Non-Drug Therapies for Tremor and Stiffness in Parkinson's Patients on Lithium
Physical activity including endurance and resistance exercises should be the primary non-drug intervention for managing tremors and stiffness in Parkinson's patients taking lithium, as these exercises slow disease progression and may improve functionality and quality of life. 1
Physical Exercise as First-Line Non-Drug Therapy
- Endurance and resistance exercises have been shown to slow the progression of Parkinson's disease and improve quality of life, making them essential components of symptom management 1
- Physical activity should be advised as long as it does not worsen the patient's physical state 1
- Exercise and neurorehabilitation are increasingly recognized as important tools to combat motor symptoms of PD 2
Occupational Therapy Interventions for Specific Symptoms
For Tremor Management:
- Engage patients in bilateral functional tasks that promote normal movement patterns and even weight-bearing to reduce tremor amplitude through distraction and motor control 1
- Video recording interventions can demonstrate tremor changeability and help patients identify successful strategies for symptom reduction 1
- Anxiety management and distraction techniques during task performance can be helpful in reducing tremor severity 1
For Stiffness/Rigidity Management:
- Encourage optimal postural alignment at rest and within function using a 24-hour management approach 1
- Promote even distribution of weight in sitting, transfers, standing, and walking to normalize movement patterns and muscle activity 1
- Grade activities to increase the time that affected limbs are used with normal movement techniques within functional activities 1
- Implement strategies that reduce muscle overactivity, pain, and fatigue, such as muscle relaxation techniques and supporting affected limbs when at rest 1
For Combined Motor Symptoms:
- Engage patients in tasks using normal movement, good alignment, and even weight-bearing, such as transfers, sit-to-stand exercises, and functional activities like kitchen tasks 1
- Consider "slow" movement activities such as yoga or tai chi as methods of regaining movement control and redirecting attention away from symptoms 1
Critical Considerations for Lithium-Taking Patients
- Lithium can induce parkinsonian symptoms including tremors and rigidity through its antidopaminergic effects 1, which compounds the existing PD symptoms
- The tremor from lithium is classified as an exaggerated physiologic postural tremor 3, distinct from the resting tremor typical of PD
- Monitor serum lithium levels regularly, as neurotoxicity can occur at therapeutic concentrations and worsen motor symptoms 1
Important Pitfalls to Avoid
- Do not use splinting for dystonia or stiffness, as it may increase attention to the affected area, promote compensatory movement strategies, lead to muscle deconditioning, and potentially worsen symptoms or cause complex regional pain syndrome 1
- Avoid immobilization strategies that could lead to learnt non-use of affected limbs 1
- Do not delay physical activity interventions—they should be implemented early in the disease course for maximum benefit 1