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Parkinson's Exam
 
 

Assessing Tone

 
 
 
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Overview

  • How to Assess

  • Ask the patient to relax and allow you to move their arms. Move the shoulder, elbow, wrist and fingers passively through their range of motion, looking for rigidity.
  • Interpretation

  • Increased: resistance to passive movementUpper motor neuron lesion
  • Normal: minimal resistance
  • Decreased: no resistanceLower motor neuron or cerebellar lesion

Spasticity

Also known as clasp-knife rigidity.
  • Feel For

  • Velocity dependant rigidity, with quick flexion / extension of the joint. Works best on the knee or elbow.
  • Significance

  • Indicative of upper motor neuron lesion.

Lead Pipe Rigidity

  • Feel For

  • Continuous rigidity that is not velocity dependant, resulting in slow flexion and extension.
  • Significance

  • Caused by Parkinson's disease, other causes of parkinsonism, and contractures.

Cog Wheel Rigidity

  • Feel For

  • Rigidity associated with tremor, resulting in jerky start / stop movement of the joint.
  • Significance

  • Caused by Parkinson's disease, other causes of parkinsonism, and contractures.
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