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Sir James Parkinson first wrote about this progressive, incurable neurological disease in 1817, when the disease was known as Shaking Palsy. The three main symptoms are tremor, rigidity and bradykinesia (slowness of movement).
Some of the earliest symptoms expressed in Parkinson’s are: difficulty performing specific movements, such as writing, which becomes progressively smaller and illegible. Sufferers will be unable to raise their voice, speak with a monotonous tone of voice and use a run of words. The cough reflex is also affected which will lead to an increased risk of pulmonary infections. Difficulties moving in bed and raising from a chair are also noticed, along with frequent constipation and an increase in skin creases. Symptoms tend to increase in severity when the individual is anxious or under stress. For this reason most sufferers stay locked up at home avoiding work and society.
Bradykinesa results in a delay in response time to a stimulus, thus the apparent slowness in initiating and performing movements. This may eventually lead to akinesia, where skilled movements cannot be initiated. This will also result in a loss of facial expression; the patient face expresses a strange look of stupidity. However, occasional once a movement is initiated they are carried out rapidly, which results in a typical shuffling gait known as festination. Suffers will have difficulty stopping, changing direction and walking around obstacles. They will also exhibit propulsion and retropulsion, which seems as if they are being pushed forwards and backwards while they are walking.
Stepping movements and protective reactions, their arms are limited and thus they are unable to prevent themselves from falling; once their balance is displaced. Rotatory movements are also decreased, especially in the trunk. This results in a progressive loss of the alternative arm swing, which is normally present during walking.
Blinking also becomes infrequent and there may be a decrease in eye movements.
Tremors are involuntary movements associated with disorders of the extrapyramidal system, consisting of alternating contractions of opposing muscle groups. This is most evident in peripheral joints and initially present at rest. The jaw is also effected by the tremor, with alternative protrusion and retraction of the tongue. These features of the disease result in difficulty swallowing, eating and talking. Difficulty swallowing saliva results in involuntary dribbling. Eventually, the tremor becomes faster, more severe and occurs during movement, instead of at rest. This may progress to the generalized shaking.
A Simian posture, as it is known will eventually develop as the disease progresses. Initially the only postural abnormality present will be a protruding head. Eventually a thoracic kyphosis with flexion and adduction of the hips and shoulders, as well as knee flexion will result. Patients tend to slump backwards while sitting and often slide sideways, with their head falling forward. Postural adjustment through weight shifting is usually difficult since weight is placed far back in the chair. This also leads to problems in getting from sitting to standing.
Balancing in standing is often difficult; as they tend to topple forwards.
Once walking is initiated it is difficult to shift weight properly a so they walk with short shuffling steps and a wide base. The normal heel-toe gait is also absent in most Parkinson’s patients, as they tend to walk with a flat foot or toe-heel pattern. Patients may also experience ‘freezing’, especially in narrow passageways or doors.
Rigidity occurs due to an increase in tonic stretch reflexes. It results in a high resistance to passive movements. They may be intermittent (cogwheel) or regular (lead-pipe), if tremor is present or not. It may be asymmetrical or unilateral and occasionally effects only a group of muscles. This symptom increases in cold environments and with stress. Posture is affected due to an increase in rigidity of one’s back extensors.
Finally, sensation is not usually effected, however patients usually experience pain, stiffness and aching of muscles and joints.
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