The Facts

Tremor

By far the most visible of the symptoms is the tremor. It occurs 'at rest', and is most common in the hands and arms. As the disease progresses the tremor may affect more of the body and/or become more pronounced.

Rigidity (muscle stiffness)

Rigidity results from a shortening of the muscles. It can be felt by the doctor as intermittent (cogwheel), or sustained (lead pipe) resistance when he/she moves the PWP's limbs.

Posture and clawing

It is rigidity which causes the postural (stooping) and cramping problems experienced by many PWP.

Slow movement (and difficulty starting movement.) - (bradykinesia)

The slowing down associated with PD results in a wide range of symptoms, including:

• an inability to start a movement (freezing)
  
• slow execution of a movement'
  
• a shuffling walk
  
• the slowing down of a movement until it stops (another type of freezing),
  
• reduced blinking,
  
• reduced arm swinging,
  
• difficulties with swallowing and eating,
  
• difficulties with speech,
  
• bowel and bladder problems,
  
• a 'mask-like' facial expression.
  

The PD experience

Tremor

Do you really have Parkinson's? The association of tremor with PD is so strong that many people think it is the only symptom there is. As a result those PWP who experience little or no tremor can expect members of the public to query their diagnosis.

Dyskinesia

On a more serious note, many PWP and even some health care professionals fail to recognize dyskinesia because they mistake it for tremor.

Dyskinesia is involuntary movement caused by high doses of, or long exposure to, levodopa. It is thought that long exposure to levodopa can cause the dopamine receptors to become hypersensitive, which is why some PWP find that dyskinesia increases even though medication levels remain static.

In the early stages it tends to affect a limb (often a leg) but can progress to affect all parts of the body. Look for the following points to identify dyskinesia:

• It only occurs during the 'on' phase of the 'on'/'off' syndrome.
  
• It includes writhing and twisting movements.
  
• Any shaking of dyskinetic origin 'feels' different to the true PD tremor experienced during the 'off' phase. An aware PWP can soon pick one from the other.
  

It is important to be able to tell dyskinesia from tremor. Tremor is a symptom of PD. Dyskinesia is a reaction to high levodopa levels. Increasing the dose of levodopa will make dyskinesia worse.

Rigidity

The shortening of the muscles of the back cause the characteristic Parkinson's stoop. As this 'bad' posture can lead to quite severe back pain it is a good idea to start stretching exercises as soon as PD is diagnosed.

Other common manifestations of rigidity are a clawing of the hands and the bending of the arms and legs at the elbows and knees respectively. The discomfort level is exactly the same as if the hands or limbs were voluntarily being held in those positions for long periods of time.

Dystonia

Dystonia, another side effect of the Parkinsonian drugs, can be confused with rigidity. It is often a feature of the transition from 'off' to 'on' or from 'on' to 'off'. Whereas rigidity results from a shortening of the muscles, dystonia is the result of a clamping of the muscles into a hard knot. The calf and foot muscles are the most often affected, the foot arching with the toes pulled in close.

Slow movement (bradykinesia)

Bradykinesia, or slow movement is perhaps the most invasive of all the PD symptoms. It affects the PWP on many levels, both physically and socially. A glance at the list of symptoms reads like a 'who's who' of the body and the difficulties associated with each symptom are self evident.

Body Language

What is not obvious is that the lack of facial expression, body movement, blinking, and spontaneity add up to a lack of body language. People in conversation with a PWP often form the opinion that the PWP is not interested in what they are saying. They are not getting those little encouraging nods, no smiles are forthcoming and the PWP could even be looking slightly away from them, making no apparent effort to make eye contact. It is hardly surprising that social contacts start to dry up. Even people who are aware of the problem have difficulty with it. Short of hanging a sign around our necks saying "I am listening-really" , all we PWP's can do is make sure that people are aware of our difficulties and then periodically verbally reassure them that we are listening.

Tiredness

Another source of friction associated with slow movement is the misconception that PWP move slowly because they are tired. This is not the case. Dr Parkinson called this disease the "Shaking Palsy" because the bradykinesia is a form of paralysis. Unfortunately no amount of encouragement or sleep will speed a PWP up. However the encouragement is very welcome if directed at helping them maintain a positive mental attitude.