Do you have shaky hands?… Have you seen an Occupational Therapist?

Hand tremors can be intermittent, occurring every so often or consistently. At times these hand tremors start on their own but can also act as a signal pointing to an underlying health issue (Barrell, 2018). On a day to day basis shaky hands can significantly impact an individual’s functionality. Individuals suffering from hand tremors due to essential tremor (ET) or Parkinson’s know that all aspects of their life can be affected.  From simple tasks such as, brushing their teeth in the morning, to cooking a meal for friends and family, or even when going out to a restaurant to eat, hand tremors have an impact on these individuals lives (Floyd, 2018). We all take the ability to do everyday activities for granted but when they start to become difficult the person effected may feel depressed, anxious, embarrassed and ultimately take on a social isolation state of mind (Floyd, 2018).

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Why you should visit an occupational therapist (OT)?

Occupational therapists (OT) can help people who have an injury, disability, or illness participate in “occupations” of everyday life (Floyd, 2018). “Occupations are all of the functional (useful and purposeful) activities someone participates in. Bathing, dressing, eating, reading, gardening, driving, and cooking are all occupations” (Floyd, 2018). It is important to realize that an OT can be very helpful in managing shaky hands. Your doctor can help you take the first step by recommending an evaluation for individuals who need this service.

“An OT who specializes in treating people who have neurological conditions can help a person with ET not only learn how to do tasks differently, but to look at the world, and the way it works, in more positive ways, says Karen Mainzer, an OT in Bridgeton, Mo., at St. Louis suburb” (Mainzer, 2019)

Why is it important to see an OT?    

An OT will serve and guide individuals with shaky hands due to ET or Parkinson’s to strengthen and increase their coordination of muscular movement (Thomas, 2019). Ultimately, this will improve functioning of muscle control, and enhance balance of coordination in most client cases. Seeing an OT will help individuals to continue engaging in daily activities with decreased difficulty (Barrell, 2018).

Typically, the process of occupational therapy for shaky hands will start off with physical therapy focused on coordination exercises, as well as exercises pertaining to increasing the balance of the tremor source (Thomas, 2019).  Clients may also be taught strategies to reduce the occurrence of tremor while using the affected body component. A commonly used practice for shaky hand’s is a medical motion hand brace during a tremor episode to help decrease its severity (Floyd, 2018).

Additionally, OT will help to find tailored techniques to best suit each individual’s condition and rate of tremor as they perform specific or daily tasks in all situations. For example, some kinds of adaptations such as incorporating large handle cups with extra grip or specific utensils, weights or even splints may help to optimize function with a hand tremor (Floyd, 2018).

Benefits of Visiting an OT For Shaky Hands

Professional Occupational therapy encompasses and draws from knowledge of proper body mechanics (Floyd, 2018). ‘Body mechanics are the way in which you use and position your body to be most effective at completing a task” (Floyd, 2018).

Techniques an OT may use:

  • Modification of tasks rather than trying to make the individual do something they cannot.
  • Promote success by changing tasks, using covered bottles, straws and filling glasses only half way.
  • Incorporate stabilized objects by using non-stick surfaces ex: grips for mugs.
  • Techniques to conserve energy.
  • Addition of weighted utensils to daily routine for things such as meals.
  • Use of assistive technology such as, hand tremor gloves, adaptable keyboards or mouse, voice activated software’s, and activity enhancing gadgets.

(Floyd, 2018)

Proposed solutions that OT’s will have access to:

  • Strength Training Programs: to ease functioning such as holding a glass as a result of improvement in strength through muscle building.
  • Incorporating weights to the wrist to stabilize the tremor under supervision.
  • Resistance training:  increasing muscular strength because of working against a weight or force.
  • Limb Cooling – source of tremor is cooled to 59 degrees Fahrenheit under supervision to help reduce tremor as short-term therapy.
  • Electro Stimulation – using electrodes, current is applied to source of tremor to try to reduce intensity of tremor.
  • Transcranial magnets – magnets are used to try to suppress the tremor through magnetic force and weight.
  • Vibration Therapy – vibration unit is used to improve tremor as a short-term therapy.
  • Bright Light Therapy – Specialized light used to suppress tremor.

(TAN, 2016)

Overall, having an OT for shaky hands will enable the sufferer to have a well-tailored plan that will cater techniques to improve and easily adapt to daily activity execution.

 

References

Barrell, A. (2018). “What does it mean if you have shaky hands?” Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/322195.php.

Floyd, J. (2018). An Occupational Therapy Perspective. Retrieved from https://www.essentialtremor.org/coping/coping-with-et-articles/an-occupational-therapy-perspective/

Mainzer, K. (2019). Managing ET with Occupational Therapy. Retrieved from https://www.essentialtremor.org/coping/coping-with-et-articles/managing-et-with-occupational-therapy-2/

TAN. (2016). Occupational Therapies for Essential Tremor. Retrieved from http://tremoraction.org/2016/10/occupational-therapies-for-essential-tremor/

Thomas, L. (2019). Treating Essential Tremor. Retrieved from https://www.news-medical.net/health/Treating-Essential-Tremor.aspx

Who to See If You Have Shaky Hands?

Shaky hands

Shaky hands are more commonly known as hand tremors. These hand tremors make everyday tasks much more difficult when compared to the average person. Usually this involuntary movement is a good early warning sign that one may have an underlying neurological or degenerative condition (Healthline, 2018). Shaky hands are a symptom of and Parkinson’s Disease (PD) but more commonly od Essential Tremor (ET) (Healthline, 2018). Parkinson’s disease is a chronic neurological disorder that affects movement starting from tremors in one hand to greater involuntary movement of the rest of the body (Mayo Clinic, 2018).  Along with tremors PD also causes slowing down of movement resulting in stiffness of muscles (Mayo Clinic, 2018). The more common cause of shaky hands essential tremor is known as a neurological disorder that causes rhythmic shaking that will affect parts of the body (Mayo Clinic, 2017). The involuntary shaking associated with ET however occurs only in the hands (Mayo Clinic, 2017).

Seek Professional Help
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If you are experiencing any involuntary hand movement issues it Is in your best interest to seek professional help. In such cases one should consult their family doctor first, treatments vary widely for specific tremors and therefore it is crucial that one allows a professional to diagnose and determine what the problem is that you are dealing with (Nazario, 2017).

General Practitioner (GP)

A family doctor or general practitioner is usually the first professional a patient will see when symptoms of shaky hands become a recurring event. It can be easily confused for other conditions as shaky hands is a common symptom in conditions such as Essential tremors, Parkinson’s disease, Multiple Sclerosis, Stroke, Tourette syndrome, overactive thyroid, and neurological disorders (Staff, 2017). Early diagnosis can mean effective treatment hence it is important to get the right kind of help at the right time (Staff, 2017).

The general practitioner will start off with performing tests to look for possible causes of the shaky hands. These tests include blood tests, urine tests, neurological exam, and physical performance tests (Weill Cornell Medical College, 2018). The tests are used as a means to rule out other possible causes and determine the most accurate diagnosis (Weill Cornell Medical College, 2018). In a lot of cases the family doctor may refer one to another specialist to receive better diagnosis outcomes.

Neurologist

A neurologist is a doctor who specializes in disorders of the brain, spinal cord and nerves (Parkinson’s Canada, 2018). A referral is needed for access to a specialist of this nature. Neurologists will help further rule out conditions that are associated with shaky hands. For example, if one has Parkinson’s Disease there are no tests such as x-rays to confirm (Parkinson’s Canada, 2018). In this case the neurologist would take the root of going though one’s family history of medical conditions and the associated linkage, perform a few tests, and a physical examination to once again rule out other conditions that are similar to Parkinson’s to make an accurate diagnosis (Parkinson’s Canada, 2018).

Occupational Therapist (OT)

In some cases where individuals are living in long term care (LTC) homes an Occupational therapy (OT) is the person who they deal with first.  An OT is a profession who specializes in helping individuals with disability, illness or an injury (Floyd, 2018). The OT will help individuals with all occupations, which are the functional activities someone participates in throughout their daily life such as, dressing, reading, eating, bathing, driving, and cooking (Floyd, 2018).  When referring to an OT in association to shaky hands the OT may be the first to notice the symptom and get a doctor involved. Alternatively, if an individual does not reside in a LTC home or have access to an OT for daily services a doctor would be their first form of contact and may refer or suggest services of an OT as they may be helpful once an individual is diagnosed with a certain condition (Floyd, 2018).  OT help to teach techniques and principles that may help make daily functioning for individuals with shaky hands from tremor or Parkinson’s easier (Floyd, 2018).

 

“I’ve done a good round of OT about 6 years ago and it was a wonderful experience. I was so appreciative of my Occupational Therapist. Thanks for answering our questions and being here for us.

I am a photographer and have had to close down my business due mostly to my cognitive issues, but also due to my hand tremor that has progressively gotten worse. I continue to do my photography as a hobby (can never give it up!), but the brace I use is just not cutting it anymore. It is just one of those used for carpel tunnel syndrome, but I just used it for immobilizing my hand while holding my camera.

The great part about my OT is that once I have been established at my Neurorehab center (which I have), I don’t have to wait for my neurologist to order it. I can call anytime and they can assess me and we can decide together whether I need it ” (MSWorld, 2016).

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Naturopathic Doctors (NDs)   

A naturopathic doctor is just like a conventional medicine doctor they both trained in a similar way and provide primary care to patients (Canadian Association of Naturopathic Doctors, 2018). A naturopathic doctor however takes on more philosophical techniques where natural forms of medicine and associated therapies are utilized (Canadian Association of Naturopathic Doctors, 2018). Naturopathic doctors (NDs) are known to treat their patients as an individual and address the physical, environmental, attitude changes, lifestyle and the emotional aspects of health (Canadian Association of Naturopathic Doctors, 2018). The NDs then help to find and treat the cause of the illness or disease using various therapies.

“The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavorable lifestyle habits. Naturopathic Medicine emphasizes disease as a process rather than as an entity. In addition to diet and lifestyle changes, natural therapies including botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation and traditional Chinese medicine/acupuncture, may also be used during treatments” (Canadian Association of Naturopathic Doctors, 2018a).

As a comparison conventional doctors on the other hand, usually address and seek treatment for the symptoms of the disease at hand using pharmaceutical therapies or surgery (Canadian Association of Naturopathic Doctors, 2018).

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Resources

Locate your ND today. Medically trained. Naturally focused

Canadian Association of Naturopathic Doctors

 

A guide to what kind of doctor you really need.

OnHealth

 

References

Canadian Association of Naturopathic Doctors. (2018a). About Naturopathic Medicine. Retrieved from https://www.cand.ca/about-naturopathic-medicine/

Canadian Association of Naturopathic Doctors. (2018). Common Questions. Retrieved from https://www.cand.ca/common-questions-about-naturopathic-medicine/

Floyd, J. (2018). An Occupational Therapy Perspective. Retrieved from https://www.essentialtremor.org/coping/coping-with-et-articles/an-occupational-therapy-perspective/

Healthline. (2018). Shaking Hands: What Are My Treatment Options? Retrieved from https://www.healthline.com/health/treating-shaking-hands

Mayo Clinic. (2017). Essential tremor. Retrieved from https://www.mayoclinic.org/diseases-conditions/essential-tremor/symptoms-causes/syc-20350534

Mayo Clinic. (2018). Parkinson’s disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055

MSWorld. (2016). Thread: OT/Hand Tremor. Retrieved from https://www.msworld.org/forum/showthread.php?111177-OT-Hand-Tremor

Nazario, B. (2017). Is there a treatment for shaky hands? Retrieved from https://www.webmd.com/brain/qa/is-there-a-treatment-for-shaky-hands

Parkinson’s Canada. (2018). Understanding Parkinson’s. Retrieved from https://www.parkinson.ca/about-parkinsons/understanding-parkinsons/

Staff, F. E. (2017). Essential Tremor. Retrieved from https://familydoctor.org/condition/essential-tremor/

Weill Cornell Medical College. (2018). Doctors Who Treat Essential Tremor. Retrieved from http://weillcornellbrainandspine.org/condition/essential-tremor/doctors-who-treat-essential-tremor

Tremors in the Workplace

Written by Tiana Corovic
Some of us take the ease for which it takes to perform a 9-5 job for granted. For others, this is a luxury that can’t be afforded. Tremors can do more than affect one’s capability to perform tasks, but can lead to discrimination, employment termination, and (most importantly) loss of confidence.

 

It’s Your Right

Under the Canadian Charter of Rights and Freedoms it is clearly stated that every individual is to be considered equal. People can also turn to The Canadian Human Rights Act to protect themself against harassment or discrimination based on disability (Government of Canada, 2017). Canada data demonstrates that about half of disabled Canadians are employed, leaving many more under-employed compared to their non-disabled counterparts (McQuigge, 2017). Unfortunately, regardless of disability laws, there continues to be cases of discrimination.

 

A case reported by Knowsley (2015) described a lift technician who was dismissed after his boss became aware of his hand tremors. While his excuse was the termination was due to safety reasons, the technician had worked there for over 5 years without prior interference. Furthermore, the employer did not seek a medical examination to determine whether working conditions were unsafe, and the tremor was overall very slight. As result of this discrimination in the workforce, the technician received $3, 700 for lost wages and $25, 000 for loss of dignity and injury.  Cases such as this one also extends to a waitress with tremors who was fired for spilling items when carrying her tray (Brody, 2007).

 

If qualification for work remains unchanged, employers have no grounds to dismiss based on disability. Everyone has the right to make a livelihood for themselves without having to worry about additional discrimination from employers.

 

How tremors affect the workplace

 

Personal anecdotes on the International Essential Tremor Foundation site provided insightful details about daily struggles faced with tremors and various coping mechanisms that were used to surpass them. For example, one author and musician revealed how his essential tremors used to be a constant source of embarrassment and anxiety. Learning guitar with tremors was a great struggle, which made him modify his pursuit to singing. After many years of trying to hide his tremors, he finally embraced it and decided to spread awareness through his music and novel audience. Another story took on the viewpoint of a Los Angeles Times new editor whose essential tremors interfered with his ability to draw cartoon characters. While his tremors were not a source of embarrassment, he was aware that his ability to draw cartoon characters without assistive devices might soon become impossible.

 

Various professions will face various barriers when dealing with tremors, however it’s important to take appropriate steps to ensure you can work to your full capacity.  A personal account by Vito Cosmo (2014) described how tremors led to small and illegible handwriting, which can be seen as a problem for a State and Local Tax director. As a solution to this issue, he would carry his laptop to meetings or have someone else take handwritten notes for him. Another student had a similar problem where she couldn’t write her own notes, but once the disability laws entitled her to a note taker she was able to return to college (Brody, 2007). While tremors are a common issue for these individuals, so is fatigue. As result, occasionally working from home or having later start times might be necessary to deal with fatigue. One important distinction with disability in the workplace is that while it might affect one’s ability to perform tasks, it doesn’t change one’s qualifications to do a good job.

 

Additional tips and tricks reported by individuals suffering from tremors include: surround yourself with positive individuals, practice deep breathing exercises and stay organized (Cosmo, 2014). Others have practiced yoga to gain flexibility or other forms of physical activity.  One woman even wrote a book where she provided advice for dealing with essential tremors, including: hold half mugs with all fingers at the rim, use a travel mug with a lid and straw, ask for already cut food from restaurants, use pens with rubber grips, replace buttons with Velcro, and carry a stack of printed labels with your contact information (Brody, 2007).

 

Tremors Brought on by the Workplace

Toxins in the workplace environment can compromise health long-term both physically and mentally. Numerous studies have pointed to manganese toxicity exposure, common for manganese miners, smelters, welders, and battery workers, as a cause for psychiatric symptoms and postural tremors. In a study that compared welders with tremors to tremors in patients with Essential Tremors (ET) and Parkinson’s Disease (PD), tremor intensity and amplitude was greater in the first two groups respectively. Hand tremors worsened with arm extensions, resulting in greater reporting of action and postural tremors in welders than patients with PD. For example, welders’ tremors doubled when the right arm was extended, but remained largely unchanged in patients with PD (Sanchez-Ramos et al., 2011). After 20+ years free of environmental toxins, blood samples yielded low to zero traces of manganese, but postural tremors continued to persist.  Unfortunately, this is neither the first nor last reporting of manganese exposure in literature.

 

Another possibility for work onset tremors is stress. One case study examined a 52 year-old nurse in the intensive care unit who developed tremors for fine motor activities. That made tasks, such as handling an arterial line, next to impossible. However, after she switched to day surgery, which she found far less stressful and allowed her adequate sleep, her tremors did not impede on nursing duties as they had on previous occasions (Lurati, 2015).

 

There are plenty of stories shared online of daily struggles faced by individuals with tremors. Creating a support network, knowing your rights, and making changes to improve daily living will help individuals take control of their tremors and workplace.

 

References:

 

Brody, J.E. (2007). Understanding and coping with tremors. The New York Times.

Retrieved from: http://www.nytimes.com/2007/05/30/health/30iht-29brod.5924602.html

Cosmo, Vito A, Jr,C.P.A., C.G.M.A. (2014). Embrace the elephant in the room:

Disability in the workplace. Pennsylvania CPA Journal, 85(2), 24-26.

Government of Canada. (2017). Rights of People with Disabilities. Government of

Canada. Retrieved from: http://www.canada.pch.gc.ca/eng/1448633334025

Knowsley, A. (2015). Employee discriminated against in workplace for hand

tremor,. Rainey Collins Lawyers.

Lurati, Ann, AR NP, AC NP-BC, MPH,D.N.P., C.O. (2015). An ICU nurse with a

history of tremors. Workplace Health & Safety, 63(1), 6-8. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1177/2165079914565346

McQuigge, M. (2017). Canadians with Disabilities Act to focus on employment:

minister. Global News.

Sanchez-Ramos, J., Reimer, D., Zesiewicz, T., Sullivan, K., & Nausieda, P. A.

(2011). Quantitative analysis of tremors in welders. International Journal of Environmental Research and Public Health, 8(5), 1478-90.

http://www.essentialtremor.org/coping/personal-storiessharing/

Having Parkinson’s and Tips for Coping Daily

Having a disability, such as Parkinson’s disease, in the workplace can prove to be very challenging. This degenerative disease affects the motor system, resulting in tremors, rigidity, bradykinesia (slowness of movement), instability and fatigue. The number of individuals with disabilities and chronic diseases in the workforce is increasing due to longer life expectancy rates.

It is the government’s responsibility to take on an active role in providing both emotional and financial support for those in need. In Canada, The Ontario Human Rights Code fights against ableism in the workplace – the discrimination against those with disabilities. It also ensures that people with disabilities in the workforce receive proper services and the necessary adjustments that would allow them to receive equal access to the same opportunities as the rest of the working force.

Studies show that PD patients tend to retire earlier than anticipated (Koerts et al, 2016). The average diagnosis age is 55 years and the longer they stay in the labor force, the harsher their symptoms progress. As a result, it becomes more challenging to perform certain tasks and duties. A PD patient’s “working capacity” (Martikainen, et al, 2006) eventually decreases and they require major adjustments in the workplace. PD patients may ask for work adjustments, such as extra breaks, option of working from home and taking on fewer responsibilities. However, these adjustments may not be enough to help them meet certain expectations. As the disease progresses, they are faced with severe symptoms preventing them from moving forward. This may lead to work dissatisfaction, which is a key factor in their decision for pursuing early retirement.

When studying the impact of having PD in the workplace, one must consider the direct and indirect costs to society. Direct costs include costs such as treatment and medications while indirect costs involve early retirement, reduced income, unemployment and the impact PD has on one’s mental health.

Many studies reveal that factors other than the diagnosis can impact an individual’s employment status. When diagnosed with PD, the challenges do not only stop at the physical level, but also spill over to the individual’s financial and mental health. Koerts et al. (2016) found that level of income depends on the age of onset, “patients who were younger than the age of 60 received a lower monthly income than individuals without PD of a similar age”. This is indicates that those with PD are more likely to be in a worse off financial state than their colleagues.

From a psychological perspective, PD patients tend to avoid public spaces due to their movement disorder being perceived as disruptive and erratic. It is psychologically problematic for one to constantly feel anxious of being in public spaces, afraid to attend work gatherings and meetings, and receive unwanted attention. Therefore, PD patients tend to leave their jobs earlier than they have to because of emotional distress. Unfortunately, the diagnosis coupled with the loss of employment does not alleviate distress.

In conclusion, PD creates many challenges for an individual in the labor force. While the direct costs may seem significant, it is the indirect costs that truly pose the greater problem to our society. Working with PD can be difficult and have psychological implications that force many PD patients to retire early. Work adjustments are important to improve an individual’s “working capacity”, however, some adjustments may not be enough to meet their work expectation. Is the government’s effort to reduce these challenges effective?

TaiChi.jpg

Tai Chi, an exercise involving yoga and meditation, is an excellent way for Parkinson’s disease patients to improve balance and motor control. This exercise known for its health benefits and would not only allow PD patients to regain control over their lives, but also increase working capacity and functionality.  If interested in Tai Chi, our blog covers the exercise more thoroughly along with other options in the post “Exercise, Not Only for the Realm of Athletes”

Sources:

Banks , P., & Lawrence, M. (2006). The Disability Discrimination Act, a necessary, but not sufficient safeguard for people with progressive conditions in the workplace? The experiences of younger people with Parkinson’s disease. Disability and Rehabilitation, 28(1), 13-24.

Koerts, J. et al. (2016). Working capacity of patients with Parkinson’s disease – A systematic review. Parkinsonism and Related Disorders, 27, 9-24.

Martikainen, K. K. (2006). Parkinson’s Disease and Working Capacity. Movement  Disorders, 21(12), 2187-2191.

Wayne, P. (2013, May 03). Tai chi improves balance and motor control in Parkinson’s disease. Havard Health Publishing 

(2016) Policy on ablesim and discrimination based on disability, Ontario Humans Rights Commission

Exercise, Not Only for the Realm of Athletes  

Written by Tiana Corovic

Among its many known benefits, exercise may also be used as a rehabilitative treatment for the reduction and control of Essential (ET) and Parkinsonian tremors (PT). Performing every day tasks requires some degree of physical ability, such as strength, dexterity, and steadiness. Gaining control of movements does not have to come at the expense of a needle or a surgical procedure. Improvements in movement control and severity of tremors may occur after only six weeks of diligently applying to an exercise routine. This doesn’t have to take form of the huffy puffy weightlifting challenges aired on ESPN. Targeted strength training, tai chi, and yoga may bring about the desired increases in physical ability.

Strength Training

Strength training may range from kettle bell movements, speed lifting to body weight exercises, all of which require muscle groups to work against a force. Besides the obvious benefits for overall health, numerous studies point to strength training as a rehabilitative program for ET and PT. Resistance training is believed to induce neuromuscular adaptions that may benefit patients with ET by reducing the variability in motor firing rate (Sequeira, Keogh, & Kavanagh, 2012). When trained on heavy versus light resistance loads, patients were more likely to have increased steadiness, overall reduced tremor amplitude, and improved dexterity, noticeably in their most affected limb (Bilodeau et al., 2000; Sequeira et al., 2012).

Furthermore, even an untrained limb may begin to see improvements in muscle contractions by about 8.2% due to the cross-over effect of resistance training (Lee, Gandevia, & Carroll, 2009).  This is further reflected in the increased activity of the sensorimotor region in the brain, associated with the untrained limb during exercise (Farthing et al., 2007).

Tai Chi

Tai Chi is an exercise involving fluid movements that occur in a sequence while body weight shifts from one leg to the other. Studies demonstrate that patients with Parkinson’s Disease (PD) benefit in terms of balance and well being from practicing tai chi (Li et al., 2012). Since impaired balance is a common issue associated with PD and is known to reduce patients’ functional abilities, tai chi may act as a beneficial tool for reducing falls and its associated injuries. The improvements in physical function are thought to occur due to the reduction of dyskinesia (i.e., impaired voluntary movement) and bradykinetic movement (i.e., slow movement).  One study demonstrates that after tai chi practice twice a week for 24 weeks, participants had an average of 10.3cm increased stride length, increased walking speed, and greater knee extensions when compared to a stretching program (Li et al., 2012). While there are varying results in gait (ability to walk at a normal pace), mobility, aerobic endurance, and flexibility among studies, there’s a common consensus that tai chi improves physical function and well being among persons with PD (Ćwiękała-Lewis, K.,J., Gallek, M., & Taylor-Piliae, R, 2017). Tai chi’s many beneficial effects for physical ability make it a promising candidate as a behavioral intervention in patients with PD.

Yoga

Yoga is another tool that may be used to improve the severity of tremors. Due to its relaxing effects and the fact that tremors are frequently aggravated by stress, yoga may serve as a noninvasive relief method for patients with ET and PD. When individuals experience tremors, their default mechanism tends to be to tighten their muscles, often producing the opposite of the desired effect (Reeva & Cambell). Learning to relax can help overcome these maladaptive techniques to prevent worsening of tremors.   Stress may increase tremor amplitudes by activating various neural projections in the brain (Helmich & Dirkx, 2017).  A characteristic that separates PD from ET is that tremors frequently occur at rest during the former and during activity performance in the latter.

Tremors in PD increase markedly during cognitive stress to the point where they may even surpass effects of drugs, such as Levodopa, used for muscle control (Zach et al., 2017). Because of yoga’s common relaxing effect, it may be used as a form of behavioral therapy to reduce stress and its adverse effects.   Yoga’s benefits may further surpass the realm of stress reduction to improve patients’ physical abilities. After three months of yoga twice a week, there’s a significant reduction in bradykinesia, rigidity, and increased muscle strength in patients with PD (Ni, Mooney & Signorile, 2016). Another study demonstrated Bikram yoga’s ability to increase maximum voluntary force by 14% as well as reduce knee extension force fluctuations in patients that had the greatest difficulty prior to training (Hart & Tracy, 2008).  Exercise in multiple forms may be used as an additional treatment option for patients with ET and PD to improve physical well being.

Health does not need to come at the expense of high cost treatment options, negative side effects or invasive procedures. Improving one’s well being and capacity to perform activities in everyday life may be attained in the comfort of one’s home. Emerging evidence is indicating that strength training, tai chi, and yoga may benefit patients with ET and PD, helping patients to regain control of their movements and, by association, daily living activities.

References

Bilodeau, M., Keen, D. A., Sweeney, P. J., Shields, R. W., & Enoka, R. M. (2000).
Strength training can improve steadiness in persons with essential tremor. Muscle & Nerve, 23(5), 771-778.

Ćwiękała-Lewis, K.,J., Gallek, M., & Taylor-Piliae, R. (2017). The effects of tai  chi on physical function and well-being among persons with parkinson’s disease: A systematic review. Journal of Bodywork and Movement Therapies, 21(2), 414-421.
doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.jbmt.2016.06.007

Farthing, J. P., Borowsky, R., Chilibeck, P. D., Binsted, G., & Sarty, G. E. (2007). Neuro- physiological adaptations associated with cross-education of strength. Brain Topography, 20(2), 77-88. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1007/s10548-007-0033-2

Hart, C. E. F., & Tracy, B. L. (2008). YOGA AS STEADINESS TRAINING: EFFECTS ON  MOTOR VARIABILITY IN YOUNG ADULTS. Journal of Strength and Conditioning Research, 22(5), 1659-69.

Helmich, R.C., & Dirkx, M.F. (2017). Pathophysiology and Management of  Parkinsonian Tremor. Seminars in Neurology, 37, 127-134.

Kavanagh, J. J., Wedderburn-Bisshop, J., & Keogh, J. W. L. (2016). Resistance  training reduces force tremor and improves manual dexterity in older individuals with essential tremor. Journal of Motor Behavior, 48(1), 20-30. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1080/00222895.2015.1028583

Kidgell, D., & Pearce, A. (2010). Neural adaptations following cross-education  strength training: A pilot study. Journal of Science and Medicine in Sport, 12, 1. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.jsams.2009.10.107

Lee, M., Gandevia, S. C., & Carroll, T. J. (2009). Unilateral strength training increases  voluntary activation of the opposite untrained limb. Clinical Neurophysiology, 120(4), 802-808. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.clinph.2009.01.002

Li, F., PhD., Harmer, Peter,PhD., M.P.H., Fitzgerald, K., M.D., Eckstrom, Elizabeth,M.D.,  M.P.H., Stock, R., M.D., Galver, J., P.T., . . . Batya, S. S., M.D. (2012). Tai chi and postural stability in patients with parkinson’s disease. The New England Journal of Medicine, 366(6), 511-9.

Ni, M., Mooney, K., & Signorile, J. F. (2016). Controlled pilot study of the effects of  power yoga in parkinson’s disease. Complementary Therapies in Medicine, 25, 126-131. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.ctim.2016.01.007

Pal, P. K. (2011). Guidelines for management of essential tremor. Annals of  Indian Academy of Neurology, 14(Suppl1), S25–S28. http://doi.org/10.4103/0972-2327.83097

Reeva, M., & Campbell, D. Exercise for relaxation & improve life’s quality

Sequeira, G., Keogh., J.W., & Kavanagh, J.J. (2012). Can resistance training  improve fine manual dexterity in Essential Tremor patients? Archives of Physical Medicine and Rehabilitation, 93, 1466-8.

Yang, Y., Li, X., Gong, L., Zhu, Y., & Hao, Y. (2014). Tai chi for improvement of motor  function, balance and gait in parkinson’s disease: A systematic review and meta-analysis. PLoS One, 9(7), e102942. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1371/journal.pone.0102942

Veterans, PTSD & Tremors

In light of International Essential Tremor Awareness Month, our team have decided to dedicate our most recent blogpost to our veterans.

Veterans are affected by tremors due to many different reasons, ranging from tremors being caused from PTSD to exposure of certain environments causing them to develop diseases such as Parkinson’s Disease (PD) after a while. The most common cause is post-traumatic stress disorder (PTSD), distressing symptoms occur after one or more frightening incidents. For the most part, a person with this disorder must have experienced or witnessed a traumatic event. The event must have involved serious physical injury or the threat of serious injury or death. The associated symptoms vary in intensity, ranging from mild and tolerable anxiety to a full-blown panic attack. Symptoms include sweating, shortness of breath, pounding heart, dry mouth, and tremor. Some war veterans suffering from PTSD have a problem with alcohol and smoking cigarettes. It is twice as likely for someone with PTSD to smoke than those without PTSD. Withdrawal of these substances can cause tremors.

Furthermore, another cause of tremors in veterans is a traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism. Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull leading to veterans suffering from tremors. Given the nature of combat in Iraq, Afghanistan, Somalia, etc., very few Veterans escape combat service without a TBI – or Traumatic Brain Injury. It has been estimated that about 300,000 OIF/OEF Vets, about 15%, have a diagnosed or untreated Traumatic Brain Injury (TBI).

Another cause of tremors in veterans is the exposure to certain chemicals in combat. For example, during the Vietnam war a mixture of toxins was used to remove leaves from trees in order to leave the enemy exposed. Around 2.6 million soldiers were exposed to this chemical. Exposure to this chemical has been known to be tied to many diseases including PD, cancer, and diabetes. Veterans exposed to Agent Orange have a 70% greater likelihood of being diagnosed with Parkinson’s disease. Additionally, from 1955-1975 researchers at Edgewood used human subjects instead of animals to test a variety of drugs and chemicals. Subjects used in these test have experienced PD later in life. Similarly, Gulf War veterans were exposed to a class of chemicals called Acetylcholinesterase inhibitors, a chemical which affects numerous bodily functions. Side effects can include muscle twitching, cramps, weakness, tremors, paralysis, fatigue, mental confusion, headache, poor concentration, and general weakness. Additionally, a newly identified disorder called Gulf War illness (GWI) has affected close to 30 percent of the military personnel who served in the 1990-1991 Persian Gulf War.

Researchers at Georgetown University have identified two distinct forms of GWI where the veterans’ brains have actually atrophied, or died from over use. Symptoms of these veterans include cognitive impairment, widespread aches and pains, and tremors.

In 2001, the Department of Veteran Affairs (VA) created six specialized centers known as the Parkinson’s Disease Research, Education and Clinical Centers or “PADRECCs”. These Centers of Excellence are designed to serve the estimated 80,000 veterans affected by PD through state-of-the-art clinical care, education, research, and national outreach and advocacy. The PADRECCs are staffed by internationally known movement disorder specialists, neurosurgeons, psychiatrists, psychologists, nurses, researchers, educators, social workers, and other PD experts.

The PADRECCs offer care to all veterans currently enrolled in the VA Healthcare System. This includes veterans who have been previously diagnosed with PD or veterans who have just started to notice Parkinson-like symptoms. They also treat veterans who have been diagnosed with other movement disorders, such as essential tremor.

To learn more about treatment facilities, click below:
USA
Canada
UK

As always, we welcome anyone to comment their anecdotes with the above topic or to ask for further advice on how to handle it.

 

 

 

Alcohol in Essential Tremor and Parkinson’s Disease

Alcohol drinks contain the substance ethanol, which is a psychoactive drug. Alcohol in low doses may cause euphoria, reduced anxiety, and sociability, while in high doses it may cause drunkenness (intoxication), stupor and unconsciousness. Long term use may lead to alcohol dependency. While alcohol may cause all these, it affects Parkinson’s Disease and Essential Tremor patients differently. Tremoring may occur due to many different diseases and reasons. Alcohol withdrawal and abuse can cause said tremors, especially in the hand, since alcohol kills certain nerve cells. For Essential Tremor patients the ingestion of alcohol has been shown to improve the tremors. Doctors may use alcohol to see diagnose ET if they see a decrease in the amplitude of tremors, albeit not very common. There are studies underway regarding the correlation between alcohol and ET. One of the studies conducted by JH Growdon, took 5 ET patients which showed a decrease in tremor amplitude after 15 minutes of ingesting alcohol. The same 5 patients were given equal amounts of ethyl alcohol infused into a brachial artery, and there was no decrease in tremor amplitude. Concluding that in patients with essential tremor, ethanol acts on sensitive structures within the central nervous system and has no effect on peripheral tremor-genic mechanisms. Providing evidence for a central mechanism in essential tremor, distinguishing it from other tremors arising primarily from oscillation in peripheral servo-loops.

Conversely, PD patients are affected differently from the consumption of alcohol. It has been suggested to be protective of PD or to have no effect at all. A study by Dr. Bettiol emphasizes the need for more studies regarding the correlation between PD and alcohol since many studies provide different results. As well as having different result some studies use different criteria compared to others. It is difficult to have a perfect study since many factors can affect the results. Small things such as intake of coffee, if individuals are drinkers or non-drinkers, and frequency of alcohol intake can vary results from study to study. Another study concluded that a history of an alcohol use disorder conferred an increased risk of admission with a diagnosis of Parkinson’s disease in both women and men. In particular, the risk seemed higher at lower ages of first admission with Parkinson’s disease. Moreover, another study by Rui Liu and others, concluded that beer and liquor consumption may have opposite associations with PD: low to moderate beer consumption with lower PD risk and greater liquor consumption with higher risk. As we can see more studies have to be done to get to a final conclusion on how alcohol affect PD patients.

As we can see both diseases affect patients differently under the influence of alcohol. Consequently, if it helps someone with their tremors it does not mean it will help everyone. Each person is different and is affected differently. Having been diagnosed with either of the diseases you must know your limits and what is good for you. Being a patient suffering from PD does not mean you cannot enjoy a glass of wine, however, moderation is key and alcohol may affect a person’s ability to accomplish task. Furthermore, if alcohol makes you more unsteady, by combining this with the instability of PD or ET it may increase the risk of falling and even injury.

We welcome anyone to comment their anecdotes with alcohol or to ask for advice on how to handle it.

Top 5 Smartphone Applications for Parkinson’s Disease and Essential Tremor

Nowadays, smartphones have become a crucial tool for social media, communication and even entertainment but what we will be shedding light on today is also the owner’s well-being. As a sufferer of Essential Tremor or Parkinson’s, it can be hard to keep track of your tremors from the comfort of your own household. Our blog team has decided to compile a short list to motivate sufferers to explore their options and connect with local resource providers and allow for more independence in their daily lives.

Here are some of the best free and paid apps for iOS and Android.  To further enhance your decision-making, we have taken a screenshot of the user interface of each application chosen.

Lift Pulse (Free) Android/iOS

liftpulse

This app will let you record motion data due to hand tremor and keep a journal. It uses the phone’s accelerometers to help track the movement. It calculates the magnitude of the tremors and can compare readings to baseline tremor (tremor on a normal day).

 

mPower (Free) iOS

 

mpower

 

This is one of the best ways to help the community of Parkinson’s and yourself. This app provides a tool to track symptoms and review trends, whilst sharing this information with researchers. It features things such as activity based measurements for symptoms that include finger tapping, voice recording, memory game, and walking. It helps you understand symptom variations and it has partnered with Apple’s ResearchKit.

 

Parkinson’s Central (Free) Android/iOS

parkinsons-central

This app is great for people who have been just diagnosed with PD. This app created by the National Parkinson’s Foundation offers answers to questions about symptoms, medications, and life with Parkinson’s in general. The app also has features such as: How to get the most out of your doctor visits, ins and outs of diagnosis and medication management, advice on how to live well with the disease, information on insurance and financial matters, tailored content for caregivers and a “Near Me” tool to find local resources according to zip code.

 

Parkinson’s Exercise ($6.99) Android/iOS French: Android/iOS

parkinsons-exercise

One of the easiest ways to help your symptoms and stay healthy. The app has a compilation of videos made by researchers and therapists, which include exercises, movement advice as well as instructions for the exercises and mobility. Focuses on walking, posture, balance, flexibility, physical condition, and relaxation.

 

IETF (Free) Android/iOS

ietf-screenshot-app

The International Essential Tremor Foundation (IETF) teamed up with OrgHunter to create this app. The app enables you to have information about ET right in the palm of your hand. It teaches the basics of what ET is, treatment options available, and comparisons with other movement disorders. Furthermore, it has a feature in which it lets you know if there will be any upcoming patient-focused education events.

All in all, we hope these apps are helpful for you or your family and friends to better understand the diseases and help you in your everyday life. If there are any apps you use that you think could help others, please mention them in the comment section below so we can update our growing list.

Children with Essential Tremor

Children with Essential Tremor

Essential Tremor (ET) is the most common movement disorder, which is often typecast as an illness of the elderly. Nevertheless, this is far from reality. ET may affect people from all ages and is prevalent among 4.6%-5.3% of the childhood population and children are often misdiagnosed due to the stereotype. ET has a hereditary trait, as a study carried in 2004 by Joseph Jankovic showed that out of a sample of 39 children, 79.5% reported at least one relative with tremor. Furthermore, the mean age at onset of the 39 patients was 8.8±5.0 years and mean age at evaluation was 20.3±14.4 years.

ET has disturbing effects on the quality of life of people who suffer from the disease. 20% of children have kinetic tremor only (i.e. tremor present only when the hands are moving), 5% have postural tremor only (i.e. tremor is visible when the hands are held outstretched), and 75% have both. It can prompt depression and also cause social anxiety. For children it can be even tougher to handle since ET may present difficulties preforming school activities as well as being in front of their peers. It can challenge them by making writing, typing, drawing, or even eating a hardship and additionally, peers may make it harder on them since they can make harsh comments. This may lead to children with ET to avoid their peers, or even refuse to try the simplest tasks. One way to avoid this is to be open about the condition with the child’s classmates and boosting self-esteem early on. Family members that suffer from ET can also be of great help and give them advice. Therefore, they will be aware about the condition and this may avoid them making fun of the child suffering from ET. Children may also get shy causing anxiety, which may cause an increase in tremors. Children are often given small doses of propranolol (20-60 mg) to improve the tremors, however there haven’t been any controlled trials to prove it helps children with the tremors.

The frequency of the tremor in children has a lower frequency from ages 7-12 years than from 14-16 years. It goes from an average of 5.3 Hz to 9.0 Hz respectively. An interesting observation is that when putting a 300-gram weight on the fingers of children with ages 7-12 years, the tremor increases in frequency from the 5.3 Hz to 8.2 Hz, whereas in teenagers and adults it has no effect on tremor frequency. Also, tremor in children can be associated with dystonia, which is a condition where there are sustain muscle spasms. Moreover, an over-active thyroid gland may also cause tremor. Consequently, a blood sample for thyroid function tests may be necessary.

If you are a parent of a child with ET, or a young person with ET we invite you to comment down below any questions, thoughts or stories. We would like this to be a place of discussion and, if possible, a way to reach out for help or to get any doubts answered. These connections should lead to a greater understanding, a support network, and opportunities to share advice with other parents or young people suffering from ET.