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Tuesday, January 16, 2018

Understanding Parkinson’s Tremors


One of the hallmark symptoms of the neurodegenerative disorder Parkinson’s is tremors, affecting about 80% of those with the disease. Understanding the types of tremors and how they are treated, may equip someone with Parkinson’s and their caregivers with tools to better manage the disease and improve day to day life.

What Causes Parkinson’s Tremors?
Different than other conditions like multiple sclerosis where tremors are most prominent with purposeful movement, Parkinson’s tremors often occur when limbs are at rest. Why exactly? The overall nature of Parkinson’s disease is a dysfunction of motor control centers due to damaged and dying nerve cells in the brain.

A decrease in dopamine production, a critical neurotransmitter, disrupts the normal communication processes between cells which help control body movements. When dopamine receptors are not sufficiently stimulated it causes a chain reaction in the brain of irregular neural impulses. As the motor cortex receives more and more irregular input from the thalamus which helps control motor and sensory signals, symptoms including tremors, bradykinesia (slowed movements), contractures, and balance problems.

Tremors specifically are believed to be the result of decreased thalamic output due to overstimulated of the globus pallidus interna (GPi), nuclei in the basal ganglia of the brain which regulate muscle tone. Skeletal muscles are voluntary which means they need specific signals from the brain to move, flex, etc. When those signals go haywire, you get movement dysfunction such as tremors.

What do Parkinson’s Tremors Look like?
While Parkinson’s tremors most often appear first in the hand, leg, or arm (and typically starting on just one side of the body), they may also present in the jaw, face, and feet. A cardinal Parkinson’s tremor is referred to as a “pill rolling tremor” because it looks like someone rolling something small, like a pill, between their thumb and forefinger, almost like a finger twitch.

Tremors in the leg when standing or lying down, as well as tremors in the hand when sitting, standing, or lying down, are often decreased when purposeful movement is taken like adjusting posture, reaching for something, or walking. Tremors may begin as minimal involuntary shaking, quivering or spasming and progress to very visible and disconcerting shaking that affects one or both sides of the body.

A clinical diagnosis from a neurologist will usually help someone with these types of tremors deduce whether Parkinson’s disease could be a factor. Other accompanying symptoms like lack of facial expressions, not blinking, not swinging arms at one’s side when walking, muscle stiffness and rigidity, and slowed movements contribute to a proper diagnosis.

Managing Parkinson’s Tremors
While some medications are used specifically to target tremor-type symptoms with dopamine-replacement therapy, there are also non-medicinal ways to mitigate the effect tremors have on your daily living at home:
  • Use a self-stabilizing spoon or other specially designed flatware which employs motion-sensing technology to counteract tremors when eating.
  • Keep up with aerobic exercises and low-impact activities which aid muscle flexibility, coordination, and balance (i.e. yoga, swimming, cycling, etc.)
  • Occupational and physical therapy can also re-train the body to better manage motor symptoms
  • Home health equipment like shower chairs, bed rails, and grab bars can simplify daily tasks and provide support and stability as tremors worsen
  • Tremors in the jaw and tongue may subside in part by chewing gum
Combined with slowed movements, muscle rigidity, and postural instability, tremors can increase risk for someone suffering from Parkinson’s to experience a debilitating, even potentially fatal falls. Taking precautions in the home to prevent falls can therefore significantly improve their health outcomes.

Fall prevention starts with clearing away unnecessary clutter from common walkways, as well as removing trip hazards like cords and curled up carpet corners. People with Parkinson’s and their loved ones may also consider installing fall mats by couches and beds where a lot of standing and sitting happens.

This is a guest blog post.

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