Assessing Bradykinesia

The other day I was out on my trike to the shops and three times different people said to me, ‘Take your time” . I go on my trike to go faster.

Years ago (may be before 2008) I remember going with a friend and her kids to the zoo. After wandering about there all day we ordered a cab. Everyone rushed ahead to find it but I couldn’t keep up. Couldn’t get my legs to go any faster .

Recently I tried a new yoga move from my youtube classes. Called the mountain climber. I was paRTicularly rubbish at it. You are in position as if you aRE Going to do a push up, then you are supposed to kind of take a step forward, alternating each leg …too fast for me . I kept pegging out.

In the movement disorder clinic they have their own manoeuvres to bring out slowness etc.

MDS clinical diagnostic criteria for Parkinson’s disease. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. Mov Disord. 2015 Oct;30(12):1591-601.

Bradykinesia is defined as slowness of movement AND decrement in amplitude or speed (or progressive hesitations/halts) as movements are continued.
Bradykinesia can be evaluated by using finger tapping (MDS‐UPDRS 3.4), hand movements (3.5), pronation‐supination movements (3.6), toe tapping (3.7), and foot tapping (3.8).
Although bradykinesia also occurs in voice, face, and axial/gait domains, limb bradykinesia must be documented to establish a diagnosis of PD.

Note: Bradykinesia as defined here combines with one term the definitions of bradykinesia (slowness) and akinesia/hypokinesia (decreased movement amplitude); both are generally present on examination, although not always simultaneously (ie, patients cannot move at normal speed with normal amplitude).

In parkinsonism caused by PD, a decline in either speed or amplitude is seen as movements are continued, a feature sometimes not observed in parkinsonism caused by alternate conditions.

MDS-UPDRS The MDS-sponsored Revision of the Unified Parkinson’s Disease Rating Scale Goetz et al July 1 2008

Part III: Motor Examination: 3.4 FINGER TAPPING
Instructions to examiner: Each hand is tested separately. Demonstrate the task, but do not continue to perform the task while the patient is being tested. Instruct the patient to tap the index finger on the thumb 10 times as quickly AND as big as possible. Rate each side separately, evaluating speed, amplitude, hesitations, halts, and decrementing amplitude.

0: Normal: No problems.
1: Slight: Any of the following:
a) the regular rhythm is broken with one or two interruptions or hesitations of the tapping movement; b) slight slowing;
c) the amplitude decrements near the end of the 10 taps.
2: Mild: Any of the following:
a) 3 to 5 interruptions during tapping; b) mild slowing; c) the amplitude decrements midway in the 10-tap sequence.
3: Moderate: Any of the following:
a) more than 5 interruptions during tapping or at least one longer arrest (freeze) in ongoing movement; b) moderate slowing;
c) the amplitude decrements starting after the 1st tap.
4: Severe: Cannot or can only barely perform the task because of slowing, interruptions, or decrements
The clinical approach to movement disorders W.F.Abdo, B.P.C.van de Warrenbur, D.J.Burn, N.P.Quinn & B.R.Bloem Nat. Rev. Neurol. 6, 29–37 (2010);

we define akinesia as an umbrella term for a symptom complex that can include bradykinesia (slowness of movement) and hypokinesia (poverty of movement, and movements that are smaller than intended), but also—crucially and fundamentally—the progressive fatiguing and decrement of repetitive alternating movements seen during finger or foot tapping… Demonstrating absence of these features is more time-consuming, and in order to be certain we recommend asking the patient to perform up to 64 repetitions in each extremity, if necessary