How I Examine My Patient

Bedside Assessment of Autonomic Dysfunction in Multiple System Atrophy

January 17, 2023 - Multiple system atrophy (MSA) is a rare, rapidly progressive neurodegenerative disorder of the adulthood, characterized by autonomic failure, parkinsonian and cerebellar features in various combinations. Distinguishing MSA from common clinical look-alikes such as Parkinson´s disease, other atypical parkinsonian disorders or alternative causes of sporadic adult-onset cerebellar ataxia may be difficult, especially at early disease stages.

Last comment on by Bonnie Chismar,

A Practical Guide to the Evaluation of Compensation Strategies for Gait Impairment in Parkinson’s Disease

January 17, 2023 - The application of compensation strategies is an important element of gait rehabilitation in persons with Parkinson’s disease. While the efficacy of these strategies is generally very high, a tailored, personalized approach is necessary to determine the optimal strategies for every patient.

Last comment on by Bonnie Chismar,

Troubleshooting Gait Problems in Parkinson’s Disease Patients with Subthalamic Nucleus Deep Brain Stimulation

January 17, 2022 - Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for a subset of patients with Parkinson’s disease, and the adjustment of DBS parameters is typically guided by the patients’ rigidity and tremor.

Last comment on by Bonnie Chismar,

The Shaking Shoelace

It is good practice to physically examine patients while being undressed. Here, we illustrate that observation of clothes in dressed patients can occasionally also yield valuable information.

Clinical Application of Brain MRI in the Diagnostic Work-up of Parkinsonism

Differentiating Parkinson’s disease and atypical parkinsonism on clinical parameters is challenging, especially in early disease courses. Here, we discuss when brain MRI should be performed in the diagnostic work-up of parkinsonism, our preferred brain MRI scanning protocol, and the diagnostic value of specific abnormalities.

The Clinical Evaluation of Parkinson’s Tremor

Tremor in Parkinson's disease can come in many different forms, and it has a highly variable appearance. This stimulated us to summarize a few crucial points as well as helpful tips and tricks for a good tremor evaluation.

How I Examine My Patient: The Art of Neurological Examination for Parkinson’s Disease

The Journal of Parkinson’s Disease is proud to announce an exciting new section entitled “How I Examine My Patient”, dedicated to the art of the neurological examination.

Medio-Lateral Balance Impairment Differentiates between Parkinson’s Disease and Atypical Parkinsonism

In early disease stages, it can be difficult to differentiate clinically between Parkinson’s disease and the various forms of atypical parkinsonism, like multiple system atrophy or progressive supranuclear palsy. Balance impairment in the medio-lateral plane (i.e. sideways) is often seen in patients with a form of atypical parkinsonism, but not in patients with Parkinson’s disease.
This is reflected by the distance between the feet during gait, which is typically normal (or even narrow) in Parkinson’s disease, but widened in atypical parkinsonism. Estimating this stance width depends on subjective judgement, and is difficult to quantify in clinical practice.

The Retropulsion Test: A Good Evaluation of Postural Instability in Parkinson’s Disease?

Postural instability is a disabling feature of Parkinson’s disease (PD), contributing to recurrent falls and fall-related injuries. The retropulsion test is widely regarded as the gold standard to evaluate postural instability, and is therefore a key component of the neurological examination in PD.

Last comment on by Bonnie Chismar,