Introduction
Tremor is one of the most common movement disorders encountered in clinical practice. It can affect individuals of any age and may interfere with daily activities such as writing, eating, or dressing. Although often benign, tremor may also indicate an underlying neurological condition requiring proper evaluation and management.
Definition
It is an involuntary, rhythmic, oscillatory movement of a body part caused by alternating or synchronous contractions of opposing muscle groups. It most commonly affects the hands but may involve the head, voice, trunk, or legs.
Pathophysiology
It results from abnormal activity within neural circuits responsible for motor control, particularly involving the cerebellum, basal ganglia, thalamus, and motor cortex. Disruption in neurotransmitters—especially dopamine—plays a remarkable role in certain tremor types such as Parkinsonian tremor. Enhanced physiological tremor may occur due to anxiety, fatigue, metabolic imbalance, or medication effects. The imbalance between excitatory and inhibitory pathways leads to rhythmic muscle contractions.
Classification
Tremors are broadly classified into:
- Resting Tremor – Occurs when muscles are relaxed and supported (commonly seen in Parkinson’s disease).
- Action Tremor – Occurs during voluntary movement. It includes:
- Postural tremor
- Kinetic tremor
- Intention tremor
- Physiological Tremor – Normal, low-amplitude tremor present in all individuals.
- Essential Tremor – A common neurological disorder often affecting both hands.
- Psychogenic Tremor – Associated with psychological factors.
Signs and Symptoms
- Rhythmic shaking of hands, head, or voice
- Difficulty with fine motor tasks
- Tremor worsens with stress or fatigue
- Imbalance (in cerebellar tremor)
- Slow movements or rigidity (in Parkinsonian tremor)
- Social embarrassment and reduced confidence
Physiotherapy Management
Physiotherapy aims to improve functional independence and decrease disability:
- Coordination exercises: Improve motor control and precision
- Weight-bearing activities: Decreased tremor amplitude
- Strengthening exercises: Enhance muscle stability
- Balance training: Prevent falls in cerebellar tremor
- Relaxation techniques: Reduced stress-related tremor
- Adaptive strategies: Use of weighted utensils and assistive devices
- Task-specific training: Improve handwriting and daily skills
- Postural correction: Enhance trunk stability
A structured rehabilitation program improves control, decreases fatigue, and enhances quality of life.
Conclusion
It is a multifactorial movement disorder that may remarkably affect functional abilities. Early identification and targeted physiotherapy interventions help optimize motor control, decrease disability, and promote freedom. A multidisciplinary approach ensures comprehensive management and better patient outcomes.
What is tremor?
Tremor is an involuntary, rhythmic, oscillatory movement of a body part caused by alternating muscle contractions, commonly affecting the hands.
What causes tremor?
Tremor results from abnormal neural activity involving the cerebellum, basal ganglia, and dopamine imbalance, as seen in Parkinsonian tremor.
How does physiotherapy help in tremor management?
Physiotherapy improves coordination, balance, muscle stability, and functional skills using exercises, relaxation techniques, and adaptive strategies.
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