Parkinson’s disease is a progressive neurological disorder that results in the loss of dopamine, a chemical signal between nerve cells and the rest of the body. Reduced dopamine leads to movement disorders, which can be used to identify the disease.
A trained clinician will perform motor examination tasks to help determine whether a patient’s symptoms are related to Parkinson’s disease or another disorder.
A tremor is a repetitive movement caused by involuntary contractions of muscles. The examiner will look for signs of asymmetric (one-sided) resting tremors. Parkinson’s disease tremors are usually present when the person is at rest. The tremors are often reduced when performing activities but become worse when distracted by other mental tasks. The tremors may be present in the mouth, hands, legs, and feet. The physician may ask patients to touch their finger to their nose to see if tremor decreases. He or she will also check to see if clenching the opposite hand or counting by a set number (such as by sevens) increases the tremor.
Rigidity is stiffness in the arms and legs often only seen on one side of the body initially. The rigidity does not depend on the speed of the movements, which sets it apart from spasticity. Rigidity is often described as a limb feeling tight. To test for rigidity, the doctor will try to passively move the limbs or neck and check for any resistance or tightness to the motion.
Bradykinesia or akinesia
Bradykinesia is slowness of movement, and akinesia is a lack of movement during regular tasks. A person with Parkinson’s may make a movement slower than usual or perform much smaller movements.
One test for bradykinesia is to ask a patient to do some handwriting. If the handwriting is small and cramped (known as micrographia), this could be a symptom of Parkinson’s. During a motor task, a patient may also be asked to make rapid, coordinated movements such as clapping, pinching, or tapping a foot. The examiner will evaluate the quality of the movement to look for bradykinesia.
Parkinson’s disease can also cause postural instability or balance issues. To test for balance issues, a pull test (also known as a retropulsion test) may be carried out where the physician stands behind the patient and pulls him or her back slightly to see the reaction. A patient with Parkinson’s will often fall backward with many shuffling footsteps called retropulsion.
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