Tremor Management for Parkinson’s Disease and Essential Tremors

Tremors are involuntary abnormal movements that make the affected parts of the body look like it is trembling or shaking. Some tremors can be rhythmic, some can be intermittent. Some tremors can appear at rest, and some can appear only during functional tasks. Tremors can come in many different patterns and forms that can make treatment difficult. Tremors are individual to each person. Living with tremors can be challenging because it can make daily activities such as feeding yourself and writing more challenging.

Parkinson’s Disease (PD)

One of Parkinson’s cardinal symptoms are a tremor. These tremors are known as a resting tremor. Typically, these tremors initially occur only when the arms or legs are at rest. Medication prescribed by your neurologist can be helpful in managing these tremors. However, in addition to medication, there are many non-pharmacological treatment strategies available.  The following strategies include:

  • Maintaining the arms as close in to the body as possible. The more proximal stability and input that is provided to an affected arm can minimize the tremors during functional activities
  • Stabilize your arms on a surface when working. For example: when eating, place elbows on the table to manage tremors
  • Eliminate multi-tasking. Standing to complete tasks with your hands (such as shaving, brushing teeth and cooking) can be challenging with PD.   When you sit to complete those tasks, it enables the body to better manage the upper body tremors
  • Manage stress. Stress, anxiety, frustration and fatigue all contribute to worsening of your Parkinson’s tremor. When you get frustrated, take a couple of deep breaths and start the task over. This can allow the nervous system to reset and better manage tremors affectively
  • Take medication on time and as scheduled by your physician. Making sure you maintain a routine as prescribed can eliminate “on” and “off” periods where tremors can be worse
  • Explore adaptive equipment to increase fine motor skills, such as button hooks or rocker knives
  • Keep a log of your tremors and when they are at their best and worst. Complete daily activities during the time of the day where your tremors are less severe. This can also be linked to your timing of your medication and where you are during the peak of the medication

Essential Tremor (ET)

Essential tremors can affect people of all ages. Frequently, tremors occur at rest and during functional activities with essential tremors. Carrying items and using hands for fine motor tasks can be extremely limited. Medication prescribed by your neurologist can be helpful in managing these tremors. However, in addition to medication, there are many non-pharmacological treatment strategies available. The following strategies include:

  • Provide proximal input to the affected upper extremity. Providing a stable surface for affected arm can lead to increased ease and decreased tremor. For example: when going out to eat, ask for a booth and sit next to the wall on the affected side. Rest your arm on the table and against the wall to manage tremors
  • Explore weighted devices. With your Occupational Therapist, explore the use of a weighted hand or arm cuff to manage your tremors during short bouts of functional activities
  • Explore various adaptive equipment and tools such as: weighted utensils, button hook, elastic shoe laces and weighted pen
  • Explore forearm cooling. This is prescribed and completed by a trained Occupational Therapist. By managing the temperature of the muscle, occasionally tremors are managed for several hours. This technique needs to be supervised and personally prescribed to fit your needs for the home
  • Parkinson’s tremor management strategies can also apply here. Manage stress, eliminate multi-tasking and take your medication as prescribed can be particularly important in the management of tremors

For more information on how to manage your tremors during your daily activities, follow up with your Neurologist or Occupational Therapist to tailor a specific plan you.

About the Author


Heather Simpson, OTR/L

Heather Simpson graduated with a B.S. in Exercise and Sport Science with a minor in Early Education from the University of Florida in 2007. Following…

Read all articles by Heather Simpson, OTR/L