As a movement disorder of the nervous system, Parkinson's disease involves numerous symptoms that may worsen over time, including tremor, stiff muscles, and difficulty with balance. Another very common effect of the disease is slowed movement, called bradykinesia, which can make everyday tasks like getting out of a chair or taking a shower much more difficult than normal. For some with Parkinson's, it can even make it hard to blink.
Because bradykinesia can be unpredictable—you may be able to walk normally one moment and struggle with exceptionally slow steps the next—it's often frustrating, an experience that intensifies as bradykinesia progresses, says neurologist Daniel Truong, M.D., medical director of the Truong Neuroscience Institute at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.
"Bradykinesia is one of the core symptoms of Parkinson's disease and it can have substantial consequences because it affects not only walking, but almost every voluntary motor activity," he says. "As it becomes more pronounced, it can interfere with mobility, independence, safety, and quality of life."
That sounds serious (and it is) but with the right treatment strategies, bradykinesia can be effectively managed. Start with this information about what causes bradykinesia, how it affects walking, and ways to keep it in check so that you are able to continue with your daily activities.
In This Article:
Early Signs and Symptoms of Bradykinesia
Similar to other signs of Parkinson's disease such as tremors, speech changes, or difficulty writing, symptoms of bradykinesia can initially be mild.
"Early bradykinesia is often subtle and typically one-sided," says Adam Mednick, M.D., a neurologist in North Haven, CT. "People may notice reduced blinking, or that one arm no longer swings while walking. Fine-motor tasks such as buttoning, typing, or brushing teeth may feel slow or clumsy, and turning over in bed can become harder."
Movements also become smaller, he adds, which contributes to changes in your gait (the way you walk) and you start taking shorter, more shuffling steps. Walking and other daily movements also begin to lose their automatic quality; where once you took steps without thinking about it, now it requires conscious effort.
"A hallmark of bradykinesia is that repeated movements, such as tapping the fingers, slow down and shrink in size the longer they continue," says Dr. Mednick. "There can also be reduced facial expression and softer speech."
How Does Bradykinesia Affect Walking?
Walking is one of the clearest ways to tell if bradykinesia is affecting someone with Parkinson's disease. Although it seems like a simple activity, walking involves complex motor control throughout the body, including balance, torso rotation, arm swinging, leg lifts, and directional changes.
With bradykinesia, any part of this process can be slowed down in a noticeable way, says Dr. Mednick. Arm swinging decreases, steps become smaller and less consistent, and walking speed is reduced. "Bradykinesia is a major contributor to mobility problems in Parkinson's disease," he says. "As the disease advances, people have difficulty initiating walking, turn by using shortened movements rather than smoothly, and experience freezing which is characterized by a sudden sensation that your feet are 'stuck' to the floor."
As movements lose their automatic quality, walking demands more concentration and combining walking with another task, such as talking or carrying something, makes it much harder and increases the risk of falls, he adds.
Causes and Risk Factors for Bradykinesia
By definition, Parkinson's disease always involves bradykinesia. To be diagnosed with the condition, you must have bradykinesia plus at least either tremor or rigidity, according to Parkinson's Foundation.
In Parkinson's disease, the body experiences a loss of nerve cells that produce the chemical dopamine. Among the many roles of dopamine in the body, the chemical helps coordinate smooth, purposeful movement. As dopamine levels decrease, the brain has more difficulty initiating and controlling movement, leading to bradykinesia. Other movement-related conditions can produce bradykinesia as well, says Dr. Truong, such as:
- Corticobasal syndrome
- Dementia with Lewy bodies
- Multiple system atrophy
- Progressive supranuclear palsy
Certain medications that block dopamine—such as antipsychotics and antiemetics—can also lead to bradykinesia because of the way that chemical messenger controls movement.
"The risk factors for bradykinesia are essentially those that increase the likelihood of developing Parkinson's disease itself," says Dr. Truong. "That includes increasing age, which is by far the strongest risk factor. Other factors include being male, since Parkinson's is somewhat more common in men, and having genetic susceptibility." Family history of Parkinson's disease raises your odds of developing it, as does traumatic brain injury and environmental exposures, particularly certain pesticides, he says.
How to Treat Bradykinesia
Treating bradykinesia in Parkinson's disease involves a mix of medications, targeted exercise like physical therapy, and potentially other options such as deep brain stimulation if response to medication is minimal.
The first-line treatment is levodopa, a generic drug that works by converting to dopamine in the brain. It's available in several forms, including tablets, capsules, inhalers, and infusions. The medication is most often combined with another called carbidopa. Carbidopa stops levodopa from breaking down too quickly in the body, allowing more of it to reach the brain.
"This treatment aims to improve dopamine signaling and preserve functional mobility," says Dr. Truong. "Bradykinesia often responds quite well to this type of therapy, particularly earlier in the disease, and can improve the speed, amplitude, and initiation of movement."
Depending on age, disease stage, symptoms, and adverse-effect risk, he adds that clinicians may also use:
- Dopamine agonists such as pramipexole, ropinirole, or rotigotine
- MAO-B inhibitors such as rasagiline, selegiline, or safinamide
- COMT inhibitors such as entacapone or opicapone to prolong levodopa benefit
- Amantadine, although it is typically prescribed in more advanced Parkinson's, and is utilized primarily for management of dyskinesia (involuntary movement) rather than bradykinesia alone
Still, medications on their own are rarely sufficient for managing Parkinson's symptoms like bradykinesia, adds Dr. Mednick. "Physical, occupational, and speech therapy are essential, in addition to medications," he says. "Regular exercise, including movements performed at increased speed and with large amplitude, has been shown to improve bradykinesia."
For people whose bradykinesia symptoms fluctuate or who are no longer responding well to Parkinson's disease medications, "advanced options such as deep brain stimulation can provide substantial relief," Dr. Mednick says.
Bradykinesia vs. Dyskinesia
The terms sound similar, but bradykinesia and dyskinesia are quite different. In Parkinson's disease, bradykinesia is primarily a feature of the disease itself, while dyskinesia is often related to its treatment, says Dr. Truong.
Dyskinesia consists of involuntary or uncontrolled movements that you're not intentionally producing. They may look like writhing, twisting, rocking, head movements, or irregular movements of the arms, legs, or trunk. While bradykinesia produces movements that are slower and/or smaller than normal, dyskinesia is characterized by too much involuntary movement.
"In Parkinson's, the most common cause of dyskinesia is use of levodopa over several years," Dr. Truong says, noting the irony that while medication to increase dopamine in the body may improve bradykinesia, it can worsen dyskinesia. "So in more advanced disease treatment, it often becomes a balance between minimizing the latter while improving the former," he adds. This may involve reducing the dosage of levodopa or changing medication timing, as a way to improve dyskinesia.
Complications of Bradykinesia
Bradykinesia is a substantial complication in Parkinson's disease because it affects every voluntary motor activity. According to Dr. Truong, potential issues can include:
- Falls and injuries
- Fine-motor impairment, making tasks such as writing, buttoning clothes, cutting food, typing, or handling medications difficult
- Freezing and gait difficulty
- Loss of independence
- Reduced mobility and physical deconditioning
- Risk of constipation, pressure injuries, contractures, and other consequences of prolonged immobility due to bradykinesia
- Social and psychological consequences due to reduced facial expression and spontaneous movement misinterpreted as disinterest
- Speech and communication problems
- Swallowing and eating difficulties
"A particularly important point is that bradykinesia itself is not usually dangerous, but its functional consequences can be," says Dr. Truong.
Managing Bradykinesia With Parkinson's
Although bradykinesia is disruptive and frustrating, the issue can often be managed effectively early in the disease, especially by combining medications with exercise and practical strategies that make movements more deliberate, explains Dr. Truong, who suggests these approaches for symptom management:
- Take Parkinson's medication consistently. Levodopa is often very effective for bradykinesia. If movements become noticeably slower before the next dose, adjusting the dose may help.
- Think "big." Parkinson's disease can cause patients to underestimate how small their movements have become. Consciously taking larger steps, making larger arm movements, and exaggerating movements can compensate.
- Use external cues. When starting or continuing a movement is difficult, rhythmic counting, music or a metronome can help, as can consciously thinking about stepping toward a visual target.
- Break complicated movements into steps. Instead of trying to get out of a chair automatically, break it down. For example: move forward, then position the feet, then lean forward, then push up, and finally, stand tall.
- Make the home easier to navigate. Remove clutter and tripping hazards, improve lighting, and consider grab bars, railings, or other mobility aids when appropriate.
- Stay active during "on" periods. If medication produces predictable periods of better mobility, schedule exercise and more demanding activities during those times.
- Watch for changes. Increasing falls, freezing, difficulty getting out of a chair or bed, problems with eating or swallowing, or substantially longer "off" periods deserve reassessment.
"Work with a physical, occupational, or speech therapist for tailored strategies," adds Dr. Mednick. "Give yourself extra time, break tasks into steps, and simplify clothing and utensils to preserve independence. Also important is reporting new or worsening slowness promptly, as it may mean the medication plan needs adjusting."
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