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Chapter 1 - Introduction
ET is typically managed via pharmacological therapies, with Propranolol
and Primidone the most commonly used (R. Elble, 2009). Initial
effectiveness has been reported as low as 50%, with the magnitude of
effectiveness diminishing over time (R. Elble, 2009; Lyons, Wilkinson, &
Pahwa, 2006). Potentially, the most potent drug available to ET is alcohol
however due to its addictiveness and social ramifications if abused, it is
not a widely recommended option (Klebe, et al., 2005; Nahab & Hallett,
2006). If pharmacological interventions prove ineffective, the option of
surgical interventions such as DBS may be considered for those severely
affected. Surgical options, such as DBS, provide positive results however
are invasive, carry associated risks and are costly (Lyons & Pahwa, 2008).
A potential movement-based rehabilitative method, bio-behavioural
therapy has also been investigated for use in ET. This has shown some
potential with reductions seen in tremor ratings, EMG activity and
improvements in some reported activities of daily living (Chung, Poppen,
& Lundervold, 1995; Lundervold & Poppen, 2004a). This method too has
some limitations, including a short-term window of improvement and
questionable long-term cost effectiveness (Lundervold, Belwood,
Craney, & Poppen, 1999).
A novel rehabilitation therapy may be that of resistance training (RT),
potentially due to the neuromuscular adaptations and improvement in
QoL that occur (Enoka, 1997). Mechanisms behind such neuromuscular
changes may include increased neural drive, motor unit changes and
muscle activation (Bruton, 2002; Engardt, Knutsson, Jonsson, &
Sternhag, 1995; Hakkinen, et al., 1998). These adaptations are seen in a
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