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.