Usability, safety and tolerability of CUE1 vibrotactile device as promising therapeutic approach in orthostatic tremor

Primary Orthostatic Tremor (POT) is a rare hyperkinetic movement disorder characterized by unsteadiness while standing, often exacerbated by anxiety and fatigue. It significantly impairs quality of life, and current treatment options are limited, with invasive procedures carrying notable risks. This unblinded interventional study assessed the usability, safety, and tolerability of the CUE1, a non-invasive vibrotactile stimulation device worn on the sternum. Secondary exploratory outcomes included objective measures of balance and mobility: maximal stance time, tandem walk, heel raise hold, tandem stance, and Timed Up and Go (TUG) with and without dual tasking (DT). Assessments were performed at baseline, immediately after a 20-minute acclimatization session, and after 9 weeks of daily use (8 h/day). Patient-reported outcomes on fatigue, anxiety, and perceived change were also collected. Ten participants with POT (70 % female, aged 58-88 years) completed the study. Compliance and tolerability were excellent (100 %), with only mild, transient skin irritation reported in two cases. Immediate post-intervention improvements were observed in TUG [-1.22 s (95 % CI: -2.03, -0.26), p = 0.020], tandem stance [+1.41 s (0.00, 6.13), p = 0.025], tandem walk [+0.50 steps (0.00, 2.50), p = 0.042], and heel raise hold [+1.62 s (1.00, 3.32), p = 0.020]. After 9 weeks, improvements were observed in TUG [-2.13 s (-4.00, -0.26), p = 0.028], TUG-DT [-7.51 s (-14.88, -0.14), p = 0.047], tandem stance [+9.06 s (1.04, 17.08), p = 0.028], fatigue [-7.00 (-13.63, -0.37), p = 0.035], and patient-reported impression of change [+1.10 (0.14, 2.06), p = 0.027]. CUE1 vibrotactile stimulation is safe, well-tolerated, and shows promise in improving balance, mobility, and fatigue in POT. Larger, controlled trials are warranted.