Why Are My Hands Shaking?

It is quite impossible to keep your hands completely still and therefore to some degree everyone has a tremor (Harvard Health Publishing, 2015). The root cause of this shakiness is due to the tiny muscle fibers found within the hands and arms that are constantly contracting and resting (Piedmont healthcare, 2017). At times this involuntary movement may become imbalanced as some of the muscle groups may continue to contract instead of entering the resting phase setting the timing off (Piedmont healthcare, 2017).

The trick here is figuring out if this shakiness of the hand is normal or abnormal (Harvard Health Publishing, 2015).

““You know your body best,” says Dr. Etienne. “If you feel shaky after a couple cups of coffee or as you prep for a public speaking engagement, it may very well be the caffeine or adrenaline causing your shakiness, and there is no cause for alarm. But if you can’t control it, even when you aren’t using your hands, this might be a sign to seek your doctor’s advice”” (Piedmont healthcare, 2017).

Causes

There are a variety of conditions that contribute to hand tremors. Common causes of shaky hands include:

Anxiety. Anxiety takes on a form of a psychological tremor, involuntary muscle movement occurring within the body of a healthy person resulting in mechanical and nervous system interactions (Tomczak, Gajewski, & Mazur–Różycka, 2014).  When dealing with such strong emotions, nerves are heightened causing shaky hands usually due to significant feelings of anger, stress, tiredness or being anxious.

Lack of Sleep. When the body is deprived of sleep it may trigger neurological reflexes that can then result in shaky hands, irritation, mood change, and lack of concentration (Piedmont healthcare, 2017).  Sleep deprivation can also contribute to chronic physical health issues and increase risk for things such as weakened immunity, memory issues, and weight gain (Healthline, 2018).

Alcoholism. The consumption of too much alcohol can result in liver and other health problems such as an alcohol disorder. Alcohol affects everyone differently however, common changes include personality and behavioral change such as irritability and lack of motivation, change in daily regimes, shaky hands, and slurred speech (Nazario, 2018). Depending on the severity of one’s alcohol intake hand shaking can last for a few days to years to even a longer duration of time (Nazario, 2018).   

Liver Damage. Cirrhosis occurs at the end stage of chronic liver disease when there is severe damage caused to the liver resulting in liver scarring (Healthline, 2018a). Common causes are due to alcohol abuse and viral infections (Healthline, 2018a). Positive physical examination tests will show pale skin, yellow eyes (jaundice), hand tremors, reddened palms, an enlarged liver or spleen, and finally, small testicles (Healthline, 2018a).  

Low Blood Sugar (Hypoglycemia). As the blood sugar levels decline well below normal, the nerves and muscles are deprived of fuel causing a variety of different effects such as, shakiness of the hand, sweating, anxiety, hunger, irritability, pale skin, fatigue and irregular heart rhythm (Mayo Clinic, 2018). Keep in mind that the adrenaline system will instantly respond and therefore it will make the shakiness worse for the time being. Overall hypoglycemia is a good indicator that an underlying health problem exists in some cases (Stearn, 2014).  

Overactive Thyroid (Hyperthyroidism). Known to be more prevalent in women and in individuals in their 20s and 30s (Piedmont healthcare, 2017). Excess thyroid hormone being released into the body speeds up processes and can not only result in shakiness but also anxiety, nervousness, rapid heartbeat, sweating, sleeping issues and weight loss (Aleppo, 2018).

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In 2007, Oprah Winfrey announced that she had a thyroid problem diagnosed as hypothyroidism (Gentile, 2017).

“ My body was turning on me. First hyperthyroidism, which sped up my metabolism and left me unable to sleep for days. (Most people lose weight. I didn’t.) Then hypothyroidism, which slowed down my metabolism and made me want to sleep all the time. (Most people gain weight. I did! Twenty pounds!)” (Parker-Pope, 2007).

Too Much Caffeine. If too much coffee, tea or chocolate is consumed it can result in shaky hands, feeling of jitters, anxiety, rapid heartbeat, stomach irritation and headaches especially if one has substance sensitivity (Zehr, 2017). Caffeine acts as a central nervous system stimulate and when consumed in adequate amounts it makes the consumer more awake, energetic and alert (Zehr, 2017).

Essential Tremor. A nerve disorder causing uncontrolled shaking or tremors to different areas of the body. Most common areas of the body that are affected include arms, hands, larynx, tongue, head, and chin. In majority of cases lower body parts are not affected by this condition (WebMD, 2018).  A key aspect of essential tremors is that it produces more noticeable movements as the muscle fibers contracting and resting are synchronous oppose to contracting at random (Stearn, 2014).

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“ The late “actress Katharine Hepburn is an extreme example of advanced essential tremor – it affected her voice, head and arms, as well as her hands,” Rezak notes. Playwright Eugene O’Neill also suffered from essential tremor. So does rocker J. Roddy Walston, of J. Roddy Walston & The Business, who became increasingly vocal about his condition in the band’s 2013 LP “Essential Tremors.”” (Colino, 2015).

Psychogenic Tremor (Functional Tremor).  Can come and go as any form of shakiness within the body. The tremor worsens during times of peak stress and declines or stops when distracted (Office of Communications and Public Liaison, 2018).  It is very common for individuals with psychogenic tremor to also have an underlying psychiatric disorder such as depression or post-traumatic stress disorder (PTSD) (Office of Communications and Public Liaison, 2018).

Multiple Sclerosis (MS). An immune system targeting disease that affects the nerves, brain, spinal cord and causes shaky hands (WebMD, 2017). Essential tremors in the hand or foot are very common in MS and occur when one is already performing the act of moving (WebMD, 2017).

Jack Osbourne Son of the famous British rock star Ozzy Osbourne,  publicly announced having multiple sclerosis in 2012.

“Since his diagnosis, Osbourne’s motto is “Adapt and Overcome.” He uses the hashtag #Jackshaft on Twitter to talk about his experience with MS. “I will never say that I am thankful for MS,” he said in an open letter. “But I will say that without MS, I don’t know if I would have made the necessary changes in my life that have changed me for the better” (Healthline, 2018b).

Post-Traumatic Stress Disorder (PTSD). A disorder where the brain reacts with excessive fear and nervousness even after one has already experienced or seen a traumatic or terrifying event, long after the original trauma event is over (Peterson, 2018). The brain reacts by staying in overdrive and in a state of hyper alertness for the next trauma (Peterson, 2018). This causes nervousness, jittering, and shaking (Peterson, 2018). Alternately, followed by a traumatic event, one can become numb and shut down their feelings and start to avoid certain situations that recall traumatic events. Other individuals can fall prey for depression, irritability, or risky behavior (Peterson, 2018).

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Lady Gaga released an open letter to her fans talking about her battle with post-traumatic stress disorder.

She wrote: “I have wrestled for some time about when, how and if I should reveal my diagnosis of Post-Traumatic Stress Disorder (PTSD). After five years of searching for the answers to my chronic pain and the change I have felt in my brain, I am finally well enough to tell you. There is a lot of shame attached to mental illness, but it’s important that you know that there is hope and a chance for recovery” (Hinde, 2017).

Parkinson’s Disease (PD). A less common condition in comparison to essential tremor. PD causes shakiness of the hand just as essential tremor but rather than causing difficulties in performing tasks the shaking of the hand is the worst when one is resting and not utilizing the hand (Stearn, 2014). The shakiness in Parkinson’s disease is referred to as ‘pill rolling’ this is because its similar to rolling a pill between one’s thumb and side of the index finger (Stearn, 2014).

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In 1984, Muhammad Ali’s condition was officially diagnosed as Parkinson’s disease, three years after he retired from the professional boxing (Sawer, 2016).

“at the age of 38, tempted back into the ring by money and his love of the crowd, he suffered a terrible beating at the hands of Larry Holmes, his former sparring partner. In 1981 he took another pummelling, losing on points to Trevor Berbick before finally retiring for good. By now Ali’s physical deterioration was obvious. He suffered from permanent fatigue, his mouth drooled saliva and he developed a tremor in his hand” (Sawer, 2016).

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Medications. Involuntary drug induced shakiness can occur as the nervous system and muscles respond to medication’s ingested (Medline Plus, 2018). Some common medications that can cause shaking include:

  • Excessive movement disorder medication (Tetrabenazine)
  • Cancer medicines (cytarabine and thalidomide)
  • Antidepressants (tricyclics and Selective serotonin reuptake inhibitors (SSRIs))
  • Seizure medicines (sodium valproate and valproic acid)
  • Heart medications (procainamide and amiodarone)
  • Asthma medication (albuterol and theophylline)
  • Lithium (mood stabilizer)
  • Immune suppressing medicines (tacrolimus and cyclosporine
  • Stimulants (amphetamines and caffeine)  
  • Antibiotics
  • Nicotine
  • Weight loss/ bariatric medication (tiratricol)
  • Overactive thyroid medication (levothyroxine)
  • Blood pressure medications
  • Antivirals (vidarabine)
  • Epinephrine and norepinephrine

(Medline Plus, 2018)

There are many causes for shaky hands ranging from non-severe issues such as consuming too much coffee to more chronic issues such as essential tremors. Information provided is for educational purposes only and does not replace a licensed physician’s professional diagnosis, treatment or medical advice on your shaky hands problem.

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References

Aleppo, G. (2018). Hyperthyroidism Overview. Retrieved from https://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-overview-overactive-thyroid

Colino, S. (2015). The Truth About Essential Tremor: It’s Not Just a Case of Nerves. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/11/11/the-truth-about-essential-tremor-its-not-just-a-case-of-nerves

Gentile, J. (2017). Celebrities with Thyroid Disorders. Retrieved from https://www.endocrineweb.com/conditions/thyroid/celebrities-thyroid-disorders

Harvard Health Publishing. (2015). Tremor – Harvard Health. Retrieved from https://www.health.harvard.edu/decision_guide/tremor

Healthline. (2018). 11 Effects of Sleep Deprivation on Your Body. Retrieved from https://www.healthline.com/health/sleep-deprivation/effects-on-body#1

Healthline. (2018a). Cirrhosis. Retrieved from https://www.healthline.com/health/cirrhosis

Healthline. (2018b). Celebrities with Multiple Sclerosis. Retrieved from https://www.healthline.com/health/multiple-sclerosis/celebrities-with-ms#2

Hinde, N. (2017). 17 Celebrities Open Up About Mental Health. Retrieved from https://www.huffingtonpost.co.uk/entry/celebrities-who-opened-up-about-mental-health_uk_591311ade4b050bdca6121d6?guccounter=1&guce_referrer_us=aHR0cHM6Ly93d3cuZ29vZ2xlLmNhLw&guce_referrer_cs=aUwns0nu64MgNodXX_C5lw

Livinglifewithessentialtremor. (2018). Katherine Hepburn & ET! Retrieved from https://livinglifewithessentialtremor.wordpress.com/2018/01/23/katherine-hepburn-et/

Mayo Clinic. (2018). Hypoglycemia. Retrieved from https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685

Medline Plus. (2018). Drug-induced tremor: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/000765.htm

Nazario, B. (2018). Signs of Drug Addiction. Retrieved from https://www.webmd.com/mental-health/addiction/signs-of-drug-addiction#2

Office of Communications and Public Liaison. (2018). Tremor Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet

Parker-Pope, T. (2007). Oprah’s Thyroid Club. Retrieved from https://well.blogs.nytimes.com/2007/10/19/oprahs-thyroid-club/

Peterson, M. (2018). Post-traumatic Stress Disorder (PTSD) Symptoms, Tests & Treatments. Retrieved from https://www.emedicinehealth.com/post-traumatic_stress_disorder_ptsd/article_em.htm#what_is_post-traumatic_stress_disorder_ptsd

Piedmont healthcare. (2017). Shaky hands – normal or not? Retrieved from https://www.piedmont.org/living-better/shaky-hands-—-normal-or-not

Sawer, P. (2016). His longest round: Muhammad Ali’s fight with Parkinson’s disease . Retrieved from https://www.telegraph.co.uk/news/2016/06/04/his-longest-round-muhammad-alis-fight-with-parkinsons-disease/

Stearn, M. (2014). Shaky hands. Retrieved from https://www.embarrassingproblems.com/problem/shaky-hands

Tomczak, A., Gajewski, J., & Mazur–Różycka, J. (2014). Changes in Psychological Tremor Resulting From Sleep Deprivation Under Conditions of Increasing Fatigue During Prolonged Military Training. Biol Sport, 31(4), 303-308. doi:10.5604/20831862.1127343

WebMD. (2017). Can multiple sclerosis (MS) cause shaky hands? Retrieved from https://www.webmd.com/brain/qa/can-multiple-sclerosis-ms-cause-shaky-hands

WebMD. (2018). The Brain and Essential Tremor. Retrieved from https://www.webmd.com/brain/essential-tremor-basics#1

Zehr, M. (2017). How to Treat Hand Tremors by Exercising. Retrieved from https://www.livestrong.com/article/449077-how-to-cure-hand-tremors-by-exercising/

Living with Parkinson’s Disease (The Caregiver Edition)

 

Parkinson’s disease is a progressive, neurodegenerative brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination (Robinette, Charles et al, 2018). Symptoms usually begin gradually and worsen. Overtime individuals may experience mental and behavioral changes, memory loss, fatigue, sleep problems, and depression. PD is most common in men aged 60. However, early onset of the disease can begin at the age of 50 (Robinette, Charles et al, 2018).

Families Coping with Parkinson’s Disease  

Parkinson’s Disease like any other chronic illness manifests many physical and psychological challenges, this can be incredibly hard on the family. Along with the affected individuals the family has to also deal with change and adopt to this new lifestyle that comes along. It can be emotionally devastating to see a family member suffer and having to support and care for them throughout (WHP, 2017).

qaulity of life

Family members of individuals with PD have their work cut out for them. Caregivers and family take part in: 

  • Maintaining quality of life
  • Keeping updated on disease progression, symptoms, treatment and challenges.
  • Offer love and support

(Senelick, 2016)

Maintaining Quality of Life

It is a crucial part of maintaining quality of life even after being diagnosed with PD that affected individuals understand that they are not alone in this journey. The family should actively be apart of the affected family members daily life. Involvement can range from different activities such as going for a walk, watching television, taking a trip to the grocery store, or even doing laundry (WHP, 2017). As long as some involvement is there from the family it can act as a temporary relief from symptoms and enhance quality of life (WHP, 2017)

(Ryerson, 2015)

Keeping Updated on Disease Progression, Symptoms, Treatment and Challenges

Many symptoms of PD are almost invisible these include fatigue, anxiety and depression (Ryerson, 2015). Most of the time it is not immediately apparent that your loved is suffering as it may be internal symptoms. Having frequent conversations about how your loved one feels and what has changed or progressed within their illness is key. This keeps family members in the loop and allows them to accommodate for long-term care.

Offer Love and Support

Doctor’s appointments, support group meetings, communicating with children and other family members can all be very overwhelming. It is a good idea to have and bring a caregiver along to listen and take part in certain situations. For example, it may be a good idea to take your spouse along to a doctor’s appointment as she or he will have a better idea about any mood or behavioral changes and concerns (Ryerson, 2015).

A poem describing Jane Davis’ experience with Parkinson’s disease when her husband, Gary, was diagnosed

Watching 

“I watch
your body slowly deteriorating
not daily, not weekly,
but it is there.
I compare to a year past
and then I know,
your body is betraying you.

Friends notice
family too,
our children don’t want to admit.
To them, you are the superhero
one that can do anything
build anything
fix anything.
Maybe that is how it should be.

I watch you move and sway,
Darn medications.
Darn disease.
I watch you struggle to button,

Darn disease.
I watch you walk with your bent back,
I watch you grimace in pain.
Darn disease.
I watch your hands tremor,
Darn disease.
I watch those many trips to the bathroom
Darn disease
I watch you take your medications
throughout the day
too many to count.
Darn disease
I watch you keep going
fighting back that pain and stiffness

I love your drive
I love that you never give up
I love that you refuse to slow down

I watch you with admiration and love.”

(Parkinson’s Foundation, 2018).

As the poem portrays PD is a rough journey that needs a strong will and strong supportive caregiver. Have any of our readers created any other poems? We would love to read or hear them. Reach out via our Facebook page

External Support Resources

We sometimes forget to keep in mind that PD takes a toll on the caregiver and family. Support is also needed to those providing care to their loved ones. Families no longer have to cope with Parkinson’s disease alone. Many support groups, charities and educational material and aid are openly available. Here is a short list that our team has found to be greatly supportive:

Caring in a Family with Parkinson’s –  Parkinson Canada

The Emotional Side of Caregiving: Parkinson’s Caregivers Share Advice  – Michael J. Fox Foundation

Parkinson’s Disease and CaregivingFamily Caregiver Alliance

References

Parkinson’s Foundation. (2018). How to Cope with Parkinson’s as a Caregiver. Retrieved from http://parkinson.org/Find-Help/Blogs/Caregiver-Corner/How-to-Cope-With-Parkinsons-as-a-Caregiver

Michael J. Fox Foundation. (2018). Support & Caregiving for Parkinson’s Patients: The Michael J. Fox Foundation. Retrieved from https://www.michaeljfox.org/understanding-parkinsons/supporting-caregiving.php

Robinette, J. W., Charles, S. T., & Gruenewald, T. L. (2018). Neighborhood cohesion, neighborhood disorder, and cardiometabolic riskSocial Science & Medicine, 198, 70-76. doi:10.1016/j.socscimed.2017.12.025

Ryerson, N. (2015). Parkinson’s Disease and Your Marriage: Advice from Our Community. Retrieved from https://www.michaeljfox.org/foundation/news-detail.php?parkinson-disease-and-your-marriage-advice-from-our-community

Senelick, R. (2016). Coping Tips for Caregivers of Those With Parkinson’s Disease. Retrieved from https://www.webmd.com/parkinsons-disease/guide/parkinsons-caregivers#1

WHP. (2017). We Have Parkinson’s. Retrieved from https://wehaveparkinsons.com/things-family-members-should-know-about-parkinsons/

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.