Wednesday, April 3, 2013

Intention tremor, and a possible neuroplastic treatment

In stroke intention tremor is caused by damage to the cerebellum. 

The cerebellum is important in fine coordination. If the stroke damages the cerebellum fine motor coordination suffers. 

(Note: Intention tremor is different from essential tremor, often found in Parkinson's) 

It is called intention tremor because the tremor happens when somebody moves intentionally. So let's say the intended movement is touching the nose with a fingertip. With intention tremor, the trajectory toward the nose is good until the finger gets close to the nose (closer to the intended target) and the tremor begins. As the New York Times put it:

Intention (or kinetic) tremors: These tremors occur at the end of a purposeful (intended) movement, such as writing, pressing a button, or reaching for an object. The tremor will often disappear while the affected body part is at rest.

Outside of stroke it is often seen in long-term alcoholics. So here's my first suggestion: If you have intention tremors, don't drink. Other drugs can cause tremors as well. So, the "Brown Bag Medication Review" may help in reducing tremors.

How has intention tremor typically been treated? 

Intention tremor is notoriously difficult to treat. There are several drugs that are used for treatment, but they all work for some of the people some of the time. (Here's an example of an herbal "remedy.")

Other things that had been tried:

Physical therapy: In some people it works great to temporarily reduce tremors. It's not cure.
Meditation, yoga, deep breathing exercises, biofeedback have all been used with varying levels of success.

The neuroplastic model
So what is the neuroplastic model for overcoming intention tremor? I guess the first question is: Is there a neuroplastic model? Is there anything that can be done to rewire the brain "around" this movement disorder?

We will wait for neuroscience to catch up to that question. It could take decades, it could take centuries. On the other hand, somebody could come up with a really good way of applying the brain's inherent plasticity tomorrow. So you never know.

Having said all that, I still have some suggestions that may very well rewire the brain to help overcome this issue. Here are my suggestions:

Mirror therapy. This is the way that mirror therapy would be applied:

Just like in mirror therapy for movement recovery, you look only at the "good" side. That is, you only see the flawless movement of the unaffected side.

Bimanual training. This option involves having the "good" train the "bad." It's a simple enough concept; whatever the good hand does, the bad hand attempts to copy.


Scott Gallagher said...

My tremors seemed to have gone away once my brain recognized my hand. Forcing myself to carry around a cane horizontally while walking all day did the trick. It was very hard constantly controlling the cane's bouncing, but since it was a long exercise my brain eventually got the message.

Richard Marko said...

What do you mean by carrying a cane horizontally all day? How many days did you carry it? I too have an intention tremor after suffering a cerebellum stroke 7 months ago. I am using mirror box therapy to stop the tremor. It's a bit early to tell if it is making a difference yet after just one month.

Richard Marko said...

What do you mean by carrying a cane horizontally? How long did you carry it for?

Amy said...

Thank you Peter. I did mirror therapy in OT. I think that might be some kind of magic.

Amy said...

My OT told me to look at the reflection in the mirror and attempt the movement, as ugly as it may be with the "bad side" that I can't see. This is working. Why do you say look at the unaffected side, oh wait I think you explained this in class. Can you explain it again?

Peter G Levine said...

Hi Amy! The idea would be that the image of the good side "fools the brain" into believing the bad side is working well, thereby driving brain-rewiring in the affected side of the brain.

Danica said...

Surgery and intake of medications are some of the treatments available for essential tremors. It will also be useful to undergo therapy for better outcome. Choice Public can be helpful about these treatments.

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