Tremor

Tremor means shaking that you can’t control. It can happen in different ways and for different reasons.

• Resting tremor happens when your muscles are relaxed and not being used.
  • It’s common in Parkinson’s disease.
  • Your hand might shake while it’s resting on your lap, but the shaking stops when you reach out to grab something.
• Postural tremor happens when you hold a part of your body still against gravity.
  • It’s often seen in people with essential tremor or anxiety.
  • Your arms might shake when you hold them out in front of you to take a photo.
• Kinetic tremor appears when you’re moving a part of your body on purpose.
  • It can make tasks like writing or drinking from a cup more difficult.
  • Your hand might shake while you’re trying to write your name.
• Intention tremor gets worse the closer you get to your target.
  • It’s often linked to problems in the part of the brain called the cerebellum.
  • Your hand might shake more as you try to touch your nose or pick up a spoon.
• Voice tremor affects the muscles in your voice box.
  • It can make your voice sound shaky or wobbly.
  • Your voice might tremble when you speak, especially if you’re nervous or tired.
• Dystonic tremor happens in people who have dystonia, a condition where muscles contract in an unusual way.
  • It often affects the neck, face, or arms.
  • Your head might shake or twist to one side without you meaning to.
• Orthostatic tremor is a fast tremor in the legs that happens when you’re standing still.
  • It can make you feel unsteady or like you need to sit down.
  • Your legs might shake when you’re waiting in a queue, but the shaking stops when you walk or sit.

Each type of tremor is different, and not all tremors mean you have Parkinson’s. If you or someone you know is experiencing shaking, it’s important to talk to a doctor or neurologist to find out what’s causing it and how to manage it.

Types of Parkinson’s tremors

In Parkinson’s, tremor is linked to dysfunction in the basal ganglia and altered dopamine signalling, but other neurotransmitter systems may also be involved.

In conditions like Parkinson’s and Essential Tremor (ET), tremors look different.

Parkinson’s tremors often start on one side of the body and can appear at rest (e.g., a ‘pill-rolling’ motion in the hand) or during action (e.g., holding a book). Parkinson’s tremors are typically slower and may improve with medication like levodopa. According to scientific literature, resting tremor is present in approximately half of people with Parkinson’s, while action tremor (which includes both postural and kinetic tremor) is present in about a third of patients. This means that approximately 20% of Parkinson’s patients have no tremor.

Tremors in ET usually occur during action (e.g., writing, holding a posture) and are often more rapid than a Parkinson’s tremor. ET affects both sides of the body from the beginning and can involve the hands, head, and voice. ET tremors can be familial and may improve with some medications like propranolol.

Resting tremor

• Resting tremor can occur in different parts of the body, but usually starts in a finger or hand on one-side of the body. This is the stereotypical tremor often associated with Parkinson’s. It sometimes looks like someone is rolling something between their thumb and fingers.
• Oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing.

Action tremor

• Postural tremor occurring when maintaining a position.
• Kinetic tremor occurring during movement.

Internal tremor affects internal body parts and is less visible.

It’s important to note that both Essential tremor (ET) and Parkinson’s are movement disorders and sometimes they can be mistaken for each other. However, there are many differences between the two conditions, and proper and early diagnosis is important for receiving the right treatment and support. ET is also twice as common as Parkinson’s in the general population and generally runs in families, so is also known as familial tremor. You can find out more at our sister organisation www.essentialtremor.org.au

How do I access assistive technology (AT) for my tremor?

Accessing occupational therapy services can provide you with a good start as to what AT is available. You can also go look at assistive technology retailers or disability equipment suppliers. These stores specialise in providing a wide range of products designed to assist you in your daily activities, mobility, communication, and overall quality of life.

It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:

• getting a GP referral to an OT with Parkinson‘s or ET experience
• your state-based Parkinson’s organisation for advice on OTs and stores to access
• private health to see what is covered in relation to OT consultations and AT expenses
• NDIS, DVA, or My Aged Care plan supports for OT and AT costs.