Tremor at rest
Tremor at rest is the characteristic feature of PD that earned it the earlier
name of the shaking palsy. Rest tremor occurs rarely in any other condition. The tremor is slow and rhythmic. It usually begins in one hand and only later
spreads to involve the other side. Occasionally, the feet or legs may also exhibit greater on the side of initial involvement. The lips and jaw may also
shake. Less commonly, the head and neck may shake as well.
The rest tremor is the predominant type seen in PD. and the tremor usually reduces or disappears upon performing a purposeful movement. In
some patients, however, the tremor may be present when holding up the outstretched arms (postural or sustention tremor) or when performing various
movements (action tremors). Rest tremor, especially when mild, is rarely functionally limiting, although many people feel self-conscious about the
shaking, whereas action tremors may interfere with certain functions, such as eating soup or drinking from a full cup.
Another type of tremor experienced by some people with PD is internal tremor; this can usually be felt by the patient and not seen by the examiner. It
may be very disturbing to the patient.
Rigidity is a term meaning tightness or increase in muscle tone at rest or throughout the entire range of motion of a limb. It may be felt as a stiffness in
the limbs, the neck, and even the trunk. This stiffness is often mistaken for arthritis (a common condition, and one that may also be present).
Improvement in rigidity, however, occurs with antiparkinson medications. Arthritis medications (such as anti-inflamatories) do not help the
Bradykinsia is Greek meaning "slow movement" and the feature which characterizes all the parkinsonisms. Under its umbrella are a variety of signs
and symptoms, including the mask-like expression (hypomimia) with decreased eye blinks, slowness in arising in initiating movement, and decrease in fine
motor coordination (manifested by the inability to button a shirt, cut meat, etc.).
Difficulty with turning over in bed is a mark of bradykinesia, as are problems with handwriting becoming slow and small (micrographia), Many of the
manifestations of bradykinsea may be very disabling as they progress, although they respond well to treatment.
Gait (walking) may be very slightly impaired early on, but usually is not disabling. Decrease in the natural arm swing is seen first, and only later do
problems with slow, small steps and shuffling (testination) occur. Patients may begin to propel themselves forward as they accelerate with rapid, short steps
(propulsion). In advanced PD (and sometimes as a side-effect of treatment), there may be episodes of freezing in which the feet appear to be glued to the
floor. This phenomenon usually happens at doorways, curbs, elevators, etc. It may sometimes be overcome by visualizing an obstruction to step over,
marching to verbal commands, or actually stepping over lines placed on the floor, among other tricks.
Balance Problems and Impairment of Posture
These usually occur late in the course of typical PD, and are unquestionably the most disabling of all the
symptoms. Patients occasionally complain of "dizziness" when they mean that their balance or equilibrium is off. Inability to maintain a steady, upright posture
or to take a corrective action to prevent a fall often results in just that-falling.
Patients tend to go backwards as well (retropulsion), and a light shove may cause the patient to continue taking many steps backwards or fall. The use of
or rollator) become necessary, and patients may
eventually require a wheelchair.