It's a core symptom of Parkinson's disease that can affect your voluntary and automatic or repetitive movements. Your movements get slower, and you may find it harder to do everyday tasks, or tasks may take longer to complete. While everyone is different, bradykinesia is "pretty much present in all patients [with Parkinson's]," says Joohi Jimenez-Shahed, MD. She's the medical director of Movement Disorders Neuromodulation and Brain Circuit Therapeutics at Mount Sinai West in New York City.
When you have Parkinson's with bradykinesia, you may blink less. Your arms may not swing when you walk. Or you may stop sometimes in the middle of a movement. Clapping or tapping your hands may be hard to do. Your feet may shuffle when you walk. You may also have trouble with facial expressions that show how you're feeling. Bradykinesia is one of the many features of Parkinson's disease related to changes in how you move.
"Bradykinesia is often accompanied by tremor or rigidity, which combined together contribute to motor difficulties in this condition," Jiminez-Shahed explains.
While bradykinesia is a major symptom of Parkinson's disease, other conditions can also cause it. It also can be influenced by your energy levels and motivation. If you notice signs of bradykinesia or think your movements are slowing down and don't know why, talk to your doctor about it.
Bradykinesia vs. hypokinesia vs. akinesia
While bradykinesia is slowed movement, akinesia is the inability to start moving. Hypokinesia is a decrease in movement and the opposite of hyperkinesia, or excess movement.
Doctors and other experts have used these words in different ways over time to describe changes in movement when you have Parkinson's disease or parkinsonism. All of them can be grouped under the umbrella term of "bradykinesia" or the "bradykinesia complex."
Bradykinesia Symptoms
Signs of bradykinesia can show up with any of your body movements. It can affect your whole body, one side of your body, or just one body part. You may feel stiff or weak. But it's possible to have bradykinesia without knowing it.
Bradykinesia may make you perform movements more slowly as you continue doing them. For example, you may notice:
Sequence effect. As you walk, your steps may get slower and closer together. This is called the sequence effect.
Freezing. For instance, when your gait freezes, you feel like you want to walk, but you can't move your feet forward. This effect can be brief and happen in short episodes. Unfortunately, it can lead you to fall, making it one of the worst movement disorders of Parkinson's disease or parkinsonism.
Masked face. Facial bradykinesia happens when you are slower to make facial expressions. Facial expressions are also reduced when you make them. This can happen with voluntary and involuntary facial expressions.
Small handwriting. You may get micrographia, where you write in small, cramped handwriting. Your handwriting may also get smaller as you continue to write. This is often an early symptom of Parkinson's disease or parkinsonism.
Other signs of bradykinesia may include:
- Not being able to cross or fold your arms or legs
- Not swinging your arms when you walk
- Having trouble standing up or taking longer to stand up
- Having trouble rolling over when you're in bed
- Having trouble clapping or tapping
- Shuffling when you walk
- Having trouble with fine motor skills you need to hold a pen, write, or do many such everyday tasks
Bradykinesia Causes
"Bradykinesia results from the loss of dopamine-producing neurons in the [brain's] substantia nigra, which is a hallmark of Parkinson's disease," Jiminez-Shahed says. "When there is less dopamine, movements become slow and less coordinated."
Dopamine is a neurotransmitter, which helps your nerve cells communicate. It plays an important role in your movements, among other functions.
Though Parkinson's disease is a main cause of bradykinesia, it can also be a symptom of other disorders.
Other causes of parkinsonism with bradykinesia may include:
- Antipsychotic medicines that block dopamine action
- Medications such as metoclopramide and prochlorperazine
- Lewy body dementia
- Progressive supranuclear palsy
- Head injury (especially repeated head injuries)
- Toxins, such as carbon monoxide and methanol
- Brain tumors
- Strokes
- Alzheimer's disease (a type of dementia with symptoms of mental decline)
- Other degenerative diseases
- Viral encephalitis (inflammation of brain tissue)
- Wilson's disease (buildup of copper in the brain, liver, and other organs)
Bradykinesia Test and Diagnosis
Your doctor can assess and measure your bradykinesia using the Unified Parkinson's Disease Rating Scale. It's a tool used to diagnose Parkinson's and measure it's severity and progression over time.
"There are specific items on this scale designated to assess bradykinesia in the arms and legs," Jiminez-Shahed says.
You'll be asked to do three tasks using your fingers, hands, and arms. These include:
- Finger tapping
- Hand grips
- Hand pronation-supination, or rotating your hands and forearms in different ways
To test your legs, you'll be asked to do heel and toe taps.
"Each task is performed in 10 repetitions — for example, tapping the thumb to index finger 10 times — while observing the speed, amplitude, and regularity of the movement," Jimenez-Shahed says.
Bradykinesia Treatment Options
Parkinson's disease has no cure, but treatments can help control your symptoms, including bradykinesia. These can include medications, therapy, and a procedure called deep brain stimulation (DBS). In DBS, electrodes are implanted in your brain and connected to a generator in your chest. This way, electrical pulses are sent to your brain, easing your symptoms.
"Bradykinesia generally responds to dopaminergic medications, including levodopa, which replaces brain dopamine, and dopamine agonists, which stimulate dopamine receptors," Jiminez-Shahed says. "Other medications that prolong the effect of dopamine may also help, as well as amantadine. Physical therapy and exercise can also improve bradykinesia."
The best treatment for your bradykinesia will depend on the underlying disorder or cause. If it's caused by medication, it may be cured when you stop taking the drug.
Living With Bradykinesia: Tips and Support
Braykinesia can make everyday tasks harder for you to do. For example, you may have trouble:
- Getting dressed
- Brushing your teeth or hair
- Using utensils (such as a spoon, fork, or knife) to eat or cut food
- Walking or standing
Everyone is different, and the way your bradykinesia affects you will be unique. Let your doctor or other members of your care team know about the specific challenges you're facing. They may be able to offer advice or refer you to another professional who can help.
"An individualized regimen and dose of Parkinson's disease medications in combination with exercise/PT are the best way to manage bradykinesia," Jiminez-Shahed says.
Other tips by Jiminez-Shahed include:
- Paying special attention to staying active
- Getting plenty of rest
- Timing your medications well
Jiminez-Shahed suggests adjusting your schedule so you're most active during times when your medications are most effective and you're feeling your best. Give yourself enough time to avoid stress, and take regular breaks throughout the day. Some changes to your environment or habits also can help when you have bradykinesia. These include using:
- Clothing with snaps or other simple closures instead of buttons
- Slip on shoes
- Raised seat cushions or toilet seats
Some lifestyle changes may relieve the symptoms of both Parkinson's disease and parkinsonism, including bradykinesia. These modifications may include:
Exercise. Exercise can help improve your balance and flexibility in addition to making you stronger. Exercise also offers emotional benefits, such as helping with anxiety and depression.
Choose an exercise that you enjoy, such as swimming, gardening, or dancing. It may also help to work with a physical therapist to find the best exercise program for you.
Occupational therapy. An occupational therapist may be able to help you with techniques that make your activities of daily living (ADL) easier. This includes activities such as dressing, bathing, and eating.
Healthy diet. There is no specific diet for bradykinesia, but your slowed movement can lead to constipation. Eating food that is high in fiber can help. Food that is high in omega-3 fatty acids may also be good for people with bradykinesia.
Avoiding falls. As your bradykinesia worsens, you may be more prone to losing your balance and falling. Here are some things you can do to help avoid falling:
- Make your home safer by removing clutter and installing bright lighting.
- Use nonskid surfaces and grab bars in the bathroom.
- Wear supportive shoes.
- Arrange furniture close together so it can be touched while walking but doesn't get in the way.
- Use canes or walkers when they are needed.
- Lower the bed to make it easier to get up.
Can Bradykinesia Be Prevented?
No, but treatment can help. It's possible with treatment you may not notice your bradykinesia, especially if you're in an earlier stage of Parkinson's disease. But there's no way to prevent it or stop it from getting worse as the disease advances to later stages.
"Bradykinesia is controlled — and may even be absent — with optimal medications and exercise, but its severity generally worsens over time," Jimenez-Shahed says. "Higher doses or combinations of treatments are needed to optimally control its various manifestations."
Takeaways
Bradykinesia is a symptom of Parkinson's disease in which your movements slow down. Along with other changes to your movement related to a decline in dopamine levels, it can make everyday tasks difficult. Bradykinesia usually gets worse over time as your Parkinson's disease progresses, but treatment and other life strategies can help you maintain your independence for as long as possible. If you're struggling with bradykinesia, talk to your care team about whether it's time to adjust your medications or if you may benefit from seeing a physical or occupational therapist.
Bradykinesia FAQs
What are the first signs of bradykinesia?
Everyone is different, so the signs may vary. But early signs may include taking longer to stand up, struggling to show your emotions, shuffling when you walk, or trouble holding small objects such as a pen.
At what age does bradykinesia start?
It's a hallmark symptom of Parkinson's disease, which is most often diagnosed after age 60. But bradykinesia can also happen at younger ages.
Which condition is most likely to cause bradykinesia?
Bradykinesia is most often linked to Parkinson's disease. But medications or other conditions can also cause it.
Are bradykinesia and hypokinesia the same?
No, but people sometimes use the terms interchangeably. They may also go together. Bradykinesia refers to slowed movements. Hypokinesia means you're moving less. Hypokinesia can occur as part of bradykinesia. As your movements slow, you may start to move less.
Can bradykinesia be reversed?
No. There's no way to reverse bradykinesia. But medicines can help you control it.
What does bradykinesia feel like?
Bradykinesia may feel different to you from how it feels to someone else. Many people report changes in writing or the ability to use eating utensils. It may be hard to cut meat with a knife. Rotational movements may also be hard. For instance, you may have a hard time shampooing your hair. Typing may feel less fluid. It may also feel like it takes more effort to do regular tasks.
