Parkinsonism,
explained.

Three explained cases for nurses caring for people with Parkinsonism.

Understand the terms first

Separate the disease from its presentation: Clinical parkinsonism requires bradykinesia plus rest tremor or rigidity; Parkinson's disease is one possible cause. Tremor-prominent and gait-prominent presentations describe PD features that can change over time.
Sources[1][2][3]
Slowness means more than walking slowly: Assessment of bradykinesia includes slow movement with decreasing amplitude or speed, or progressive hesitations during repetition. Pain and joint problems also need consideration.
Sources[1][13]
Rigidity requires an examination: Rigidity is assessed through passive joint movement. A bent posture, facial expression or animated figure cannot demonstrate it on its own.
Sources[1][13]

A tremor at rest.

Established PD with prominent tremor

Mr Chan, 68. Fictional case.

His right hand has gradually slowed over two years, making buttons and writing harder. A specialist has diagnosed PD. Today, the relaxed, supported right hand trembles; the tremor briefly reduces when he reaches for an object.

A supported hand: AI illustration

AI-generated fictional dramatization. Not a real patient or a diagnostic test.

A close-up of a supported hand making repeated small movements.

This AI clip is not a clinically validated example of rest tremor. In the fictional case, PD is already diagnosed. Use the annotated diagram and official examination video to study the movement signs.

Official examination demonstration

Annotated movement diagram

Optional 30-second demonstration

The complete observations and nursing explanation are written alongside.

Programmed teaching illustration, not patient footage or a diagnostic test.

When does the tremor appear?: Observe the relaxed, supported limb, then record what changes during reaching or holding an object.
What changes with repetition?: In this case, right finger taps are slow and progressively smaller. Slowness alone does not complete the assessment.
Connect the movement to the history: Symptoms began on the right, and the clinical record documents rigidity. The animation cannot confirm rigidity.

What the pattern suggests

Tremor is currently prominent in someone with established PD. This describes his presentation; hand tremor alone cannot diagnose a new patient or formally assign a motor subtype.

How does essential tremor differ?

Essential tremor typically affects both upper limbs during action. PD can also cause action tremor, and PD can occur without tremor. Consider bradykinesia, the examination and the timeline together.

Nursing priorities

Document the activity, affected side, functional impact and relationship to medication timing.
Check the individual's prescribed medication times. Do not delay doses to fit routine drug rounds, or independently stop or change treatment.
Report new or substantially changed symptoms for assessment by the clinical team.

Handover example

Right-hand tremor is present when relaxed and supported; repeated finger taps become smaller. Record the observation time, last medication dose and changes in tasks such as fastening buttons.

Sources[1][2][3][5][4][13]

When the next step stops.

Established PD with prominent gait difficulty and freezing

Ms Ho, 73. Fictional case.

She was diagnosed with PD seven years ago, initially with right-hand slowness and rigidity. Over the past year, starting, turning and passing through narrow doorways have become harder. At times, she wants to walk but briefly cannot take the next step.

Walking beside a handrail

AI-generated fictional dramatization. Not a real patient or a diagnostic test.

A woman takes a few steps beside a handrail, then stands, with a nurse nearby.

Freezing episodes belong to the fictional case history. This AI scene does not demonstrate why she stops or provide a validated example of freezing. Refer to the lesson, diagram and official guidance.

Official freezing guidance

Annotated movement diagram

Optional 30-second demonstration

The complete observations and nursing explanation are written alongside.

Programmed teaching illustration, not patient footage or a diagnostic test.

Describe the gait, not just the slowness: In this case, steps are short and turning takes several steps. Record the assistance needed and any falls.
Identify the freezing situation: Starting, turning and narrow doorways are useful contexts to document. Freezing is a brief difficulty initiating or continuing steps.
Check the course and medication timing: Gait problems became prominent after years of PD. Record medication timing, fatigue and distraction; do not automatically label every freeze as wearing-off.

What the pattern suggests

Gait and postural difficulties are now prominent in someone with established PD. This is not a separate, permanent type of PD or a disease stage that can be assigned from an animation.

Freezing is not unique to PD

Freezing can occur at different stages of PD and in other disorders, including PSP. Freezing and wearing-off can be related, but they are not the same phenomenon.

Nursing priorities

First support safe standing, assistance and a clear space. Do not pull the person forward.
Use assessed visual or rhythmic cues according to the individual's physiotherapy or rehabilitation plan. Arrange review of gait, transfers and walking aids.
Record the trigger, episode, falls and medication timing to inform the care plan.

Handover example

Brief stepping blocks occur when turning and near narrow doorways. Record the assessed level of assistance needed, the trigger, medication timing and whether the prescribed cueing strategy helped.

Sources[3][4][9][14][6]

Falls early in the story.

A pattern that warrants assessment for PSP

Ms Lam, 70. Fictional case.

Within three years of symptom onset, she has had repeated unexplained falls. A specialist examination documents slow vertical saccades. Recently, she has coughed when drinking and developed a wet-sounding voice after meals.

A seated consultation

AI-generated fictional dramatization. Not a real patient or a diagnostic test.

A woman gestures during a seated conversation with a nurse holding a clipboard.

Falls, swallowing concerns and specialist eye findings belong to the fictional history; none is demonstrated here. This AI conversation scene does not establish a PSP diagnosis.

Specialist diagnostic criteria

Annotated movement diagram

Optional 30-second demonstration

The complete observations and nursing explanation are written alongside.

Programmed teaching illustration, not patient footage or a diagnostic test.

Establish the falls timeline: The clue is repeated unprovoked falls within the first three years, rather than one accidental trip.
Read the formal eye examination: Vertical saccades are rapid gaze shifts between upper and lower targets. Slowing is documented by a specialist here; arrows or tracking animations cannot confirm it.
Act on swallowing concerns: Coughing with drinks and a wet voice after meals warrant swallowing assessment. These signs are not specific to PSP.

What the pattern suggests

Early recurrent falls combined with vertical eye-movement abnormalities warrant specialist assessment for progressive supranuclear palsy (PSP). PSP is not a PD motor subtype, and these clues alone do not establish the diagnosis.

A characteristic combination, not every presentation

PSP has several presentations, and obvious eye-movement abnormalities may be absent early. Do not perform a shoulder-pull test on a person at high risk of falls simply to reproduce the illustration.

Nursing priorities

Arrange fall prevention and transfer assistance. Report the symptom course, falls history and formal eye findings clearly.
If swallowing is unsafe, stop the current feed, assess breathing and follow local procedures for medical and swallowing assessment. Do not repeatedly offer water to test swallowing.
Swallowing problems can interrupt essential medication. Promptly involve the prescriber and pharmacist in an administration plan; do not independently crush all medicines.

Handover example

Repeated falls occurred within three years of symptom onset; the specialist record notes slow vertical saccades. New coughing with drinks and a wet voice have been escalated under the swallowing-safety procedure.

Sources[6][10][4]

Quick comparison

A guide to organising observations, not a complete differential diagnosis or diagnostic tool.

Pattern	Features to consider	Keep in mind
Parkinson's disease (PD)	Bradykinesia plus rest tremor or rigidity establishes parkinsonism. A specialist then considers the history, exclusions and supportive features to determine whether the cause is PD.	The balance of tremor and gait problems can change. The presence or absence of hand tremor alone cannot classify the condition.
Essential tremor (ET)	Typically bilateral upper-limb action tremor. The MDS classification requires at least three years and no other established neurological signs.	ET is not a PD subtype. PD can also cause action tremor, so rest versus action is not an absolute dividing line.
Progressive supranuclear palsy (PSP)	Early recurrent unprovoked falls with slow vertical saccades or other vertical eye-movement abnormalities warrant specialist assessment.	Some PSP presentations lack this early characteristic combination. One fall or eye finding cannot establish a diagnosis.
Multiple system atrophy (MSA)	Prominent autonomic problems, such as urinary dysfunction or orthostatic hypotension, alongside parkinsonism or cerebellar signs need assessment.	PD, medicines and dehydration can cause similar problems. A single low blood-pressure reading cannot diagnose MSA.
Drug-induced parkinsonism	Check the timing of symptoms against newly started or increased medicines, including some dopamine-receptor blockers.	The presentation can also be asymmetric. Refer to the prescriber rather than independently stopping medicines abruptly.

Three checks before handover

Time-sensitive medication
Give medicines at individually prescribed times. If oral doses cannot be taken or may be missed, involve the prescriber and pharmacist early.
Mobility and swallowing safety
Arrange movement assistance according to the individual assessment. Coughing during meals, wet voice or other swallowing concerns need timely assessment.
A sudden change today
Breathing difficulty, acute altered awareness or sudden new focal neurological symptoms need immediate assessment and help under local emergency procedures.

Sources and clinical boundaries

A single sign or animation cannot establish a diagnosis. This material has not received clinical sign-off in Hong Kong. Follow individual prescriptions and your institution's assessment and escalation procedures.

Source check: 12 November 2026

See real examination demonstrations

These official resources open online. They are additional to the complete written lesson.

Stanford Medicine 25: Parkinson's disease examination
Watch a real-person examination demonstration, focusing on decrement during repetitive finger movements and rest tremor.
The video includes examinations requiring training. Do not independently perform a shoulder-pull test on a person at high risk of falls. Use MDS criteria and specialist assessment for diagnosis.

Parkinson's UK: Freezing and cueing strategies
The official page links to a video about cues such as a metronome and floor strips. Read it alongside an individual rehabilitation assessment.
Cueing needs individual assessment. A public demonstration is not a universal walking prescription.

讀懂病徵，
理解柏金遜症。

為香港護士而設，從三個案例理解觀察重點與護理行動。

開始閱讀

先理解三個用語

先分清病與表現: 臨床柏金遜症候群需要動作遲緩，加靜止震顫或僵硬；柏金遜病只是其中一種病因。震顫突出與步態突出是PD的表現描述，可能隨時間改變。
資料來源[1][2][3]
慢，不只是走得慢: 動作遲緩的評估包括動作慢，以及重複動作時幅度或速度遞減、或逐漸停頓；疼痛及關節問題也要納入評估。
資料來源[1][13]
僵硬需要檢查: 肌強直／僵硬需透過被動關節活動評估；不能從彎腰、表情或示意人物姿勢直接判斷。
資料來源[1][13]

手放鬆時，震顫出現。

已確診PD：震顫較突出的表現

陳先生，68歲，虛構個案

兩年來右手逐漸變慢，扣鈕及寫字較吃力，已由專科確診PD。今日右手放鬆承托時有震顫，伸手取物時暫時減輕。

承托手部的 AI 情境示意

AI 生成的虛構情境演示，並非真實病人或診斷測試。

近鏡顯示獲承托的手部做出重複小動作。

這段 AI 影片並非經臨床驗證的靜止震顫示範。虛構病例已有柏金遜病診斷；病徵教學請配合註解圖解及官方臨床檢查影片。

官方臨床檢查示範

附註解動作示意

可選擇播放 30 秒示範

完整觀察重點與護理解說已列在旁邊。

程式化教學示意，並非真實患者影像或診斷測試。

甚麼時候震: 在肢體放鬆、獲承托時觀察靜止震顫，再記錄伸手或持物時的變化。
重複動作有何變化: 本例右手重複指敲既慢，幅度亦逐漸縮小；單純動作慢仍不足以完成判斷。
把畫面接回病史: 病徵由右側開始，病歷亦記錄僵硬；僵硬並非由動畫外觀確認。

這些線索提示甚麼

在已確診PD的背景下，這次以震顫較突出。這是目前的運動表現描述，不能只憑手震替新病人確診或正式分型。

與原發性震顫怎樣分開想

原發性震顫通常以雙上肢動作性震顫為主。但PD也可有動作性震顫，沒有震顫亦不能排除PD；需要連同動作遲緩、檢查及時間線判斷。

護理重點

記錄震顫出現時的動作、左右側、日常功能及與服藥時間的關係。
核對個別處方給藥時間；不能為配合病房派藥輪次而延誤，亦不可自行突然停藥或改量。
把新出現或明顯改變的症狀交予醫療團隊評估。

交更例句

右手在承托放鬆時有震顫，重複指敲幅度縮小；記錄觀察時間、最近一次給藥及扣鈕等功能變化。

資料來源[1][2][3][5][4][13]

想向前走，雙腳卻停住。

已確診PD：步態與凍結較突出

何女士，73歲，虛構個案

已確診PD七年，早年主要是右手慢和僵硬。近一年起步、轉身及通過窄門較困難，有時想走卻短暫踏不出下一步。

扶手旁的行走情境

AI 生成的虛構情境演示，並非真實病人或診斷測試。

一名女士在扶手旁走了幾步，然後站立，旁邊有護士陪同。

凍結步態發作屬於虛構病史。這段 AI 情境沒有呈現她停止行走的原因，也不是經驗證的凍結步態示範。請配合課文、圖解及官方教學閱讀。

官方凍結步態教學

附註解動作示意

可選擇播放 30 秒示範

完整觀察重點與護理解說已列在旁邊。

程式化教學示意，並非真實患者影像或診斷測試。

記錄步態，不只記錄慢: 本例步幅短，轉身需要多步；記錄是否需協助及有否跌倒。
找出凍結情境: 起步、轉身及窄門附近都是值得記錄的觸發情境；凍結是短暫踏步困難。
核對病程與用藥時序: 這次步態問題在多年PD後較突出；記錄服藥、疲倦及分心等背景，不自行等同藥效消退。

這些線索提示甚麼

在已確診PD的背景下，步態及姿勢問題現在較突出；這不是另一種固定不變的PD，也不是單靠動畫可判定的病程分期。

凍結不等於只有PD

凍結可在PD不同階段出現，也可見於PSP等疾病。凍結與藥效消退可有關聯，但兩者不能直接畫上等號。

護理重點

先確保病人站穩、有協助及有安全空間；不要用力拉扯病人向前走。
按個別物理治療／復康計劃使用已評估的節奏或視覺提示，並安排步態、轉移及助行器評估。
記錄觸發位置、持續情況、跌倒及用藥時間，供團隊調整照護計劃。

交更例句

轉身及窄門前有短暫踏步困難；記錄評估後所需協助程度、當次誘因、給藥時序及所用提示是否有效。

資料來源[3][4][9][14][6]

病程早期便反覆跌倒。

需要考慮PSP的提示模式

林女士，70歲，虛構個案

病徵開始不足三年，已反覆無明顯誘因跌倒。專科檢查記錄垂直掃視變慢；最近喝水會咳嗽，餐後聲音變得濕濁。

坐下交談的問診情境

AI 生成的虛構情境演示，並非真實病人或診斷測試。

一名女士坐著與持有寫字板的護士交談，期間做出手勢。

跌倒、吞嚥問題及專科眼動檢查所見均屬於虛構病史，影片沒有示範這些徵象。這段 AI 交談情境不能確立 PSP 診斷。

專科診斷準則

附註解動作示意

可選擇播放 30 秒示範

完整觀察重點與護理解說已列在旁邊。

程式化教學示意，並非真實患者影像或診斷測試。

先問跌倒時間線: 重點是起病首三年內已反覆無誘因跌倒，而非一次失足就判定病因。
閱讀正式眼動檢查: 垂直掃視是視線在上下目標間快速轉移；本例由專科記錄變慢，不能靠方向箭頭或追視動畫確認。
及早處理吞嚥警號: 飲水咳嗽及餐後濕聲提示需要吞嚥評估；這些表現並非PSP專有。

這些線索提示甚麼

早期反覆跌倒合併垂直眼動異常，需要考慮進行性核上性麻痺（PSP）並由專科評估。PSP不是PD的運動表型，亦不能由這幾項線索直接確診。

典型組合，不等於所有患者

PSP有不同表現，早期未必已有明顯眼動異常。不要為重現動畫而自行對高跌倒風險病人做拉肩測試。

護理重點

安排防跌及轉移協助，把病程、跌倒次數和正式眼動結果清楚上報。
出現不安全吞嚥時停止當次餵食，評估呼吸並依本院程序安排醫療及吞嚥評估；不要反覆試飲清水。
吞嚥受限會影響必要藥物；及早與處方者及藥劑師協調給藥方案，不自行磨碎所有藥物。

交更例句

病徵不足三年已反覆跌倒，專科記錄垂直掃視慢；今日新增飲水咳嗽及濕聲，已按吞嚥安全程序升級評估。

資料來源[6][10][4]

重點比較

這是整理觀察的簡表，並非完整鑑別診斷或診斷工具。

模式	值得觀察的線索	不要忽略的限制
柏金遜病（PD）	動作遲緩加靜止震顫或僵硬構成柏金遜症候群；專科再結合病史、排除條件及支持線索判斷是否PD。	震顫與步態問題的相對程度會改變；不能只靠有沒有手震分類。
原發性震顫（ET）	典型是雙上肢動作性震顫；MDS分類要求至少三年，且無其他確立的神經體徵。	ET不是PD子型；PD也可能在動作時震，不能用休息／動作震顫作絕對二分。
進行性核上性麻痺（PSP）	早期反覆無誘因跌倒，加垂直掃視變慢或其他垂直眼動異常，值得專科評估。	不同PSP表現可沒有這個早期典型組合；單一跌倒或眼動線索不能確診。
多系統萎縮症（MSA）	明顯自主神經問題如排尿障礙、體位性低血壓，連同柏金遜症候群或小腦徵象，需要評估。	PD、藥物或脫水也可造成相關問題，單次低血壓不能確診MSA。
藥物誘發柏金遜症候群	核對相關藥物新增或加量與症狀出現的先後，例如部分多巴胺受體阻斷藥。	表現也可不對稱；交由處方者評估，不自行突然停藥。

交更前，先確認三件事

時間敏感藥物
按個別處方時間給藥；不能口服或漏服風險時，及早聯絡處方者及藥劑師。
行走與吞嚥安全
按個別評估安排移動協助；飲食咳嗽、濕聲或其他吞嚥警號需及早評估。
今天是否突然改變
呼吸困難、急性意識轉變或突然新出現的局部神經症狀，應按院內急症程序即時評估及求援。

資料來源與判斷邊界

單一病徵或動畫不能確診；本教材未經香港臨床專家簽核。實際評估、用藥及升級處理須依個別處方與所屬機構程序。

來源核對：2026 年 11 月 12 日

延伸觀看真實檢查示範

以下官方資源需要上網，作為完整文字課程的補充。

Stanford Medicine 25：柏金遜病身體檢查示範
觀看真人動作示範，留意重複手指動作的幅度遞減及靜止震顫。
影片包含須受訓人員進行的檢查；不要依影片自行對高跌倒風險病人做拉肩測試。診斷框架以MDS共識及專科評估為準。

Parkinson’s UK：凍結步態與提示方法
官方頁連結介紹節拍器及地面標記等提示方法的影片，配合個別復康評估閱讀。
提示方法須按個別情況評估；不把公開示範當作所有患者的通用步行處方。

Parkinsonism,explained.

Understand the terms first

What the pattern suggests

How does essential tremor differ?

Nursing priorities

Handover example

What the pattern suggests

Freezing is not unique to PD

Nursing priorities

Handover example

What the pattern suggests

A characteristic combination, not every presentation

Nursing priorities

Handover example

Quick comparison

Three checks before handover

Sources and clinical boundaries

See real examination demonstrations

讀懂病徵，理解柏金遜症。

先理解三個用語

這些線索提示甚麼

與原發性震顫怎樣分開想

護理重點

交更例句

這些線索提示甚麼

凍結不等於只有PD

護理重點

交更例句

這些線索提示甚麼

典型組合，不等於所有患者

護理重點

交更例句

重點比較

交更前，先確認三件事

資料來源與判斷邊界

延伸觀看真實檢查示範

Parkinsonism,
explained.

讀懂病徵，
理解柏金遜症。