The Other Movement Disorder
Parkinson’s disease is best
known for how it manifests itself: presenting with gait and movement
dysfunction related to dopamine depletion. What about other movement disorders?
Though diseases such as
progressive supranuclear palsy, Lewy body, multiple systems atrophy and
corticobasilar degeneration may present similar to idiopathic Parkinson’s
disease, there are clinical features that differentiate them. For the first
time, in my professional carrier, a patient with a different kind of movement
disorder was referred to me – akathisia, which is a scientific word for severe,
drug-induced restlessness. The reason for physical therapy: falls
Parkinsonism, related to
antipsychotic or neuroleptic medications, presents very similarly to idiopathic
PD. Patients display bradykinesia, rigidity and mask-like facies, but they have
an underlying psychiatric condition that requires treatment with antipsychotic
or neuroleptic medications. Akathisia, on the other hand, presents differently.
It resembles severe agitation, leg tapping, and constant movement can be debilitating
for patients and can cause imbalance.
It is important for
therapists to recognize this manifestation of drug-induced movement disorders
by taking a thorough initial history and being aware of medication adjustments.
Though akathisia is generally resolved when neuroleptic medications are
discontinued or modified, physical therapy for balance and strengthening can be
very beneficial. Gait training that focuses on amplitude mitigation and
stride-length cadence improvement can help to improve gait rockers. Balance
exercises that include dynamic gait and multitasking, pacing and stopping to
make safe decisions can improve fall prevention strategies.