Motor symptoms

Shaking or Tremor at restStiffness or Rigidity of the muscles of the limbs or trunkSlowness of movement or BradykinesiaProblems with balance or Postural Instability
What is a Tremor?
It is an early symptom and is seen in about 70% of people presenting with Parkinson’s.

A tremor usually occurs in the fingers and/ or hand of one side when the patient is at rest or when the patient is walking with his hand by his side or while watching TV.

The tremor seen in Parkinson’s do not occur when the hand is in use and hence is called a “resting tremor”

However it should be noted that not everyone with Parkinson’s may present with tremor as a symptom. Additionally having only a tremor, does not always imply that one has Parkinson’s, as it can be a symptom of other conditions as well.
Would my tremor increase?
A tremor may begin with the fingers and then proceed to the arm. Sometimes it can proceed to the leg of the same side. In some people, a tremor may begin as a mild twitching of the tongue, lip or jaw. After few years of Parkinson’s, the tremor may involve the other side as well, although it remains most noticeable on the initially affected side.
How can I cope with my tremor?
In the early stages of Parkinson’s, you may be able to suppress your tremor by holding an object like a pen or by making a fist.

Tremor in Parkinson’s often tends to increase with an anxious state of mind. Therefore, some people use different forms of relaxation to help relax themselves and thus cope with their tremor.

Tremor is responsive to medications (like levodopa or dopa agonists). It is important to discuss with your doctor about the medical options available for controlling the tremor.

What does RIGIDITY or stiffness mean?
In normal physiology, a muscle contracts during a movement, and relaxes after the movement is completed or when the body is in a state of rest. In Parkinson’s, however, the muscles of the body often tend to become stiff and are in a state of continuous contraction and do not relax even at rest.

Rigidity manifests in the following ways:
Heaviness of limbs especially the legs
Aching and painful muscles
Stiff muscles
When one is experiencing the above, & it is causing discomfort and pain, it is called as rigidity and is one of the motor symptoms of Parkinson’s. However, it would be ideal to ask your neurologist about your symptoms.

Some people have problems turning over in bed, or getting up from a chair or are unable to swing their arms while walking or have difficulty while taking a turn. Some people also have problems with speech and facial masking due to rigidity of the muscles of the face.
How can I cope with rigidity?
Physiotherapy incorporates certain exercises which help maintain muscle flexibility. Regular exercise will help you in easing out your daily activities and in maintaining an active lifestyle.
Yoga has a number of asanas which are also helpful in maintaining muscular flexibility.
Speech therapy helps in maintaining the integrity of the vocal cords and other muscles that help in speech articulation and production.For more information click here for Speech Therapy for Parkinson’s
Medications are available that reduce rigidity. It is important to discuss with your doctor about the medical options available for the same.

Slowing of movement or Bradykinesia (Brady=slow, kinesia = movement)
One of the hallmark symptoms of Parkinson’s, ‘bradykinesia’ is described as a reduction of spontaneous or automatic movement. This involves not only slowness in carrying out a movement, but also hesitancy in initiating a new movement and fatiguing easily. This often causes inability to move out of postures like sitting and reduces the speed of functioning in everyday activities like eating, grooming, bathing and toileting, dressing etc.

Initially, activities that involve fine movements like buttoning up a shirt, tying shoe laces are affected. This may gradually progress and gross movements like walking, sitting and standing up tend to get affected. Walking generally becomes slower, with short shuffling steps and reduced arm swing.

PwPs may stop suddenly near doors or in crowded places, as their body does not respond to commands right away due to bradykinesia. This phenomenon is called as ‘freezing’. A person with Parkinson’s may not be able to swing their arms due to both rigidity and bradykinesia.
What do you mean by automatic movements?
Automatic movements basically are movements that happen without a conscious effort. These are greatly affected in Parkinson’s because of underlying bradykinesia. These include reduced facial expressions (often creating a staring look/ mask like face), decreased rate of spontaneous blinking and reduced arm swing while walking. The ability to gesture while talking may also get affected.
How can I cope with slowed movement?
Physiotherapy comprises of certain exercises and techniques which can help you in coping with bradykinesia. It also includes various strategies and tips on overcoming freezing episodes. For more information click here for Physiotherapy for Parkinson’s
Medications do help in overcoming bradykinesia to a certain extent. It is important to discuss with your doctor about the medical options available for the same.

Problems with balance or Postural Instability
Change in posture and difficulties in balance are other important motor related symptoms associated with Parkinson’s.

A balance problem manifests as a feeling of instability while standing and a subsequent fear of falling. In Parkinson’s, the reflexes that maintain normal upright posture tend to be affected consequently causing problems with staying steady in standing, walking etc.

Problems with balance may also manifest while trying to get up from a chair or while sitting down, where some may lose balance and dangerously topple backwards. Negotiating a turn while walking may also predispose to a fall as it can be a threat to balance.

Your doctor may pull you backwards and test your balance. The neurologist will pull you backwards from your shoulders and look for retropulsion (tendency to fall backwards). Normally a person would take up to 2 steps backward to prevent a fall.

As Parkinson’s progresses, the posture tends to become stooped or bent down. Also some develop a tendency to walk very fast with shuffling footsteps and sometimes may fall due to loss of balance.
How do I cope with balance problems?
incorporates certain exercises which help maintain balance.
Occupational therapy will help in making the environment you live in safer and which would help reduce the risk of falling.For more information click here for Occupational Therapy for Parkinson’s Concentrating on walking can help ease out balance problems to an extent
Additionally, if you experienced dizziness, it should not be confused with postural instability & it would be advisable to talk to your doctor about the same. Dizziness can also lead to falls and other injuries.
It is also important to get your blood pressure checked at regular intervals as some medications interfere with blood pressure which may increase the risk of falling.