Treating and managing tremor
Managing tremor is an ongoing process. As there is no single approach that works for everyone, you will probably need to try different things before you find what works best.
You may need to try different approaches at different times, and as your needs change.
How tremor can be managed
Specialists like physiotherapists and occupational therapists can assess the problems that tremor and other movement difficulties are causing for you and find ways to make them interfere less with daily activities. There are a number of areas a physiotherapist might focus on, including:
- Posture and balance
- Core stability
- Speech therapy
Posture and balance
The positions we use for sitting, standing and lying down – our posture – can affect the muscles we use and the range of movements we can make. This can have an effect on tremor.
Having the right support for your torso while you’re sitting down is important – whether in a wheelchair or any other kind of chair.
If you sit in a chair that’s too big, you might be using too much effort to balance and hold yourself upright. This can lead to tension in your muscles, or to over-using muscles that aren’t designed for the job of balance. This can make tremor worse.
If your arm rests are too high, this can restrict how you use your arms for certain tasks. So having a chair that’s the right size and is properly supportive can relax your muscles and calm your tremor, as well as making your movements more coordinated.
Being upright can help develop and maintain your balance, and to align muscles so they work together more efficiently. If you use a wheelchair, or you spend a lot of your time sitting, you may be able to stand using supportive equipment, with the help of your physiotherapist. This can help you develop better control of your posture.
A physiotherapist can help you develop stable and controlled posture. An occupational therapist can help you learn to carry out daily tasks in ways that keep your body as aligned and well balanced as possible. You can also speak to your physiotherapist or occupational therapist about getting the right support from a chair.
For more information
Well with MS However your MS affects you, regular activity can keep your body working to its full potential. A physiotherapist can work with you to develop a series of exercises to increase the range of movement you have in specific muscles. This could be a routine you can carry out at home or in the gym, and would be tailored to your abilities and energy levels.
If you improve your core stability, it can reduce tremor in your limbs. Core stability is the ability to control the position and movement of your torso – the core of your body. A physiotherapist can help you to work on this, by finding exercises that target muscles running the entire length of your torso. These exercises are usually done lying or sitting down.
Pilates is a form of exercise that specifically focuses on improving core strength. While there hasn’t been any research looking into its effect on MS tremor, an MS Society-funded research project found that it may improve other areas including pain, posture, function and quality of life in people with MS who use wheelchairs.
If you have tremor in your lips, tongue or jaw it can affect how you speak. This might be either with breath control, which affects phrasing or volume, or with the ability to pronounce sounds. A speech therapist can help you to speak more fluently. This could be by changing the speed you speak at, or how you phrase your sentences. They will also look at how you place your lips, tongue and jaw to make sounds, and make suggestions for how you can improve it. If needed, a speech therapist can also offer advice on assistive technology, such as communication charts, speech aids and computer-assisted alternative communication systems.
Your GP or MS nurse can refer you to a speech therapist.
An occupational therapist can help you to find techniques for coping with tremor on a day-to-day basis. This might include general advice such as:
- try to plan movements in your head before doing them
- try to work in sequence and give conscious thought to how you move
- try to concentrate on one thing at a time
- plan and prioritise what you want to do, and build in rest breaks
- minimise stress
- keep as fit as you can, and try to eat healthily
- make sure you are sitting in a supported position
Practical tips for day-to-day living
You may have found your own solutions for particular activities – such as using your ‘good’ arm to steady your shaky one, or propping your elbows on the table to eat without spilling your food. An occupational therapist can help you to find other ways to manage, and to reduce the amount of effort involved.
Solutions might include learning to do an activity in a different way, using different equipment or utensils, or making changes to your environment. An occupational therapist can also help you to identify any personal triggers that make your tremor worse, such as heat or stress, and how to avoid them.
Some techniques and equipment that can help include:
- Making sure your clothes don’t have fiddly zips or buttons. This can make getting dressed easier.
- If you wear make-up and your tremor makes it difficult to apply, consider getting an eyelash tint. This will make it look as if you’re wearing mascara.
- In the kitchen, things like non-slip working surfaces, electrical labour-saving gadgets, two-handed cups, and specially designed cutlery, crockery and kitchen utensils can all make preparing and eating food more manageable. Boiling vegetables in a wire basket within the saucepan, so that you don’t have to lift a heavy pan full of water to drain them, can also help. There are more tips in the MS Society booklet Adaptations and your home, along with information on sources of funding for equipment like this.
- Eating different foods, if your tremor affects holding or reaching for things. For example, a sandwich may be easier to manage than spaghetti or soup. But sometimes, finding a way to still eat what you love could be as simple as using a different shaped pasta.
- Using pre-chopped or frozen vegetables reduces the amount of preparation you need to do.
- If you find it difficult to hold a drink without spilling it, you could use a straw so you don’t have to lift it.
- Sitting, rather than standing, to do things. You might find a ‘perching stool’ particularly helpful. It’s designed so you can ‘perch’ on it while carrying out daily tasks.
- When you’re using a computer, voice-recognition software can help if you find typing difficult. Adaptive technology such as keyboard guards or a mouse with reduced sensitivity may also help.
- Weighted wristbands or weighted cutlery can be used to dampen down a tremor. However, they appear to only have a temporary benefit, and they may not work for you – particularly if you have problems with fatigue, which they can add to.
- Weighted pens are also available, and some people find them helpful – although they, too, can add to problems with fatigue.
- A Lycra splint (tight-fitting Lycra sleeves, gloves, leggings and so on) may help to stabilise and control movement in the part of your body affected by tremor. You would need to be individually assessed for a Lycra splint, and it would need to be fitted by an experienced therapist.
These are just some of the aids and techniques available – your occupational therapist will be able to advise you what might work best for you. The Disabled Living Foundation also has information about the kinds of equipment available.
Getting help at home
If tremor makes it difficult to do day-to-day tasks, you are entitled to have an assessment for social care.
The assessment will be used to decide what services you need.
There are no drugs specifically for treating MS tremor. However, some people have found that drugs licensed for treating other conditions can be beneficial in reducing tremor.
Few of these drugs have been evaluated in trials or studies for tremor in MS and none have been tested in large-scale clinical trials for MS tremor.