Movement Disorders, Tremors, Spasms, Cerebellar Ataxia, Parkinson’s Disease, Balance Problems

The OTvest™ denim weighed vest can benefit those with movement disorders such as cerebellar ataxia (spinocerebellar ataxia), ataxic dysarthria, dystonia, athetoid cerebral palsy, Parkinson’s disease, multiple sclerosis, and other balance problems due to lack of body awareness in space or cerebellar damage. As the information sheet from the National Ataxia Foundation describes, “Affected individuals might notice difficulty knowing where their feet or hands are in space (impaired position sense).”

The deep pressure from the weight insert in the OTvest provides proprioceptive input to the joint receptors, which send messages to the brain about body position. Proprioceptive input allows us to know, without looking at our arm, for example, that our arm is behind us, next to our body, or up in the air.  Deep pressure and an increase in proprioceptive input can, therefore, help improve coordination through the increased sense of body positioning awareness. Weighting helps compress the joints and therefore adds sensory stimuli for co-contraction, so that the OTvest, with the strategically positioned weights inside,  can be beneficial for postural stability. The calming effects of deep pressure touch therapy, are important, as well. AND if overheating is a problem, the weight insert inside the OTvest can be detached and cooled in the refrigerator (or put the entire garment in before wearing).


The pressure on the shoulder blades (scapula) and across the shoulder-girdle provides increased trunk stability for improved balance and upper extremity function–decreasing tremors and spasms–and improving body position awareness–helping the wearer to feel more grounded and less anxious

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The OTvest also stabilizes the trunk with the applied weight to the shoulder-girdle area, which helps control balance and improves the distal movement of the arms and hands. The weight across the back puts mild pressure upon the scapula, which encourages the scapula to lie flatter upon the back, which improves trunk stability. As the trunk is stabilized, drinking from a cup, combing one’s hair, keyboarding, holding a pencil or spoon, and other activities of daily living can be more controlled–especially if due to tremors or spasms.

The occupational therapist, N. VandenBerg, MS, OTR  whose expertise is fundamental in the design of  the OTvest, received training directly from Berte and Karl Bobath, who are the founders of Neuro Developmental Treatment, or NDT. NDT or Neuro Developmental Treatment uses an in-depth knowledge of the human movement system, including the understanding of typical and atypical development, and expertise in analyzing postural control, movement, activity, and participation throughout the lifespan, [in order to] form the basis for examination, evaluation, and intervention. Therapeutic handling, used during evaluation and intervention, consists of a dynamic reciprocal interaction between the client and therapist for activating optimal sensorimotor processing, task performance, and skill acquisition to enable participation in meaningful activities.*

One example of the use of NDT treatment and how occupational treatment experience helped in the strategic weight placement design of the OTvest is described in the following:  Ms. VandenBerg was providing occupational therapy treatment to a three-year old with severe ataxia, and very limited vision, who was unable to pick up a toy because of too much uncontrolled arm movement. Working with the youngster at the home with the mother was difficult, as the child was severely involved and progress was very slow, and Ms. VandenBerg was facilitating the child learning to sit and play. She was unable to pick up any toy as she over-reached or could not coordinate her hand to touch the object. The young child was able to pick up a toy when Ms. VandenBerg applied weight around the shoulder-girdle, stabilizing the trunk , decreasing the excessive arm movement or athetoid movements, and improving her hand function. By being able to pick up a toy, she was gaining some necessary experience with hand and finger manipulation she would someday need for self feeding–or meaningful activity–and showed hope for the important developmental child skill of PLAY!  Ms. VandenBerg observed the effect of the strategically placed weight placement and its impact upon trunk stability and improved hand function–utilizing this important weight placement concept in the OTvest design (as well as the calming effect observed on hundreds of children and adults she worked with).  This is one small example to help illustrate how direct experience with disabled individual’s and the knowledge of neurology and neurodevelopmental treatment  impacted where the weight is placed in the OTvest. The evidence is further seen in those who have benefitted since the creation of the OTvest in 2002, with over 20,000 in use. Person’s even into their 90’s are seeing improvement with tremor and spasm reduction and increased ability in functional daily living activities such as combing their hair, drinking coffee, and brushing one’ s teeth when wearing the OTvest because of the stabilizing weight placement across the upper chest and upper back (shoulder-girdle).

Persons with movement disorders who have purchased the OTvest have written letters telling us how much the OTvest has benefitted them. Here are just a few:


profile The vest has been amazing. ..It has actually made my arms usable again…to play the keyboard. [I] learned that if I wear the vest, I have more use of my more affected left hand, and can isolate the keys better…The dystonic movements are almost gone with the [OTvest] on.”
Jennifer Zubko, dystonic adult in Canada (ataxic)


profile The OTvest makes my feet feel more like they are touching the ground. I feel grounded, more secure when walking.
Lili Kazepis, Brooklyn, New York, cerebellar ataxia


profile I got the OTvest (sic)…and I was able to sleep through the whole night. Usually I have to take medication but I haven’t had to touch it since I got the vest. The OTvest helps me to stabilize my trunk…with the vest, I am able to walk without swaying back and forth and having to hold on and grab things. It helps give me a feeling of security..it helps me get things done.
Robin Stevenson, Gainsville, Florida, cerebellar ataxia (quoted from video above)


profile In physical therapy we have been working on stability and core control (with Robin). We have noticed a remarkable difference when walking with the OTvest and walking without it. When she first came to physical therapy, she wouldn’t walk in a crowd because she thought she would fall and now she is able to walk through the gym with other patients coming in when she wears the OTvest. She is far more stable and confident.
Eileen Branham, physical therapist, Gainsville, FL (quoted from video above)


profile Just received my OT Vest less than an hour ago. I love it and can already tell I am using my arms better. I am even being more accurate with the keyboard as I sit to type this. My PT and therapeutic riding instructor have been working very hard on my shoulders and arms this week, as they were extremely tight. I put on the vest and they went immediately limp. It is as if I don’t have any tone at all in that area, which of course has calmed my whole system down. The vest feels very much like my therapists hands constantly on my shoulders. First impressions are that I love it! I don’t want to take it off! Thank you for everything.
Jennifer Zubko,  Canada, dystonia


The vest seems to keep me straight not going to one side like I do. It makes me walk more straight without leaning towards one side. I am 50, had Ataxia SCA1 since 38, 130 pounds, wear 10 or 12. The vest has the 3 pounds… It works good with keeping me more balanced and grounded. My muscles are very weak and sore from the ataxia.I also can’t button things. The snaps work great.
Cathy Letson, Claxton, GA,  Sca 1 cerebellar ataxia    6/16


“Why I Love My OTvest”:

Normally, I am a very private person but.. I wanted to share with you how the OTvest has affected my life. I have now reached the stage that I am unwilling to go out alone and find it challenging to walk more than a short distance. My OTvest has given me new self-confidence, my walking is so much better to the point that I held on to my husband’s arm yesterday in the supermarket carpark and asked him to make me walk as quickly as possible. Yes, my sense of fun is back and I am doing more and more things independently….The OTvest is like a comfort blanket and every day, I am doing more independently. Yesterday, I crossed a quiet road alone and walked around a small shop…Physically, I am also noticing differences and I don’t know if this is due to the weights, or the reduction in my stress levels, or both.

I seem to have improved manual dexterity. I had got to the stage where the zip on a particular coat had become quite difficult and now, for four consecutive days, I have been able to do the coat up without any help. I have also begun to find the buttons on the duvet cover easier.

My hips are beginning to move freely which is giving me a longer gait and rather than being restricted to shoes that I wear all the time, I am now alternating between three pair.

Finally, I have never slept so well in years and now occasionally sleep through the night, and I am sleeping much more deeply.

It takes a while for the vest to have an effect. The vests are so comfortable that it is easy to forget that you have got it on.

I have experienced such physical changes in the last two weeks that I can hardly believe it myself. My typing speed has at least trebled but I still lack stamina and so I can only type quickly for a short period of time. My son noticed how quickly I was typing and made a comment– he couldn’t believe it. The other problem that I have always had is putting a key in a lock and it has always been the cause of embarrassment. I have always looked like someone who was drunk but today I did it first time.

Finally, at the shops we generally use a card machine to pay for the groceries and I usually struggle to such an extent that I have to ask my husband to do it if he is there but for the last two/three weeks, I have done it, first time every time. You cannot imagine how wonderful such a tiny thing is.
I believe that within about two weeks most people will feel different. Everyday tasks will take less effort and before they know it, they will want to lead more active lives by choice, not necessity. Even my skeptical husband can no longer believe what he is seeing.

Stacey Goodeve, Great Britain, cerebellar ataxia


Research by Lucy and Hayes ¹ has shown that weight applied in the shoulder area of persons with cerebellar ataxia (some had multiple sclerosis) improved their lateral (side-to-side) sway when six pounds of weight was applied. Another study by Widener, Allen, Gibson-Horn, ² also demonstrated improvement in lateral sway using less weight. In the video above of Robin wearing an OTvest with weight applied around the shoulder-girdle, reduction in lateral sway is also demonstrated so that she does not have to hold onto a wall or depend on support from her physical therapist, Eileen. Robin is wearing a size medium with 4 lbs. of weight in this video.

*Instructors Group of NDTA. (2016, May 27). The NDT/Bobath (Neuro-Developmental Treatment/Bobath) Definition. Retrieved fromhttp://www.ndta.org/whatisndt.php

Note: The OTvest is not recommended for those with spinal cord problems and the accompanying balance problems associated with those disorders, such as herniated or dislocated discs, degenerative disc disease, or other spinal cord injuries. The balance problems that benefit from the OTvest, weighted vest are those with upper motor neuron and/or cerebellar problems described in the first paragraph.

More information can be found on the LINKS page for the National Ataxia Foundation blog (USA) and the United Kingdom Ataxia Blog


References:

1.  Lucy SD, Hayes KC. Postural sway profiles: normal subjects and subjects with cerebellar ataxia. Physiother Can 1985;37: 140-8.

2. Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence. Arch Phys Med Rehabil 2009;90:602-9.

Smedal T, Lydren H, Myhr KM, et al. Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept. Physiother Res Int 2006;11:104-16.

 Chase RA, Cullen JK, Sullivan SA. Modification of intention tremor in man. Nature 1965;4983:485-7.

Hewer RL, Cooper R, Morgan MH. An investigation into the value of treating intention tremor by weighting the affected limb. Brain 1972;95:570-90.

Morgan MH, Hewer RL, Cooper R. Application of an objective method of assessing intention tremor–a further study on the use of weights to reduce intention tremor. J Neurol Neurosurg Psychiatry 1975;38:259-64.

Morgan MH. Ataxia and weights. Physiotherapy 1975;61: 332-4.

Clopton N, Schultz D, Boren C, Porter J, Brillhart T. Effects of axial loading on gait for subjects with cerebellar ataxia: prelimi- nary findings. Neurol Report 2003;27:15-21.