Author Topic: Student with an Essential Tremor  (Read 3134 times)

Offline ridefun2

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Student with an Essential Tremor
« on: March 31, 2014, 11:02:13 PM »
I've been talking with a young man who may be coming to an April 19th event here in Florida.  Some of his family recently attended an Appleseed, and now the whole family is wanting to go together.

This young man has an essential tremor, basically his whole body shakes constantly.  He's an enthusiastic shooter and has worked with other shooters to shoot off of a bench.  He's actually worked together with a non-Appleseed instructor (not sure of his qualifications) and a physical therapist.  What they have ended up doing is using isometric pressure, pulling the rifle back with his support hand and pushing forward with his trigger hand.  This stopped the tremors as long as he kept up the pressure.

Has anyone worked with a similar student before?  I'm wondering if a tight sling will suppress the tremors (I have some doubts), or if there is some hybrid approach that will work better for him.  Any advice or thoughts will be much appreciated.

Offline Unbridled Liberty

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Re: Student with an Essential Tremor
« Reply #1 on: April 01, 2014, 08:11:02 AM »
I have not worked with anyone with this particular condition.  Sounds like the non-AS instructor/PT and the young man have it figured out and you are just seeking ideas to allow him to move from the bench to Appleseed prone, seated and standing? If I were the Shoot Boss for his event, my first concern when he tells me (and I see) that he shakes without this isometric pressure, is can he be safe? Can he control the muzzle when slinging up and getting into position?  Can he transition safely?  Can he keep his finger off the trigger until the sights are on the target?   Can he get his finger off the trigger when the sights come off the target?  Those, and other potential safety issues need to be addressed first. 

You say he pushes forward with his trigger hand, which implies he is shooting something with a grip like an AR.  If not, that seems like it would be a good idea.  And likewise, either a vertical or angled fore grip would give him something to pull back on.  And I would have him experiment with both loop and hasty sling in each position to see which is best.  What about mag changes?  Is the shaking so bad that they will be an issue?

A pre-event meeting, ASAP, between the young man, the Shoot Boss, and the non-AS instructor/PT is imperative.  It does not have to be at the range if that is not convenient.  He could demonstrate for the SB using a cleared and safe rifle with empty mags.  This would give them all the opportunity to collaborate, experiment, communicate and give him the greatest opportunity for a safe and successful shoot.  Best wishes, and I look forward to reading the AAR.

UL
« Last Edit: April 01, 2014, 08:14:12 AM by Unbridled Liberty »

Offline Two Wolves

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Re: Student with an Essential Tremor
« Reply #2 on: April 01, 2014, 09:18:22 AM »
Lots of dry fire!
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Offline ridefun2

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Re: Student with an Essential Tremor
« Reply #3 on: April 01, 2014, 08:40:01 PM »
A tremor is really a better description than shake.  It's not severe enough to cause any problems loading or preparing a magazine, even a tube fed.  I don't see it causing any safety issues that need any more attention than what is covered in our standard safety rules.  It's not bad enough to cause muzzle swings, and if he keeps his finger out of the trigger guard until he is on target (which everybody should be doing) he'll be fine.  My questions are more along the lines of how the instructions will change for his technique.  NPOA is where the relaxed body naturally points the rifle, but he most likely will not be able to relax.  Is there some technique that will give him a similarly repeatable position after recoil?  What about trigger control?  Can he steadily increase pressure, pausing when the sights leave the target?  If not, what technique is best?

He hasn't signed up for a shoot yet, but if he does it will be very interesting.  And a learning experience for me as much, and probably more than, for him.  Hopefully I'll have a chance to talk to him in more detail about what he's doing now sometime this week.

Offline AFTERMATH

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Re: Student with an Essential Tremor
« Reply #4 on: April 01, 2014, 09:24:19 PM »
I've worked with older shooters before that have had some sorta tremors/shakes.
I'm not sure if it's the same thing, but for the most part it's been nothing more than another obstacle to overcome.

NPOA should work - he's just not going to see the rock-solid front sight that we see.
If he's going to be using the isometric pressure as you describe, it'll be a matter of being consistent and relaxing as best as possible.  Think - Offhand.  In the offhand position there is always some 'wobble' and it's difficult to find and maintain a NPOA because you have to use muscle to stand.  But you work to eliminate as many as possible and minimize your wobble by firing the shot the moment you pause your breath as well as taking rests in between.

As far as the trigger work goes - that'll be a question you might have to find out there.  I'm not sure how this would affect actual motor skills.  But I suspect there won't be an issue unless he's got a hair trigger... 

If he's got good eyes, I wouldn't recommend a scope - and if he uses one, it ought not be more than 3x as the amplified movement would likely break the mental game.

Present the instruction as normal - Work with him, if something needs adjustment - IAO.  No big deal.
I'm not even sure I'd go right into the isometric pressure thing, without a huge background of how/why it works for him. 
Sounds a lot like the push/pull pistol technique.  If you've got access to a laser trainer - put him on that and work with him 'till the movement is minimized.  If not, just watch his front sight.

One older gentleman I worked with who had the 'shakes' or whatever it ought to be called - had them pretty bad.  Made it real difficult to trust his NPOA.  I did notice one thing, and I'm not sure what he was doing, but his front sight would bounce like crazy up until the moment he was firing the shot - somehow he would stop it - BANG - then back to bouncing.  Didn't think at the time to ask how he did it.  Anyway, as soon as I got him to turn his scope down, trust his NPOA and follow through, he was shooting good groups - once he got stage 2 & 3 down, he scored Rifleman.
Now in this instance, he did have some sort of mental control over the tremors - so I'm not sure how relevant this is.

Perhaps there's someone here that knows more about this specific condition.  But if all else fails, work with him, do the best you can and let us know how what worked and what didn't.
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Offline LesMoore

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Re: Student with an Essential Tremor
« Reply #5 on: April 02, 2014, 12:21:33 AM »
I am a physical therapist assistant.  I have not had a shooter with this problem, nor do I claim to be any expert about this. 

I don't know that safety will be a huge problem, because I agree that it will probably be more of tremoring than whole body shaking.  I also think the tremor may be more with his head and arms, not legs.  The only major safety I would want to watch for is his transitions.  Also, the tremors may slow him down a bit with mag changes. 

I think some tremors, depending on the cause, will stop with movement, but I'm not sure this is the case with essential tremors.  I know one thing I would be thoughtful of is the tremors may worsen with fatigue.  I don't think anyone should not try, and I think with a little trial and error, he will be fine.  Most of the time, people are able to figure out a way to adapt to situations.  He, as the weekend goes on, will probably be able to give you good feedback on what he needs to adapt. 

I know this probably hasn't helped a great deal, but maybe a few things to think about.  Please keep us posted if this shooter does attend.  I will be interested to know how he does.

Leslie

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Re: Student with an Essential Tremor
« Reply #6 on: April 11, 2014, 06:54:13 PM »
Les,

I had a shooter on my line this past weekend with a minor essential tremors in the support hand.  He called it familial tremor.

The rest of his body was rock solid.  When attempting to do anything with his support hand - even writing or holding a drink, he has a shake that makes detailed tasks very difficult with that hand.

Any suggestions on how to deal with this?  He is completely safe, but the tremor is putting movement into the rifle.  He is reluctant to use a sandbag because he thinks that would be cheating.  He wouldn't accept a patch if he earned it that way.

-Rusty

P.S.  The condition can be hereditary... and the shooter is my father.    :(
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Offline AFTERMATH

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Re: Student with an Essential Tremor
« Reply #7 on: April 11, 2014, 11:19:53 PM »
Les,

I had a shooter on my line this past weekend with a minor essential tremors in the support hand.  He called it familial tremor.

The rest of his body was rock solid.  When attempting to do anything with his support hand - even writing or holding a drink, he has a shake that makes detailed tasks very difficult with that hand.

Any suggestions on how to deal with this?  He is completely safe, but the tremor is putting movement into the rifle.  He is reluctant to use a sandbag because he thinks that would be cheating.  He wouldn't accept a patch if he earned it that way.

-Rusty

P.S.  The condition can be hereditary... and the shooter is my father.    :(

Let's hope, it's not a 100% chance.

It's just his support arm?  I'd have him try switching to weak side.
Snug that sling up real good, probably making sure he's got a good hand-stop.
Essentially, make sure that his position is solid without any involvement of the trigger hand.  That'll allow him to make minimal contact with his shaking hand.
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Offline jmdavis

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Re: Student with an Essential Tremor
« Reply #8 on: April 12, 2014, 01:48:22 PM »
I don't think that you want to move the tremor to the trigger hand. You could try using a wrist rest. Use a sandbag and rest the support hand on the sandbag. You can do this while slung up and it is one method described in military manuals.  This will help to remove the tremor issues and let the shooter work on the rest of accurate shooting (sight alignment, sight picture, breathing and  trigger control).

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Offline LesMoore

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Re: Student with an Essential Tremor
« Reply #9 on: April 14, 2014, 01:06:04 PM »
Rusty,
The type of essential tremor, aka familial or benign tremor, that you are referring to- I believe has an unknown cause.  Typically affects the upper extremities and maybe mostly seen, or at least starts, in the hands.  It is a tremor that occurs when the affected muscle is exerted.  So, basically the tremor gets worse with movement. 

As far as how to help him with the tremors....I'm afraid I have little advice.  There is no stopping the tremors.  He may could try some type of wrist brace? like one of those little splints that Velcro on- maybe that would help support his wrist and hand some.  A sand bag might not be a bad idea if he could be talked into it. 

Physical and mental stress also may increase the intensity of the tremor, so when he knows he is being timed on shooting, that would increase the stress.  Caffeine may also increase tremor intensity, so avoid that before a shoot and get a good night of sleep prior to a shoot.  Other than that, unless he has talked with his Dr to try medications, that is all I can think of that might help. 

Leslie

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Re: Student with an Essential Tremor
« Reply #10 on: April 14, 2014, 01:51:11 PM »
Rusty,
The type of essential tremor, aka familial or benign tremor, that you are referring to- I believe has an unknown cause.  Typically affects the upper extremities and maybe mostly seen, or at least starts, in the hands.  It is a tremor that occurs when the affected muscle is exerted.  So, basically the tremor gets worse with movement. 

As far as how to help him with the tremors....I'm afraid I have little advice.  There is no stopping the tremors.  He may could try some type of wrist brace? like one of those little splints that Velcro on- maybe that would help support his wrist and hand some.  A sand bag might not be a bad idea if he could be talked into it. 

Physical and mental stress also may increase the intensity of the tremor, so when he knows he is being timed on shooting, that would increase the stress.  Caffeine may also increase tremor intensity, so avoid that before a shoot and get a good night of sleep prior to a shoot.  Other than that, unless he has talked with his Dr to try medications, that is all I can think of that might help. 

Leslie

Thank you for the input.  There is an SSRI that will cut back on the tremors, but the dosage required to completely quiet them does other things - like mess with heartrate.   :(

Trigger hand is steady and firm.  Solid, repeatable trigger control.  Breathing in the right place.  The issue is only with his support hand. 

I saw it a about 10 years ago and instantly though Parkinsons - so glad that's not the case.  A wrist brace could be the key.  I may recommend he tries one of the wrist braces commonly used for carpal tunnel.  Some of them have a reinforcement that bends the hand back at the wrist to reduce compression on that nerve.

He'll be spending more time at the range this spring and summer.  Hopefully, this can be manageable.  I'll report back with any progress made.   :)
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