The physical exam in Parkinson’s Disease (PD) is essential both for making a diagnosis and following the patient over time to determine when a medication adjustment or other treatments are needed. Stanford Medicine has made available an online training tool for neurologists, which demonstrates in text and several videos the proper way to evaluate the four main characteristics of PD. We thought you’d like to see it!

In order to make a diagnosis of PD, doctors must observe bradykinesia (slowness) plus at least one of the other motor abnormalities: rigidity (stiffness), tremor, or gait and balance.

The first video in this training tool for neurologists explains that the doctor should begin observing the patient from the first moment of interaction. They are watching for spontaneous movements, eye blink, fidgeting, crossing and uncrossing of legs, hand gestures, and tremor. Being VERY observant is important because, while Parkinson’s Disease is the most common form of parkinsonism, there are other similar disorders where treatment differs and disease progression is faster.

Because there are not yet diagnostic tests for any form of parkinsonism, including PD, getting an accurate clinical diagnosis is key to patient safety (esp. fall prevention) and quality of life. It can also be important for caregivers to know if dementia is common in the type of parkinsonism that is diagnosed, so they can learn what to expect and how to respond to behaviors associated with dementia.

Once a diagnosis is made and the patient is started on treatment, it is important to check these four features (bradykinesia, rigidity, tremor, and gait/balance) at every follow up visit. It is also important to tell your doctor if new motor or non-motor symptoms have appeared. A medication adjustment may be needed or it may be time for a referral to physical, occupational, speech therapy, or even palliative care.

If you are seeing a primary care physician or general neurologist and are having difficulty getting a diagnosis or managing symptoms effectively, you may benefit from seeing a neurologist who specializes in movement disorders. The Stanford Parkinson’s website has a list of movement disorders specialists in Northern California, as well as physical therapists, occupational therapists, and speech therapists on the San Francisco Peninsula and in the South Bay who specialize in working with people who have PD.

Amazingly, Stanford Palliative Care has one doctor on the palliative care team who is also a board certified movement disorders specialist. Dr. Jocelyn Jiao is the perfect choice for anyone with a PD diagnosis who wants to add palliative care to their healthcare team. If you’re a little unclear on the difference between palliative care and hospice care, check out the information on Hospice and Palliative Care, which includes Dr. Jiao’s talk on Caring for the Whole Person with PD.