Job Accommodation Network

Essential tremor is a nerve disorder in which tremors (shakes) occur without an identifiable cause when a person is moving or trying to move. Essential tremor of the hands typically occurs when the hands are in use. In contrast, tremors from Parkinson's are most prominent when a person's hands are at his sides or resting in his lap. Essential tremor can involve your hands, head and voice.

Essential tremor is the most common form of abnormal tremor. It resembles an exaggerated shaking. Essential tremor is a relatively benign condition, affecting movement or voice quality, but with no other effects. It involves a rhythmic, moderately rapid tremor of voluntary muscles. Purposeful movements may make the tremors worse, while avoiding hand movements may suppress the tremors completely. There may be difficulty holding or using small objects (such as silverware or writing utensils).

In the workplace, people with essential tremor may have difficulty writing, keyboarding and mousing, grasping small tools or items, and communicating. Limitations may be worsened by fatigue, stress and anxiety, and temperature extremes.

The following provides an overview of accommodations that might be useful for people with essential tremor:

Fine Motor (Writing, Keyboarding, Gripping):

Implement ergonomic workstation design
Provide alternative computer access and alternative mice designed to reduce the effects of spasticity
Provide alternative telephone access such as auto-dialers, gooseneck holders, hands-free telephones, headsets, and speech recognition integration
Provide arm supports
Provide writing and grip aids
Provide a page turner and a book holder
Provide a note taker or tape recorder

Communicating:

Provide speech amplification, speech enhancement, or other communication device
Use written communication, such as email or fax
Transfer to a position that does not require a lot of communication
Allow periodic rest breaks

Dealing with Fatigue:

Reduce or eliminate physical exertion and workplace stress
Schedule periodic rest breaks away from the workstation
Allow a flexible work schedule and flexible use of leave time
Allow work from home
Implement ergonomic workstation design

Reducing Stress and Anxiety:

Provide praise and positive reinforcement
Refer to counseling and employee assistance programs
Allow telephone calls during work hours to support person
Allow the presence of a support animal
Allow breaks as needed

Temperature Sensitivity:

Adjust work-site temperature
Use cooling or heating clothing
Use fan/air-conditioner/space heater at the workstation
Allow flexible scheduling and flexible use of leave time
Allow work from home during extreme hot or cold weather

Performing Activities of Daily Living:

Allow use of a personal attendant at work
Allow use of a service animal at work
Provide grip aids
Allow longer breaks

Accommodation Scenarios:

An RN in a nursing home was having difficulty writing notes in patient charts due to essential tremor. She was accommodated by using a typewriter or computer with word processing software when possible and using a writing aid when she had to write in a patient's chart.

A self-employed CPA could no longer write or keyboard due to chronic shaking caused by essential tremor. He was accommodated with speech recognition for data input and a writing aid for writing.

A teacher with essential tremor was having difficulty talking, especially toward the end of the day when she was more fatigued. She was accommodated with a speech amplifier so she did not have to project her voice and her study hall period was moved to the end of the day.

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