The Shaking Shoelace

Bastiaan R. Bloem*, Rick C. Helmich, Tiane Tilanus, Bart P. van de Warrenburg

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands

View video that accompanies this article here: Supplementary Video (opens in new screen)

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.

A 59-year-old man with Parkinson’s reported a subjective tremor. Yet, neurological examination showed no tremor while observing the bare extremities (video section A; showing no discernible tremor in the bare feet).

However, while wearing shoes, a subtle tremor was revealed by rhythmic oscillations of the left shoelace (video section B), which presumably acted as a lever, much like the mechanisms used for earthquake detection.

Power spectrum analysis of the video showed no discernible tremor in the bare feet, but examination of the oscillations of the left shoelace revealed a distinct tremor (peak frequency of 3.45  Hz) compatible with Parkinson’s disease (video section C).

This underscores that observing patients while still dressed may occasionally be needed to bring out the full repertoire of key physical signs.

Caption: Screenshots of accompanying video: top left = video section A; top right = video section B; bottom center = video section C

CONFLICT OF INTEREST

BRB, RH, and BvdW report no disclosures.

AUTHOR CONTRIBUTIONS
BB and TT: collecting video data and drafting the manuscript.

RH: expert opinion and revising the manuscript.

BvdW: arranging tremor quantification and revising the manuscript.

ACKNOWLEDGMENTS
We thank Radim Krupička and Evžen Růžička for analysis of the tremor.

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Full citation:

The Shaking Shoelace, by Bastiaan R. Bloem, Rick C. Helmich, Tiane Tilanus, and Bart P. van de Warrenburg, J Parkinsons Dis, 9:1, 249–250, 2019 (DOI 10.3233/JPD-181541).

Last comment on by Rose Mountford,

Comments

Submitted by Jaynemarie Styles, on

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Submitted by Rose Mountford, on

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Submitted by Rose Mountford, on

I am 63 years old, I was diagnosed of Parkinsons disease at the age of 57. I had severe calf pain, muscle pain, slurred speech, frequent falls, loss of balance, difficulty getting up from sitting position. I was placed on Sinemet 3 times daily, it helped me but not very much. My neurologist advised me to try natural treatments and introduced me to Mayaka Clinic Parkinsons Disease Herbal formula, I read alot of positive reviews from other patients who used the treatment and i immediately started on the treatment. I had great improvement and relief with this treatment, total decline of symptoms. Great improvement with speech, co-ordination, balance, muscle, mood etc, I gained back my life with this treatment and can never be thankful enough. Visit Mayaka Natural Clinic official website ww w. mayakanaturalclinic. com