Other motor symptoms

OverviewProblems with walkingProblems with speech and swallowingSmall crowded handwritingMasked faceDystoniaCramps

In addition to these four main symptoms, Parkinson’s also includes other motor symptoms. However, it is important to note that not everyone with Parkinson’s may have these symptoms.

Problems with walking

Walking is often affected and difficulty with walking tends to progress with increasing duration of Parkinson’s.

A PwP often tends to walk with short, shuffling steps.
Also some people tend to have episodes where they are unable to initiate a walking activity, or may stop abruptly when they are walking. This is termed as a “freezing episode” and is a sign of Parkinson’s. Freezing in Parkinson’s is a phenomenon, when one feels like their feet are ‘glued to the ground’ or are ‘frozen’ or feel ‘stuck’. It may last for a few minutes or longer. Freezing often increases a PwP’s chances of falling.

When does freezing usually occur? It can happen when you:

  • Start to walk
  • Walk towards a narrow doorways
  • Turn or change direction in crowded places
  • There is a physical obstruction or object when you are walking
  • Are coming close to your bed or chair, in order to use it

Why does this occur?

Freezing is thought to be a “motor block” wherein the signals from the brain to the body get interrupted thereby triggering the episode. However this is temporary and can be overcome with several techniques.

How do I cope with freezing?

  • Various strategies like auditory and visual cues help overcome freezing episodes. These tips help you to distract your brain from the activity that is causing the ‘freezing’.

If you experience ‘freezing’ do not panic.

  • For more information click here for Physiotherapy for Parkinson’s (Knowing Parkinson’s – Treatment- Supportive Therapies – Physiotherapy)

If you’re experiencing recurrent episodes of freezing, please discuss this with your doctor

Festination/ sudden accelerations
Some patients with Parkinson’s may suddenly walk with an increased speed and are unable to control the same. This may lead to a fall in the forward direction.

Similar accelerations are also seen in speech, wherein the rate of word production is very fast which often renders the speech incomprehensible.

Coping up with festination
A technique to overcome festination, is to consciously reduce your pace of walking or talking; the moment you realize it is increasing.

Problems with speech

Speech problems in Parkinson’s are thought to be a mixture of motor and non motor symptoms.

In Parkinson’s, the volume of the voice may become low, i.e. a PwP’s voice becomes soft or the clarity or clearness of speech may be affected.

Both these difficulties, i.e. a soft voice and unclear speech, make it difficult for people to understand what PwPs are trying to say, because of which they may frequently ask them to repeat what they’ve have said, especially when talking on the telephone.

Additionally, in Parkinson’s, the voice may become monotonous i.e. there is only one volume level and a flat tone. The voice may sound like it does not have any emotion, neither happy or excited or sad or angry, and sounds ‘expressionless’.

The same thing may happen with your face, where your face may appear ‘blank’ or ‘expressionless’.  The flat voice and blank face may make people feel that you show no emotion during any communication/ interaction.

A combination of all these factors may cause embarrassment or may make speaking an extremely frustrating experience for PwPs. At the same time, this may also be extremely frustrating for people trying to understand what they’re trying to say.

Such problems may make one feel like staying away from conversations with others. But ceasing communication would be a mistake. It is an absolute must that you interact with others on a daily basis, no matter how difficult it may be. Communication is a very important part of all our activities.

Why are speech problems so common in Parkinson’s?

Speaking is an activity which involves the movement of many muscles in the face, mouth and throat. All these muscles need to act together to produce loud and clear speech.

In Parkinson’s, as with other muscles of the body, this control and co-ordination of  muscles of the face, mouth & throat get affected due to symptoms like rigidity and slowness of movement. Also, breathing and posture which are often affected in Parkinson’s contribute to speech problems, as both these aspects are important requirements for clarity of speech.

Problems with swallowing

Many PwP’s have difficulty in chewing and swallowing their food and/or water.
These difficulties could lead to several other problems such as:-

  • Choking on food which could affect your breathing.
  • Food can enter the lungs instead of the stomach and cause a chest infection leading to repeated coughs and colds.
  • Drastic reduction in food and water intake which could lead to malnourishment and constipation.
  • Difficulty in swallowing medications which can affect your symptoms.
  • Embarrassment due to drooling or taking too much time to eat a meal.

These swallowing difficulties are experienced because the mouth and throat muscles become weak due to Parkinson’s. This affects the control patients have over chewing and swallowing.

How do I cope with speech and swallowing problems?

The good news is that there are treatments & therapies available, such as voice exercises and strategies that help tremendously in improving the speech and swallowing problems associated with Parkinson’s.

A change in the size of your handwriting may be an early indicator of Parkinson’s. This is mostly noticed in the form of a change in signature. A distinctive change in the handwriting occurs progressively, moving across the page, letters get smaller and less legible.
Often in Parkinson’s, skills that require fine motor control like writing, buttoning up a shirt, pleating a saree, counting money are affected early during the course of the disease.

Has anybody told you that you have a serious expression on your face all the time? Have your family members told you that you don’t blink regularly? Parkinson’s often affects the muscles of the face and produces a mask like appearance.

Dystonia and Parkinson’s

Some individuals with Parkinson’s may experience muscular contractions/ spasms which may force parts of the body into unnatural postures. This is a motor symptom of Parkinson’s called as dystonia. As opposed to dyskinesias, these movements are slower, and may be painful.

Dystonia can either affect one or multiple parts or the entire body. People with Parkinson’s commonly tend to experience dystonia in their feet. They may often notice their toes curling inwards, or tightness in their calf muscles.

What causes dystonia?
The exact cause is not completely understood, but it is believed to be due to changes occurring in deeper areas of the brain. It is thought that the brain sends irregular signals to the muscles causing them to contract together resulting in dystonia.

Dystonia may be either due to Parkinson’s itself or manifest due to a side effect of Levodopa. In Parkinson’s, dystonia is more common with younger age of onset i.e. before 40.

Coping with dystonia
If you feel you might be experiencing dystonia please consult your neurologist. Your doctor would then alter your medications and the dosage and help you achieve a balance between your other Parkinson’s symptoms and dystonia.

Cramps and Parkinson’s

Many PwPs experience cramps or a pulling sensation in their muscles (particularly in the calf/toes). Cramps in Parkinson’s are very different from dystonia. They are caused by muscular rigidity and slowed movement (bradykinesia) Cramps are painful and can also interrupt a full night’s sleep.

Coping with cramps
This might usually occur when the medication effect wears off. Most often, this will probably be relieved by the next dose of medication.

To prevent this from happening, it is advisable to maintain a good intake of water and electrolytes like Calcium, Magnesium etc. One can also drink a glass of water with a pinch of sugar and salt/ or a commercially available electrolyte powder. (Electral etc.)

Muscle cramps also respond well to hot water fomentation and massage. Movement of the ankle and toes may also help in stretching out the muscle and may release the cramp.

If cramps persist, then it is advisable to consult a neurologist who may prescribe muscle relaxants to reduce the pain.