Archive:Parkinson disease

Physical Examination of Parkinson's Disease

1. Introduce yourself and wash your hands

2. Listen for the patient's characteristic speech pattern

• Microphonia
• Soft
• Faint
• Palilalia
• Hard to understand

3. Inspection

• Mask like facies
• Flexed posture
• Few spontaneous movements
• Stooped posture
• Sialorrhea (Drooling)

4. Tremor

• Resting
• Pill rolling (4-8Hz)
• Begins distally, fingers hands, forearm, feet and can involve the chin and mouth
• Decreased tremor with finger to nose testing
• Increaqsed tremor in left hand if clenching the right hand
• Increased tremor with serial 7's

5. Gait

• Ask to ris, walk, turn quickly, stop and start
• March a petite pas (shuffling gait)
• Difficulty initiating, stopping, turning and with balance
• Propulsion/retropulsion (difficulty maintaining balance if tapped)
• Festination (walk faster and faster so that they do not fall over)
• Lack of arm swing
• Kinesia paradoxica (can do rapid movements but not slow ones)
• Bradykinesia

6. Dampening - difficulty with repeated movements such as tapping the thumb and index finger together