Gait & Balance Problems Associated with Tremors

Medical Reviewer: Dhira Khosla D.O.

Essential tremor (ET) can impact various parts of the body, including dexterity, speaking, and cognitive function. Another obstacle people with ET may experience is issues with their balance and gait, which can be especially dangerous in elderly individuals.

In this post, we’ll take a look at the connection between essential tremor gait and balance, the range of associated symptoms, and treatment options to consider. Read on for a detailed overview of essential tremor and balance problems, or use the links below to navigate to the section that best answers your query.

The Connection Between Essential Tremor and Balance Problems

Historically, essential tremor has been classified as a monosymptomatic disease, meaning that it’s associated with a single symptom—tremors. However, researchers have found that the disease impacts several other physiological and psychological functions due to its ties to the cerebellum.

The cerebellum is located at the base of the brain and plays an important role in motor function and balance. Individuals with essential tremor can experience structural changes to the cerebellum  and cerebellar dysfunction.

Cerebellar dysfunction may present symptoms such as:

• Gait ataxia—an unsteady or staggering gait
• Eye movement abnormalities
• Abnormal motor timing skills
• Hand tremors
• Balance issues—inability or struggle to maintain the body’s center or base of support
• Cognitive changes

Gait issues explained

• Gait ataxia: The ataxic gait is most commonly seen in individuals with cerebellar disease and conditions associated with the cerebellum, such as essential tremor. Ataxic gait is marked by clumsy, staggered movements and a wide gait. When a person with an ataxic gait is standing still, they may sway from side to side.
• Parkinsonian gait: The Parkinsonian gait is characterized by rigidity in a person’s gait. Individuals who meet the description also tend to keep their neck and back stooped over with their fingers extended, often taking very slow, small steps. As its name suggests, this gait abnormality is most closely associated with Parkinson’s disease.

Scales Used to Measure Balance & Gait Issues

How are essential tremor and balance problems assessed? There are several ways medical professionals and researchers measure essential tremor balance and gait issues. Let’s take a look.

Berg balance scale

The Berg balance scale (BBS) is an assessment tool that is commonly used in elder care. The 14-step test analyzes an individual’s gait and balance abilities. Each test is scored on a scale of 0 to 4, with 4 being the highest level of performance. In total, the test consists of 56 available points.

• 41-56 points have been described as “independent”
• 21 to 40 points are interpreted as “walking with assistance”
• 0 to 20 points are generally classified as “wheelchair bound.

BBS can be used to assess an individual’s fall risk and help determine their care needs but it’s also used to test a range of conditions, including dementia.

Dynamic gait index

The dynamic gait index (DGI) is another assessment used to analyze an individual’s balance, gait, and fall risk. DGI consists of 8 tests that evaluate an individual’s normal gait and how it changes when it’s met with obstacles, stairs, and turns. The test is typically employed in the following populations and circumstances:

• Elderly population
• After a stroke
• Individuals who have vestibular disorders
• Those who have balance issues due to non-vestibular causes
• People who have had a brain Injury

Timed up & go test

The timed up & go test (TUG) is a timed mobility test that evaluates how well a person can stand up from a seated position, walk 10 feet, turn around, and sit back down in the same chair. TUG test administrators consider the following metrics to help them assess patients:

• Slow tentative pace
• Loss of balance
• Short strides
• Little or no arm swing
• Steadying self on walls
• Shuffling
• En bloc turning
• Not using assistive device properly

These practices can indicate neurological issues, such as essential tremor.

International cooperative ataxia rating scale

The international cooperative ataxia rating scale (ICARS) is an assessment used to quantify the severity of cerebellar ataxia for a number of neurological conditions, including essential tremor.

Each of these methods, or a combination of them, can be used to assess essential tremor gait issues. But what exactly does essential tremor gait look like? One study used the following metrics to identify gait and balance issues in individuals with ET:

• More than three mis-steps per minute
• An enlarged step width
• Often show ataxic deviations of the feet during tandem gait

Improving Essential Tremor and Balance Issues

Struggling with essential tremor symptoms and balance problems can become a frustrating, daily challenge, but there are several things you can do to improve your symptoms. Let’s take a look at how medication, surgical procedures, non-invasive treatments, and lifestyle changes can help.

Essential tremor treatments

Essential tremor can cause a number of uncomfortable symptoms, primarily tremors, that make it hard to complete daily tasks. Essential tremor treatment options generally include medication, surgery, and non-invasive treatment.

It’s important to note that these therapies are designed to target tremor symptoms, but may not be effective in improving balance and gait issues.

Medication

While there is no cure to essential tremor, there are beta-blocker and anti-seizure medications that can be used intermittently or as long-term therapies to help alleviate hand tremor symptoms associated with ET. Before using medication, make sure to talk to your doctor.

• Propranolol: Used to treat high blood pressure, kidney tumors, irregular heart rhythms, and certain types of tremors. Propranolol relaxes blood vessels and slows heart rate to promote blood flow and decrease blood pressure. Propranolol can also result in dizziness due to low blood pressure.
• Primidone: Used to treat seizures and certain types of tremors by limiting abnormal electrical activity in the brain. Note: primidone can cause dizziness and exacerbate balance issues.

Surgery

If your essential hand tremor symptoms are severe, surgery may be the answer. There are two main types of surgery used to treat essential tremor:

1. Deep brain stimulation (DBS): This minimally invasive surgical technique implants a neurostimulation system to administer electrical signals that are believed to be the source of the tremor to particular locations in the brain. These electrical pulses block the brain from irregular activity, allowing the brain to operate more normally.
2. Focused ultrasound: The concentrated ultrasound approach uses magnetic resonance imaging (MRI) to assess the precise location of tremors in the brain. To focus ultrasound waves on that spot, doctors use MRI guidance.
3. Gamma Knife®:  A type of computer-guided radiation surgery that is used for the treatment of brain disorders. The surgery employs up to 192 radiation beams to precisely target affected areas in the brain. Gamma Knife surgery is also known as stereotactic radiosurgery.

Non-invasive treatment

Surgery and medication can be viable options to mitigate essential tremor symptoms, but they also require a level of risk that might not be suitable for every patient.

Cala Trio’s tremor bracelet is a simple, wrist-worn prescription therapy that decreases your specific hand tremor. Easy-to-use and effective, Cala Trio meets you where you are. The treatment is tailored to your individual tremor pattern and stimulates the nerves during therapy sessions, helping soothe your symptoms.

Although these treatment options do not improve the balance and gait issues associated with ET, they can help alleviate other symptoms, such as persistent hand tremors. Mitigating these symptoms can make daily tasks much more manageable.

Lifestyle changes

In addition to treatment methods recommended by your doctor, there are plenty of lifestyle changes you can make to help minimize symptoms. Here are some practices to avoid and adopt when living with essential tremor.

What to avoid:

• Alcohol, tobacco, caffeine—these substances can exacerbate essential tremor symptoms.
• Stressful situations—stress can increase frequency and severity of essential tremor symptoms.

What to adopt:

• Relaxation techniques.
• If your tremors tend to worsen during a particular time of day, try to complete challenging tasks during other windows of time.
• Use assisted devices, such as heavy glasses and utensils, wrist weights, and heavy pens to minimize the effect of tremors on daily tasks.

Balance & gait treatments

Improving your balance and gait can be a long-term process involving careful exercise and training. Let’s take a look at a few things you can do to work toward better balance and gait.

Balance-promoting exercises

The National Institute on Aging recommends the following exercises to improve balance and gait:

• Stand on one foot: Using a sturdy chair, table, or countertop to steady you, slowly lift one leg and hold for 10 seconds. Repeat 10-15 times on each side.
• Balance walk: With your feet shoulder-width apart and arms spread out, walk with high knees, placing one foot in front of the other. Keeping your form, take 20 steps forward.
• Heel-to-toe walk: Standing up with your arms spread out wide, step one foot in front of the other, touching your heel to your toes as you go. Use a nearby wall or railing for extra support as needed.

Struggling with challenging daily activities because of essential tremor symptoms can be discouraging. But there are treatment options to minimize symptoms of hand tremor associated with essential and reclaim your quality of life. Learn how Cala Trio can help.