Concrete advice and strategies

Make the movement "voluntary", so that the patient is actively shaking - change the amplitude and frequency of the movement.

Teach the patient how to relax their muscles by actively contracting them for a few seconds and then relaxing them.

Changing normal postures and movements that are important for symptoms.

Have the patient perform a 'competitive' movement, such as clapping to a rhythm, or a flowing movement such as conducting.

Focus on another part of the body, for example have the patient tap with the other arm or leg.

Muscle relaxation exercises. For example, progressive muscle relaxation techniques, biofeedback EMG for the upper trapezius muscles, or using mirror therapy.

Side-to-side or anterior-posterior weight shift. When the tremor decreases, slow weight shift to reach rest.

Competitive movements such as tapping your toes.

Make sure the patient distributes weight evenly when standing. This can be helped by using scales and/or a feedback mirror.

Changing the habitual postures that are important for the symptoms. For example, reduce the load on the front of the foot.

Change your usual sitting and standing posture to avoid long periods in fixed joint positions and promote good posture.

Normalise movement patterns (e.g. sitting and standing, moving, walking) with an external or altered focus of attention (i.e. not the dystonic limb).

Discourage unhelpful protective avoidance and encourage normal sensory experiences (e.g. wearing shoes and socks, weight bearing).

Prevent or eliminate hypersensitivity and hypervigilance.

Teach the patient strategies to 'switch off' overactive muscles when sitting and lying down (e.g. by allowing the supporting surface to take the weight of the limb. Folded towels may be needed to allow the support surface to rise up to the limb where contractures are present).

The patient may need to be taught to be aware of maladaptive postures and overactive muscles so that strategies can be applied.

Consider trying electrical muscle stimulation or functional electrical stimulation to normalise posture and limb movement.

For occasional sudden jerky movements, focus on the pre-shock predictor symptoms, which can be addressed by distraction or diversion.

If present, address pain, excessive muscle activity or altered movement patterns that may be present before the jolt.

Early weight bearing with progressively less upper limb support + weight bearing in a safe environment

Walking on a treadmill (with or without a weight support belt and with mirror feedback)

Walking faster

Induce ankle dorsiflexion activity by asking the patient to walk backwards, by shifting weight to the anterior/posterior side while standing, or by using a gliding gait.

Using electrical muscle stimulation

Stimulate an automatic postural response of the upper limbs by having the patient sit on an unstable surface such as a therapy ball, with the upper limbs resting on a support surface.

Practise tasks not directly related to symptoms, e.g. making phone calls

Walking faster (with caution, it can sometimes worsen symptoms)

Slower walking

Patients should walk with their feet sliding forward (plantar surface of the foot in contact with the ground; as if wearing skis). Progress gradually towards a normal gait.

Build a pattern of normal walking from simple achievable components that gradually converge to normal walking. For example - weight shift, continue with a weight shift that allows the feet to "automatically" advance in small amounts, gradually increasing the length of this stride by focusing on maintaining a rhythmic weight shift rather than the act of stepping.

Walk with lighter weights in each hand.

Walking backwards or sideways.

Walk in a certain rhythm (e.g. to music, counting: 1,2,1,2...).

Excessive exercise (e.g. walking with high steps).

Walking up or down stairs (this is often easier than walking on the flat).