The TRAP of Parkinson’s Disease (PD)
The PD TRAP
The cardinal signs of Parkinson’s Disease are:
| Tremor | The tremor in PD is a rest tremor which means that it is most visible when the shaking body part (e.g. a hand) is at rest supported by gravity and not engaged in any purposeful activity. This tremor is often described as “pill-rolling.” This is in contrast to the tremors seen in other conditions, such as essential tremor or multiple sclerosis, which are typically action tremors. Action tremors are more visible when the affected limb is being used. This is the initial presentation in about 70% of patients with PD. The resting tremor is pathognomonic for Parkinson disease. |
| Rigidity | This refers to increased resistance to passive movement about a joint and occurs in about 75 to 90% of patients with PD, Cogwheel rigidity. Increased tone. Worse when doing repetitive movements with the opposite limb. |
| Akinesia / Bradkikinesia | There is a generalized slowness of movement. Decreased ability to initiate voluntary movement. Patients find it hard to describe and may use words like, “Weak” “Clumsy” “incoordination,” “tiredness,” etc. It is the major cause of disability in PD and is eventually seen in almost all patients. |
| Postural Instability | Patients have a feeling of imbalance and a tendency to fall. They have decreased arm swing and shuffling gait. Postural instability usually comes much later in the course of PD. As such, if a patient has postural instability early in their course, it is an indication to consider other causes of parkinsonism such as progressive supranuclear palsy or multiple system atrophy. |
TRAPS : You may add Shuffling Gait.