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L.S. is a 78-year-old man who was referred to physical therapy after a progressive reduction in his physical capabilities secondary to Parkinson’s disease diagnosed 7 years ago. The patient stated that he did not require medication initially, but 6 months ago he was started on a combination of levodopa and carbidopa when his signs and symptoms had worsened and his neurologist felt it was time to begin medication. The patient’s chief complaints are generalized stiffness, slow movement, and a resting tremor in his hands and arms. He also feels that he has gotten very weak over the last several months. During the initial evaluation, the physical therapist observed that the patient had a minimal stooped posture. L.S. also had limited passive and active range of motion in bilateral hips and upper extremities in flexion, abduction, and external rotation. His overall functional strength was diminished for his age and he had extremely poor endurance. Upon interview by the therapist, L.S. revealed that he had lost 25 lb over the last 6 months and that his appetite had diminished drastically.


The major movement disorders include Parkinson’s disease, Huntington’s disease, Wilson disease, and Tourette syndrome. Table 17-1 defines terms used to describe different types of abnormal movements or signs that may be characteristic of particular movement disorders. Abnormal movements can also be caused by a variety of general medical conditions and certain drugs.

TABLE 17-1Types of abnormal movements.

Many of the movement disorders have been attributed to disturbances of the basal ganglia, but the precise function of these anatomic structures is not yet fully understood, and it is not possible to relate individual symptoms or impairments to involvement at specific sites. Furthermore, clinicians must recognize that individuals with the same disease can present very differently in terms of physical manifestations and symptoms and may respond quite differently to drug and rehabilitative therapies.


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