Motor Symptoms

Tremor

Tremor is a shaking, rhythmic movement of one or more body parts which is not in our control. Tremor is one of the most characteristic manifestations of Parkinson’s disease (PD). It is the presenting sign in approximately 75% of patients with PD.

Resting tremor is commonly found in PD. It occurs when the body part is resting and disappears on movement and in sleep. Pin Rolling (rolling movement between thumb and index finger) or supination pronation (turning the palm up and down) are two commonly found resting tremor. Having a resting tremor is a positive diagnostic criterion for PD. Tremor can also appear in other parts of the body, including the tongue, lower lips, chin, jaw, hands or leg. These tremors can interfere with routine activities such as shaving, dressing, writing and many other tasks that require fine motor coordination.

Action tremor is also found in PD patients. As the name suggests, it is ours when the muscle is voluntarily involved. Either when you are holding a position or trying to do some action.

Rigidity

It is one of the cardinal features in diagnosis of Parkinson’s disease. There is an increase in muscle tone/tightness especially in upper limb and trunk muscles. Rigidity is a sign detected by the clinician rather than a symptom described by a patient.

Effects of rigidity:

Rigidity causes mask like face(hypomimia)
Reduced arm swings when walking
Reduced voice tone and loudness(dysphonia)
Difficulty in swallowing(dysphagia)
Difficulty in changing positions, like turning, sitting or standing.
Changes in handwriting(micrographia)
Bradykinesia

It means slowness of a movement which you were able to do faster. It is an important cardinal feature for PD diagnosis. Speed of a movement reduces. Patients feel exhausted by doing basic tasks. Rigidity could be one of the causes for Bradykinesia. Patients face difficulty in initiating a movement like getting up from bed. “Earlier, wearing a shirt was an easy task.” Simple daily activities like dressing, bathing, walking and turning in bed become tiring.

Abnormal Gait

Festination

Increased speed while walking without having a control making it difficult to stop or take a turn is festination.

Freezing of Gait (FOG)

FOG is when a patient is unable to take a step forward while walking as if their feet get glued to the ground. Difficulty in initiating the first step specially after standing for a long time. In FOG, the patient tends to take short shuffling steps to compensate. Sometimes the body moves ahead of the feet which increases the risk of fall. FOG happens especially during walking in narrow hallways, entering a lift, crossing a busy road, changing directions while walking and taking turns.

Shuffling Gait

Parkinson’s patients may also have a forward stooped posture with bent knees. This particular position shifts their body’s center of gravity too far forward, so to avoid falling the person takes short, shuffled, narrow steps. Patients put their toes first while walking, putting more pressure on the toes rather than on the heels.

Pain/Cramps

Cramps:

People with PD normally face muscle cramps during any part of the day. It can affect the calf and leg muscles, causing a disturbed sleep. Light stretching, massage, and saltwater bath for legs can be helpful.

Musculoskeletal pain:

This pain originates from muscles and bones; it is generally localized to the area affected. It can worsen with age. Gentle exercises, hot water fermentation and painkillers should take care of it.

Dystonia:

Involuntary muscle contractions (dystonia) can affect body parts, such as toes, fingers, ankles or wrists and make the affected part go into spasm. Pain can be controlled by adjusting the medicine dosage and timings. Relaxation techniques can also be useful. Involuntary movements (dyskinesia) can also lead to pain due to its twisting movements.

Restless leg syndrome (RLS):

This can cause symptoms such as pins and needles, painful sensations or burning of the legs. You may feel an irresistible urge to move your legs when relaxing, for example while sitting watching TV or going to sleep.

Radicular Shooting pain, pain in mouth and jaw, headaches are other types of pain found in PD.

Speech Difficulty

Forward Stooped posture, masked face, abnormal breathing, weak neck muscles, weak oropharyngeal muscles lead to a low toned voice in PD patients.

Features of speech difficulty:

Speech is soft and difficult to understand.
It becomes difficult to convey an emotion or have a normal conversation (Due to masked face)
Volume and voice clarity is affected.
Patients can be misinterpreted as depressed or having lack of interest.

Dysphagia

Dysphagia is having Swallowing difficulty. 80% of PD patients have difficulty in swallowing in the later stages of PD. Patients face difficulty swallowing medicines and solid food. Coughing, throat clearing during eating or drinking and feeling as if food is getting stuck can be the symptom of having swallowing difficulty. Try to look for such symptoms and get it managed in early stages.