A12. Examination of Parkinsonism (muscle tone, hypo- and bradykinesia, alternating movements, gait, postural instability)

• Parkinsonism
  • = A set of symptoms seen in Parkinson disease, Parkinson-plus syndromes, other diseases
  • Examination of muscle tone
    • See topic 11
    • Rigidity is typical for Parkinsonism, especially cogwheel rigidity
  • Examination of bradykinesia
    • Bradykinesia = active movements are slow and have decreased amplitude
    • Observe patient’s active movements for slowness and decreased amplitude
      • Not only slow execution of the movement, but pauses occur too
  • Examination of alternating movements
    • Ask patient to perform quick, alternating movements
      • Touching thumb and index finger and spreading them again, repeatedly
      • Clenching and opening the fist repeatedly
      • Pronating and supinating the hand repeatedly
      • Dorsiflex and plantarflex the foot repeatedly
    • Observe for slowness
    • Negative:
      • Normal movements, no slowness
    • Positive:
      • Bradydiadochokinesia = alternating antagonistic movements are performed slowly
  • Examination of gait
    • Ask patient to walk
    • Negative:
      • Normal gait
    • Positive:
      • Short, narrow-based steps
      • Pauses when turning around
  • Examination of postural instability
    • Ask patient if they have had falls or experience postural instability
    • Pull test
      • Ask patient to stand upright
      • Pull the patient’s shoulders gently from behind
      • Observe the patient’s ability to regain their posture
      • Negative:
        • Can regain posture with 1 – 2 steps
      • Positive:
        • Posture only regained with 3 or more steps, or patient needs help to regain balance
  • Examination of tremor
    • Observe for tremors during rest and during active movements
    • Rest tremor is characteristic of Parkinson disease
  • See also topic 39