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Parkinson's Exam

Parkinson's Exam

Positioning: Patient sitting comfortably
Summary of Parkinsonism

The Patient

Around the Room

Mobility devices
General Features

Age, gender, general comfort
Orientation

To time / place / person
Tremor

Resting pill-rolling tremor

Look at the hands, legs, tongue, lips, jaw

Gait Assessment

Gait

Shuffling gait with reduced arm swing and difficulty turning
Pull Test

Stand behind patient and pull them backward

The Face

Mask-Like Facies

Expressionless, with reduced blinking
Smell

Take Hx, test with common smells
Speech

Hypophonia
Glabellar Reflex

Tap between the eyebrows
Eye Movements

Impaired downward gaze is suggestive of progressive supranuclear palsy (PSP)

The Upper Limbs

Hand Movements

Bradykinesia / hypokinesia, micrographia
Tone

Passive movement of shoulders, elbows, wrists, hands
Blood Pressure

Sitting and standing

Pull Test

Overview

The pull test is useful for assessing for postural instability in patients with Parkinsonism.
- How to Perform
- Stand behind the patient and firmly pull them backward by the shoulders.
- Interpretation
- Normal - maintains balance and steps backward
- Postural instability - takes multiple steps backward, or falls

Last updated on April 19th, 2019

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Read More...

Hallett M. Clinical neurophysiology of akinesia. Revue neurologique. 1990;146(10):585-90.

Hunt AL, Sethi KD. The pull test: a history. Movement disorders: official journal of the Movement Disorder Society. 2006 Jul;21(7):894-9.

Zach H, Dirkx M, Bloem BR, Helmich RC. The clinical evaluation of Parkinson's tremor. Journal of Parkinson's disease. 2015 Jan 1;5(3):471-4.

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