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Parkinsonism, 巴病分期(Hoehn&Yahr stage), Spasticity vs Rigidity …

- - - - Apomorphine
      - 左多巴(Levodopa)
        high-dose levodopa therapy (>1000 mg daily)
        若是病人對levodopa反應不佳，較可能是其他parkinsonism
    - - Motor parkinsonism
        
        Bradykinesia
        
        RAM test
        Finger tapping test(most sensitivity) 指示要做快做大，觀察有無越變越慢，越變越小
        Fist open close
        Pronation/Supination
        Toe tapping(more sensitivity)
        Heal tapping
        
        [Muscle Tone] Rigidity
        
        Circle wrist maneuver
        Activation maneuver if under medication(tap hand)
        最嚴重可到lead pipe rigidity，但大部分很輕微或有服藥看不來，
        一定要請病人盡全力放鬆，測試no limitation of ROM
        特殊類型的Rigidity : Tremor w/ in Rigidity called cogwheel rigidity
        
        Tremor
        [放鬆Tremor]在見到病人當下就開始觀察
        將肢體放在不出立的狀態，否則可透過收縮肌肉抑制tremor
        [Posture tremor]
        [Action (kinetic) tremor] FNF 請病人手伸到最直
        
        Gait & Balance / Postural instability
        直到PD的晚期才會出現，疾病早期出現考慮其他parkinsonism