nikolau et al., 2018).

Ok. I think my 5 parameters are in there.

1) stimulation perpendicular to the skin

2) 0.5mm precompression of the skin

3) -30db (ref 1mm) peak to peak amplitude

4) 250 Hz stimulation frequency

5) Rapid rise and decay times (max 5ms)

OK. Now, your confusion. For which I think the rather confusing logarithmic decibel takes much of the blame.

I'm going to break here to use pictures

WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

1) Perpendicular - surely I don't have to explain. it means at 90 degrees. so, if the skin is a flat plain, the vibrations are at 90 degrees to it. This helps just trigger FA2 PC's

2) 0.5mm (=500 micron) precompression. The rod that is going to vibrate in and out at 90 degrees to the skins surface starts by digging in by 0.5mm. See the picture. Thats the same as "0.5mm preloading". It's the same as "around the constant indentation of 0.5mm". People who speak English understand that. It's illustrated by the picture. The tip of the actuator squashes the skin by 0.5mm, and the vibrations move that tip in further and then out a bit.

But the vibration is centred on a point 0.5mm in. In the graph it moves 0.0175mm up then 0.0175mm down, so "peak to peak", from the topmost point to the bottom most point 0.035mm. Or 35 micron. Now - this is where those darn decibel things confuse life. Let's stick with mm for now

In the quote above, Peter Tass observes that Syrkin−Nikolau et al. used a 0.35mm peak to peak vibration - and it didn't work! So Peter Tass used 0.06 to 0.1mm. Now, I quote from the document you linked to

" it seems of major importance to use small peak to peak vibration amplitudes of 0.1 mm or even less, say 0.03 mm, (see above) to avoid spatially widespread activation [13,15]."

So we have "small is best". 0.35 is much too much. 0.1 is probably a maximum limit, 0.06 would be nice, and 0.03 is preferred (but not easy). Bear in mind copier paper is about 0.1mm thick. 0.03mm is 1/3 the thickness of copier paper. Find a feeler guage. it's not much.

Because we are dealing with audio frequencies, and we may want to measure loudness in terms of voltages and currents, we can also express those measurements in decibels (abbreviated to db) . My audio meters show sound levels in db. This is a log scale which is convenient because loudness works that way. To stick with physical measures, it will be db relative to a reference point. We have been using 1mm. If 0db is 1mm, -6db is 0.5mm, -12db is 0.25mm, -18db is 0.125mm, -24db is 0.0625mm and -30db is 0.03125mm. We have been rounding those numbers off, so referring to -30db as 0.03mm, -18db as 0.1mm

But nothing has changed - just different units of measurement, and some conventional rounding up and down of very very tiny measures.

plot of a vibration signal
WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

Now I can measure exciter displacement in millimeters to about +-0.01mm, which given all the other approximations and roundings and physical characteristics is close enough for Jazz. I can't easily measure peak to peak. But I can measure mid-point to peak, which is 50% of peak to peak. So if I measure 0.5mm mid to peak, I have measured 1mm peak to peak. I do this by turning up the volume until the tip of the exciter just buzzes on the upper caliper. Using the volume control on the power amplifier, with the pre-amp at 0db

audio exciter in a micrometer
WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

So back to these pesky decibels. This is the audio file I play at the moment (Edit - expand the picture to full size). If I calibrate at 0db, and my power amp setting for that channel gives me 0.05mm mid to peak, 0.1mm peak to peak, if I set the sliders to -6db I will have 0.05mm peak to peak, at -9db I have approx 0.035mm peak to peak. Or I could leave the measurement at 0.5mm, so 1mm peak to peak and set the sliders at -30db. This is particularly useful because I can program the signal amplitude in db.

But the measures and criteria have been consistent - just expressed in different units

4 channel audio file
WinnieThePoo profile image
WinnieThePoo in reply to WinnieThePoo

250Hz pulse frequency. Vibratory burst at 250Hz. What are you struggling with? I altered nothing. Those pulses or "bursts" in the 4 channel audio file are 250Hz sine waves. Maybe its different in Italian?

Which brings us to the rise and fall times. These bursts are 1/10 of a second. They need to be precise, or they are a blur. The 2 ms Peter Tass quotes is near instant, and probably not essential by his own definitions. There are 25 cycles in a burst (Hz is "cycles per second" 250 cycles per second is 25 cycles per 1/10th of a second) so 2 ms or 2% of the burst is less than 1 of the cycles. It is not a performance that the LRA he uses can achieve mechanically - due to the stored energy in the spring, but he probably achieves it with control circuitry -including a 180 degree phase shifted signal at "stop"

Loudspeaker drivers, and that includes exciters, are pretty much instant. One of the design challenges of loudspeaker design is time delay and phase shift. There will always be a time delay in multi driver loudspeakers unless the drivers are concentric . A 20ms delay between treble and mid-range is clearly audible. Speaker design works in microseconds (that funny little u with a tail I can't find in character map). micro seconds are 1/000 of a millisecond. Lets call it instant in this context.

So - in conclusion, nothing has changed - you just didn't understand the measurements. Maybe strut a bit less when you don't understand things

Gioc profile image
Gioc in reply to WinnieThePoo

LoL extra Lol

Offending others is a minefield since the risk of being autobiographical is very high.

Here you just have to see the number of lines I write and the 30x you write, all on your gloves, to understand who the real "First Lady" is.

WTP guarda che ti sbagli.

La stima delle vibrazioni è diversa dalle onde sonore , le misure e parametri possono variare.

È meglio che ti informi cosi tu puoi copiare meglio., ti correggi , tu non fai brutta figura e io non mi annoio a scrivere un post dí correzione al tuo.

No ironia.

Greetings from Italy

John_morris71 profile image
John_morris71

Could you please let me know how did you built it - website/source for software etc

Furch profile image
Furch

The build is from the YouTube Pcbuzzboard.However my friend a computer whizz actually did all the build and programing. As if tonight it still seems like my wife responds better to 60min sessions . Aftet she did the last 2hr session see felt like her entire body was buzzing for almost an hour after the device was turned off. The effect is she becomes more alert and less freezing and shorter duration of freezing. She can walk with cane instead of walker for a few hrs pist session. Actually right after session she could actually walk without cane or walker at which time I noticed a slight but actual arm swing. But she has the fear of falling and uses a walking stick. Her printing is improved with acceptable spacial accuracy. We are developing a very basic check list. Again this has been my observation for only 6 sessions. Placebo effect ?

I really don't think so.

Okay that's our story..for now.

Squarepusher profile image
Squarepusher

Also for you engineering mavens.....please consider a foot device so I can work with my hands

From Dual Echo Steady State Magnetic Resonance imagine of human volunteers
Manypony profile image
Manypony in reply to Squarepusher

I’m also curious about foot/ toe device

WinnieThePoo profile image
WinnieThePoo

Once more I can't help reflect that it's as well we only have soldering irons to play with and not chemistry sets

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

I'm waiting for the first garageband CRSPR/Cas9 in vivo gene editing post

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Do you think if I 3d printed a small dome and epoxied it to a coin it would make a performance improvement?

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

Who knows. It's thinking out of the box. It might give a more defined contact point. It might pre-compress the skin. It would be better if you could 3d print a shroud which the dome poked through. But I doubt you can make the vibration perpendicular to the skin shrfaceAt least, unlike Manypony, you can presumably turn the volume down, although that probably won't help because you're not quietly tickling just one sort of receptor.

The big problem is timing. You are sending 4 separate morse code signals in a block. Peter Tass uses a flash light and a black disc, and covers and uncovers the flashlight instantly. You are using a light that is the same brightness but it's switched on and off with a dimmer switch. And it takes 5 rotations to get from full off to full on. The message gets confused

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Thank you, that's really interesting. I assumed the 2ms rise time was meant to get the viscoelastic membrane of the corpuscle to act more like a solid and less like a liquid (time-temperature superposition) so that the amplitude required for one action potential is minimized as none of the force is dissipated. But you point out that it is to minimally stimulate other types of nerve endings, which was not in my framework so thank you.

I've been reading some foundational papers from 1951 to 1964 where these nerve endings are first characterized as a function of frequency response and voltage applied to the actuator via an amp. And you know these things have quite a clever design: for example the Pacinian corpuscle has a built in low pass filter, that is, built in viscoelastic dampeners, and early papers demonstrate that they are not responsive below 50 hz. I mean you can get an action potential but you need to apply an exponentially larger voltage vs, say, 170 Hz. And above 500Hz the same "material science based" high pass filter.

So I wonder if the other nerve endings have high pass filters based on material properties and perhaps Peter is overthinking the case for short rise time. He's a super smart guy so probably not, but the more I read the more I see that nature has already done some filtering and specialization here.

Also...I was looking through the pile of junk I've accumulated over the centuries and I found a high-speed camera and micrometers that measure to 4 decimal places of mm. So thinking of running some experiments and sharing with the group. If you have any suggestions for experiments I would appreciate them. I'm pretty sure the camera runs up to 1000 fps

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

I understand your point about over-thinking the subject. And Manyponys about the relative lack of experience (by drug standards human clinical trial data is negligible. But the guy has been studying this area for 30 years, and for sure knows a lot more about it than I do. And I think a lot of the potential for "noise" in the signaling comes as much from neighbouring PC's as it does from FA1 Meissner corpuscles. It also comes from the slow adapting mechanoreceptors.

Generally my impression is that Tass finds clinical results match theoretical models. If you take the low and high pass filter to extremes, nothing gets detected by a 170hz signal. I think they are more in the nature of resonant frequencies of LRA’s than cliff edge low pass or high pass. And so noise frequencies will be transmitted by all receptors – particularly at higher amplitude. Pre-compression** , 250Hz and low amplitude, together with a shield surround are all devices for focussing on a confined area of PC’s.

** PC’s are located deeper in the skin and their firing response is changed by constant compression

PC’s respond to frequencies between 5Hz and 1000hz. But best to 250 Hz. But their sensitivity to stimuli, and hence the timing of their response transmission can vary with the type of input stimulation received

I should empasise that my interest in the subject, is that I have Parkinsons Disease (diagnosed 6 years ago) and I am impatient for new treatments which can help significantly. To that end, I have tried to copy his glove as closely as possible. To that end I have tried to get a bit of a grasp of the importance of the various parameters. I’m not in the business of challenging his methodology or conclusions.

I find it amusing that his “dumbed down” message to the media that “a treatment for PD could be provided by something as simple and non-invasive as a glove” has been reinterpreted as “any vibrating glove, using a pattern like the one I published, will treat PD”.

Also, his innovation is Coordinated Reset, with most of the experience in DBS. The vibrotactile thing is a new delivery mechanism here. But it is a recognised therapy in it’s own right. Charco Neurotech Cue1, whole body vibration plates, ncbi.nlm.nih.gov/pmc/articl...

And more

michaeljfox.org/grant/optim...

All potentially provide therapy or relief by vibration therapy. The new “easy gloves” appear to do likewise. But they don’t treat toxic patterns of synchronisation by reprogramming them in a sustainable manner. To try one more simplification which explains a point, but will only sustain so far as an analogy, the relevant sections of the brain are locked in a very cohesive pattern. You can disrupt that pattern with almost any loud noise intervention. But once the noise intervention ceases the pattern reverts.

By contrast Peter Tass tries to lightly tickle the neurons into changing to a sustainable random desynchronised, sustainable state with a delicate multi-locational coordinated, precise stimulus.

Regarding rise (and particularly fall) times, one of the big tenets appears to be that stimulation should only occur on one channel at any one time. A bit like “don’t cross the streams” in the ghostbusters movie. But the silences are only 67ms without jitter, as little as 24ms with 23% jitter. So how does a rise time of 70ms and a fall time of 90ms impact that???

vybronics.com/coin-vibratio...

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Well put. It makes me think the silent period for the gloves I'm using should be increased to 100 ms until I determine the actual rise and fall times with a high-speed cam. Thanks for everything you wrote here

And I wonder would you agree with 100ms as a replacement for 67ms or would you go higher? 120?

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

I don't know. Like I said I try to copy the specification. I think , but don't know, that if the rise and fall times are less than one cycle of the burst frequency ( so at 250Hz that is 1/250th of a second or 4ms) then it shouldnt be a problem. You would still get 23 full cycles per burst on that basis. Vaguely, somewhere I think I saw mention that the minimum required was 10.

67ms is not an arbitrary number. It's a function of the main frequency that the therapy supplies - namely freqCR - which is related to the frequency of the synchronisation he is trying to disrupt. This is 1.5Hz. So, if you have 4 fingers and 100ms stimulation burst duration, and 1.5 cycles per second (or 3 cycles in 2 seconds, each cycle lasts 667ms. 400 of those ms are taken up with 4 fingers at 100 ms , leaving 267 ms for the silences - divided by 4 gives 67 ms each . (You can see why the 5 finger approach adds a complication). If you extend the rest durations to 100ms - so 400 ms in total, then you get an 800 ms cycle, which is a CR frequency of 1.25Hz. At 120 you have 880 or 1.14Hz. I have no idea how that affects the therapy - but different frequencies are related to different aspects of PD, and Tass picked 1.5Hz deliberately

Squarepusher profile image
Squarepusher in reply to WinnieThePoo

Coin is 10mm in diameter and 4.4mm high. 170hz. Could it be

vybronics.com/coin-vibratio...

Note the description, eery

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

They're not the first to jump on the bandwagon. I wonder if Tass / Stanford will respond. Or not bother on the basis they are not a threat because they don't work. I find it interesting that we now have 2 participants in the Synergic trials on the forum, both of whom (100%) did better on the placebo. That's going to make for an interesting FDA application

WinnieThePoo profile image
WinnieThePoo in reply to Squarepusher

SorryI didn't really answer your question. I think measuring a - 30db stimulus and comparing it with - 12db is a bit of an eye opener.

Not sure whether that's possible with a coin exciter. It's fairly easy with an audio exciter and presumably with a C2 lra, if you can get your hands on one. That's a 0.25 mm peak to peak displacement compared with 0.03mm.

An erm device will change frequency with amplitude presumably

Squarepusher profile image
Squarepusher

Hi everyone. I was talking to a friend who is a professor of psychiatry at Harvard and is quite knowledgeable about neurology. Apparently this field we are dabbling in is called neurophysics. Just knowing that has opened up a boatload of resources when I do google searches. And for background, she recommended we read "Rhythms of the Brain" by Buzaki. I have not started reading this book, so don't shoot the messenger.

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