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. |Favorite Table|Download (.pdf) TABLE 17-1 Types of abnormal movements.
|Movement ||Description |
Rhythmic oscillatory movement around a joint (eg, fingers, wrist, jaw)
Occurs in the absence of any intended movement
Occurs while maintaining a particular posture
Occurs during voluntary effort (eg, picking up a phone)
|Chorea ||Irregular, involuntary movements occurring in any part of the body. May involve facial grimacing or tongue movements and abnormal speech. Impairs voluntary activity. |
Form of chorea involving proximal muscles in which a limb may move violently
Sudden, involuntary, and repetitive coordinated movements (eg, blinking, turning head, smacking lips)
Involuntary slow, writhing movements
Prolonged, sustained athetosis that resembles abnormal posture
Acute dystonia or muscle spasm, often caused by dopamine-blocking drugs
Inability to sit or stand still, motor restlessness; usually caused by dopamine-blocking drugs
|Myoclonus ||Sudden, rapid, twitch-like movements; may be localized or generalized |
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.
PATHOPHYSIOLOGY OF PARKINSON’S ...