Parkinson's Disease and Movement Disorders

Common types and symptoms of movement disorders include:

• Ataxia, which is characterized by poor coordination of the arms or legs due to damage to the nervous system.
• Chorea (uncontrolled movements) and dyskinesias, which lead to abnormal writhing type of movements of the face, mouth, jaw, neck, trunk or arms/legs. These may be caused by certain medications or due to underlying brain damage.
• Tourette syndrome, a tic disorder which produces involuntary movements or vocalizations.
• Dystonia, which is a condition associated with slow and involuntary movement of large muscle groups, often in a twisting manner. It most often affects physical control of the head, neck, arms or torso.
• Essential tremor, which involves involuntary shaking movements of the arms. In more severe cases, it may affect the head and voice. 
• Huntington’s disease, which is a genetic condition that leads to degeneration of nerve cells, which can trigger uncontrolled movements (chorea), cognitive issues and often psychiatric or emotional disturbances.
• Parkinson’s disease, which is caused by the loss of dopamine cells in the brain that help control movement and coordination, leading to involuntary shaking, slowness, stiffness, and difficulty walking and moving.
• Myoclonus, which is characterized by a brief uncontrollable jerking of a muscle or muscle group followed by relaxation.
• Restless leg syndrome (RLS), in which patients have a sense of discomfort or restlessness in the legs that is improved with movement.

To diagnose movement disorders, Scripps neurologists perform comprehensive neurological exams and review symptoms and medical histories.

In some cases, the movement disorders specialist also may order appropriate diagnostic tests, including:

• Magnetic resonance imaging (MRI)
• Dopamine transport scans (DAT)
• Genetic tests

The most common symptoms of Parkinson’s disease include:

• Tremor or shaking 
• Stiffness
• Rigid muscles
• Difficulty walking or moving normally
• Speech problems 

Parkinson’s disease symptoms can vary greatly from person to person, depending on the individual and how far the disease has advanced. According to the Parkinson’s Foundation, there are five stages of Parkinson’s disease progression.

Stage One

The person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions are noticeable.

Stage Two

Symptoms begin to worsen. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture are apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.

Stage Three

Loss of balance and slowness of movements mark this stage, and falls are more common. The person is still fully independent, but symptoms significantly impair self-care activities.

Stage Four

Symptoms are severe and limiting. Standing unassisted is possible, but moving may require a walker. The person needs help with activities of daily living and is unable to live alone.

Stage Five

At the most advanced stage, stiffness may make standing or walking impossible, and the person needs a wheelchair or is bedridden. Around-the-clock nursing care is required for all activities. Hallucinations and delusions may be common.

The Parkinson’s Disease and Movement Disorder Center at Scripps Clinic is home to a team of experts who have dedicated their careers to providing patients with the best therapeutic options, as well as access to rehabilitation services at several locations across San Diego County. 

Scripps Clinic offers patients being treated for Parkinson’s disease and other movement disorders a full spectrum of care and services, including:

• Integrative medicine
• Nutritional specialists
• Supplement pharmacists
• Exercise physiologists who specialize in Parkinson’s disease rehabilitation 
• Multiple exercise programs specifically designed for Parkinson’s patients
• Speech therapists who specialize in voice treatment (LSVT LOUD) 
• Physical therapists teaching LSVT BIG program

Because speech and voice disorders are common in those with Parkinson’s disease, speech language pathologists at several Scripps locations specialize in Lee Silverman Voice Treatment (LSVT) LOUD — an evidence-based training technique that focuses on improving voice quality, articulation and vocal intensity.

LSVT LOUD improves vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a series of exercises. The goal of treatment is to bring the voice to an improved, healthy volume level with no strain, so patients participate in conversations and have greater confidence in social settings.

We also offer a LSVT LOUD maintenance class for people who have completed the initial LSVT LOUD protocol. Visit our page on rehabilitation classes to learn more about the maintenance class. 

To simultaneously treat the unique movement impairments caused by Parkinson’s disease, physical therapists at several Scripps locations also offer LSVT BIG. Using core movements and other exercises, the training focuses on improving speed, trunk rotation, gait and balance.

Scripps offers the LSVT BIG program on an outpatient basis. A referral from a primary care physician or specialist is required.

We also offer a LSVT BIG maintenance class for people who have completed the initial LSVT BIG protocol. Visit our page on rehabilitation classes to learn more about the maintenance class.

The Parkinson’s Disease and Movement Disorder Center at Scripps Clinic offers “Parkinson’s Boot Camps” twice a year. These daylong seminars include Parkinson’s education and exercise training. 

Scripps Clinic deep brain stimulation (DBS) experts also participate in semi-annual hosted picnics in San Diego County that bring together DBS patients and those who may be considering DBS as a treatment option.

Check our events page for upcoming boot camps, seminars and other events.

Scripps hosts a weekly exercise group for people with Parkinson’s disease or stroke. The free class offers you a safe exercise program that supports the physical activity prescribed by your physician. Participants must be assisted by their caregiver. Learn more or register for the exercise group or rehab class.