A good example of bradykinesia

On my elective placement in Orthopaedic In-patients I treated a lovely lady suffering from Parkinson’s disease. She had undergone a right total hip replacement. Her progress notes showed she had been transferring and ambulating stand by assist for a number of days with no complications. I was curious to see whether signs of her Parkinsonism would show and if I would be required to implement strategies to overcome any bradykinesia.

During the treatment she transferred independently and without prompts, from sitting in her chair, to standing with a zimmer frame, to walking outside her room. She appeared to show no signs of bradykinesia other that the slight pause in her step at times.

However when we reached the hallway, she suddenly gave a cry “I’m going to fall”. She began to fall like a tree that had been lopped from its base. She remained as straight as a soldier as she began to plummet backwards. Although she was physically capable, she was unable to implement any saving responses to prevent herself from falling. She knew she was falling, but her body was unable to act in response to this. Her bradykinesia was now a lot more evident to see!

I thought this was a perfect example of how this impairment has the potential to put a patient at risk of falling.

In the future I will consider all patients with Parkinsons disease as having potential for falls risk and guard them accordingly, until I know them well enough to decide otherwise.