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  • Paralysis agitans


  • 332.0 Paralysis agitans


  • G20 Parkinsonism (idiopathic) (primary)


  • 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System1


A 75-year-old male with a 7-year history of Parkinson’s disease (PD) was admitted to the hospital following a fall. He did not suffer any fractures, but reports pain in his back when he exerts himself. He has been admitted to in-patient rehabilitation for mobility retraining. He has a festinating gait pattern with poor disassociation in his trunk and no arm swing. He demonstrates bilateral upper-extremity (UE) tremors that increase in amplitude when he is under physical, mental, or emotional stress. He struggles both to initiate a movement and to control the movement once it is initiated. His wife reports that he walks better when he holds on to her arm and they walk together, but that walking seems more effortful for him over the past several months.2



  • Progressive degenerative disorder of the central nervous system

  • Death of dopamine-producing cells in the substantia nigra

  • Named after English MD, James Parkinson

  • Parkinsonian syndromes (4 types)

  • Primary or idiopathic, no known cause

  • Secondary or acquired

  • Hereditary parkinsonism

  • Parkinson plus syndrome or multiple system degeneration

Essentials of Diagnosis

  • Core features include a tetrad of hypo- or bradykinesia, resting tremor, postural instability, and rigidity

  • Some people have a rigidity-dominant presentation; others have a dyskinesia-dominant presentation (predominantly those with onset at a young age)

  • Pathophysiology


Classification of drugs used in the treatment of Parkinson’s disease. (From Panus PT, Katzung B, Jobst E, Tinsley S, Masters S, Trevor A. Pharmacology for the Physical Therapist. New York, NY: McGraw-Hill; 2009: p. 228.)

General Considerations

  • Positive diagnosis of PD is made with a successful levodopa (l-dopa) trial


  • Onset generally between 45 to 70 years of age

  • More common in men

  • Impacts all ethnic groups and socioeconomic classes

  • Most cases are idiopathic; genetic variants exist, but are rare


Schematic representation of the sequences of neurons involved in Parkinson’s disease and Huntington’s chorea. Top. Dopaminergic neurons (light gray) originating in the substantia nigra normally inhibit the GABAergic output from the striatum, whereas cholinergic neurons (gray) exert an excitatory effect. Middle. Neurons in Parkinson’s disease. The dopaminergic neuron (dashed, light gray) is lost with a relative increase in cholinergic activity. Bottom. Neurons in Huntington’s disease. The cholinergic neurons may be lost (gray), but even more GABAergic neurons (dashed ...

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