Bradykinesia Test

What is the Bradykinesia Test?

Before we discuss the Bradykinesia Test properly, let’s briefly discuss what Bradykinesia is.

Bradykinesia is a particular condition that emerges alongside Parkinson’s Disease. You can even say that this condition is a symptom of it because it is common among those with Parkinson’s Disease.

If a patient is afflicted with Bradykinesia, they will struggle to start movement in either the upper or lower extremities. Once the patient manages to start a movement, it is often sluggish. In the context of this particular assessment, the hands (including the wrists and fingers) and feet (including the toes) show slowness of movement.

The Bradykinesia Test is one of the tests that healthcare professionals have their patients undergo to check for the likeliness of Parkinson’s Disease. It is composed of five exercises, with three of them focusing on the hands and two focusing on the feet. Here are the five exercises:

1. Finger Tapping - This exercise will be performed using both hands, but one hand at a time. The professional will have their patient tap their thumb and index finger repeatedly for a few seconds (it’s up to the healthcare professional).
2. Hand Grip - This exercise will also be performed using both hands, one hand at a time. The professional will instruct the patient to repeatedly open and close their fists for a set amount of time.
3. Hand Pronation/Supination - One at a time, the patient will extend their arms forward, and they will repeatedly pronate and supinate their hands for a set amount of time.
4. Toe Tapping - This exercise will have the patient tap their toes on the floor while their feet are planted. They will also do this for a set amount of time. They will also do this one foot at a time.
5. Heel Tapping - This one is similar to the Toe Tapping exercise, but instead, the patient will lift their feet a bit and repeatedly tap the ground with their whole feet. They will do this one foot at a time.

For this guide, we will discuss all five of these because you want to cover as much ground as possible before diagnosing your patient with Parkinson’s Disease.

How to perform the Bradykinesia Test exercises

So that you know, we created a Bradykinesia Test template. We will show you this template in the next section.

Before conducting these exercises, you must prepare two comfortable chairs with backrests. Your patient will be seated for all exercises, and you will be seated beside them with you facing their side (or in front, if you prefer) to observe their movements. Once you’re both seated, you can begin conducting the exercises.

1. Finger Tapping Exercise

For this part of the Bradykinesia Test, you will simply have your patient tap their thumb and index finger repeatedly and as fast as possible.

Before they tap both fingers, they need to make sure that they can separate their thumb and index finger as far as possible before tapping them together.

They must do this with both hands, one at a time, for at least ten seconds each.

While the patient performs this exercise, you will need to observe how fast they can tap their fingers, how wide they can separate both fingers before each tap, if they slow down, or if they stop before the ten seconds are up.

2. Hand Grip Exercise

For this exercise, the patient won’t grip anything, despite being called the Hand Grip Exercise. All they need to do for this test is open and close their fists repeatedly and as fast as possible. Before they close their fists, the patient must spread their fingers as wide as possible. They will do this with both hands, one at a time, for at least ten seconds each.

While they perform this exercise, you will observe how fast they can do it, how wide they can spread their fingers, if they slow down, and if they stop before the ten seconds are up.

3. Hand Pronation/Supination Exercise

For this exercise, instruct your patient to flex their shoulder forward by 90 degrees and have them straighten their arm forward. Next, while maintaining the extension of their arm, they will pronate and supinate their hands repeatedly and as fast as possible. They will do this for both hands, one at a time, for at least ten seconds each.

While they perform this exercise, you will observe how fast they can alternate between the two positions, if they can fully pronate and supinate their hands or only partially. if they slow down at any point, and if they stop before the ten seconds are up.

4. Toe Tapping Exercise

For this part of the Bradykinesia Test, you will instruct your patient to plant both feet on the floor. They will do this exercise with both feet, one at a time, for at least ten seconds each.

While their foot is planted on the floor, they will raise their toes while keeping their heel on the floor. Then, they will repeatedly tap their toes on the floor. To give you an idea of how that should look, imagine a drummer tapping the kick pad for the bass drum, but their toes need to hit the floor.

While they perform this exercise, you need to check if they can do it fast, if their speed drops over the course of ten seconds, and if they stop before the ten seconds are up.

5. Heel Tapping Exercise

This is the last part of the Bradykinesia Test. For this exercise, the patient must tap their whole foot on the ground. They only need to raise their foot slightly, then stomp (but gently). They need to repeatedly tap the floor using their whole foot for at least ten seconds. This exercise must be done for both feet, one at a time.

While they perform this exercise, you need to check if they can do it fast, if their speed drops over time, and if they stop before the ten seconds are up.

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If they perform these exercises slowly or if they slow down while doing the exercises, they are likely to have Bradykinesia, which means they are also likely to have Parkinson’s Disease. However, the Bradykinesia Test should not be used as the sole assessment to confirm it. Before diagnosing a patient, you must check other factors like rigidity, gait abnormalities, balance abnormalities, and tremors. Please assess the patient for those before conducting tests like DAT Scans and SPECT Scans.

When is it best to conduct a Bradykinesia Test?

Before conducting the Bradykinesia Test on a patient, you must determine if the patient is eligible to undergo Parkinson’s Disease-related tests. To deem them eligible, they need to have the following symptoms:

• Bradykinesia (the slowness of movement), which is what this test is for
• If they are struggling to balance themselves
• If there are tremors in their limbs even while at rest
• If their arms, legs, and/or trunk are showing signs of rigidity

If your patient seems to be moving slowly, that’s the best time to whip out a copy of our Bradykinesia Test template and conduct the exercises.

Do note that this test should be included as part of a comprehensive examination. These exercises should not be the only ones you’ll conduct because they won’t give you the full picture of the patient. Any person can have sluggish movements, especially the elderly.

After conducting these exercises and recording your observations, the next step is to conduct other tests that account for the other signs of Parkinson’s Disease. That way, you’ll get better results before conducting scans. There might be a chance that you might misdiagnose your patient for Parkinson’s Disease, so it’s best to be thorough to avoid that from happening.

The research conducted by N.P.S. Bajaj et al. (Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study. J Neurol Neurosurg Psychiatry, 81(11):1223–1228, Nov 2010) and C.B. Levine et al. (Diagnosis and treatment of Parkinson’s disease: a systematic review of the literature. Evid Rep Technol Assess (Summ), (57):1–4, May 2003), discuss that the rate of misdiagnosis, even among experienced neurologists, is twenty-five percent. That’s why it’s best to cover as much ground as possible before making a diagnosis.

What are the benefits of the Bradykinesia Test?

The exercises are easy to conduct and don’t require much.

All five exercises of the Bradykinesia Test don’t require special equipment. You just need two chairs and a stopwatch, then you’re all set to conduct the exercises! You don’t even have to do much other than demonstrate the instructions to the patient, observe the patient as they perform each exercise, and record your findings. That’s it!

There might be difficulty, but this will be on the part of the patient. If they have Parkinson’s Disease, they will likely have trouble moving their limbs, and their movements will likely be sluggish.

It can account for patients with arthritis.

Patients with arthritis will likely not be able to perform the Finger Tapping exercise of the Bradykinesia Test. This is because arthritis will affect a patient’s ability to tap their fingers repeatedly and at a fast pace, so if they perform the exercise, it will not produce the ideal results.

That’s where the other exercises come in! The other four exercises can still detect signs of Bradykinesia, and the Hand Grip and Hand Pronation/Supination exercises are more than enough to check for Bradykinesia in the hands. Even if the Finger Tapping exercise is taken out of the equation, you still have four exercises that will produce valuable results.

The exercises can be used to monitor patients later on.

Parkinson’s Disease can’t be cured, but it can become manageable! Treatments can involve medication, physical therapy, and even surgery, though the last one should be the last resort because it involves operating on the brain.

Now, let’s stipulate that your team has developed and implemented a treatment plan for your patient, which involves medication and physical therapy. As part of the team handling the patient, you’d want to know how your patient is doing and whether your treatment plan is working.

You can schedule routine check-ups with them and conduct all the exercises of the Bradykinesia Test to see if their movements are not as sluggish as before. If their movements are faster, even slightly, then it’s safe to say that your patient is improving and your treatment plan is working. If they are not getting any better, then you and your team might want to adjust your plan and see if the adjustments will do the trick.