The effects of disease of the extrapyramidal system on movement can be regarded as negative (primary functional deficit) and positive (secondary effect due to release or disinhibition in undamaged regions).
1. Bradykinesia: - a loss or slowness of voluntary movement. This is a major feature of Parkinson's disease and produces:
- reduced facial expression (mask-like)
- reduced blinking
- reduced adjustments of posture when seated.
When agitated the patient will move swiftly - 'kinesia paradoxica'.
2. Postural disturbance: - most commonly seen in Parkinson's disease.
Flexion of limbs and trunk is associated with a failure to make quick postural or 'righting' adjustments to correct imbalance. The patient falls whilst turning or if pushed.
1. Involuntary movements:
- chorea (irregular, repetitive, jerking movements).
- athetosis (irregular, repetitive, writhing movements).
- dystonia (slow, sustained, abnormal movement).
- ballismus (explosive, violent movement).
Chorea and athetosis may merge into one another - choreoathetosis.
Stiffness felt by the examiner when passively moving a limb. This 'resistance' is present to the same degree throughout the full range of movement, affecting flexor and extensor muscle groups equally and is described as PLASTIC or LEAD PIPE rigidity. When tremor is superimposed upon rigidity it produces a COGWHEELING quality.
In Parkinson's disease both positive features, e.g. tremor, and negative features, e.g. bradykinesia, occur.
In Huntington's chorea positive features, e.g. chorea, predominate.
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