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Date: Sat, 02 May 1998 18:35:47 -0400
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To: Janet313 <[log in to unmask]>
Subject: [Fwd: Unified Parkinson Disease Rating Scale (UPDRS)]
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I hope this is helpful.
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Date: Sat, 02 May 1998 17:59:20 -0400
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To: Janet313 <[log in to unmask]>
Subject: Unified Parkinson Disease Rating Scale (UPDRS)
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Margaret Tuchman sent this to the list:
You will, no doubt, recognize this rating scale as the "script" we
perform during our "audition" when visiting the neurologist.
Unified Parkinson Disease Rating Scale (UPDRS)
and Schwab and England Activities of Daily Living can be found on
Comprehensive links to online information about Parkinson's disease from
MGH/Harvard at the URL:
http://neurosurgery.mgh.harvard.edu/pdstages.htm
Unified Parkinson Disease Rating Scale (UPDRS)
The UPDRS is a rating tool to follow the longitudinal course of
Parkinson's
Disease. It is made up of the 1) Mentation, Behavior, and Mood, 2) ADL
and
3) Motor sections. These are evaluated by interview. Some sections
require
multiple grades assigned to each extremity. A total of 199 points are
possible. 199 represents the worst (total) disability), 0--no
disability.
I.Mentation, Behavior, Mood
Intellectual Impairment
0-none
1-mild (consistent forgetfulness with partial recollection
of
events with no other difficulties)
2-moderate memory loss with disorientation and moderate
difficulty handling complex problems
3-severe memory loss with disorientation to time and often
place, severe impairment with problems
4-severe memory loss with orientation only to person, unable
to
make judgments or solve problems
Thought Disorder
0-none
1-vivid dreaming
2-"benign" hallucination with insight retained
3-occasional to frequent hallucination or delusions without
insight, could interfere with daily activities
4-persistent hallucination, delusions, or florid psychosis.
Depression
0-not present
1-periods of sadness or guilt greater than normal, never
sustained for more than a few days or a week
2-sustained depression for >1 week
3-vegetative symptoms (insomnia, anorexia, abulia, weight
loss)
4-vegetative symptoms with suicidality
Motivation/Initiative
0-normal
1-less of assertive, more passive
2-loss of initiative or disinterest in elective activities
3-loss of initiative or disinterest in day to say (routine)
activities
4-withdrawn, complete loss of motivation
II.Activities of Daily Living
Speech
0-normal
1-mildly affected, no difficulty being understood
2-moderately affected, may be asked to repeat
3-severely affected, frequently asked to repeat
4-unintelligible most of time
Salivation
0-normal
1-slight but noticeable increase, may have nighttime
drooling
2-moderately excessive saliva, hay minimal drooling
3-marked drooling
Swallowing
0-normal
1-rare choking
2-occasional choking
3-requires soft food
4-requires NG tube or G-tube
Handwriting
0-normal
1-slightly small or slow
2-all words small but legible
3-severely affected, not all words legible
4-majority illegible
Cutting Food/Handing Utensils
0-normal
1-somewhat slow and clumsy but no help needed
2-can cut most foods, some help needed
3-food must be cut, but can feed self
4-needs to be fed
Dressing
0-normal
1-somewhat slow, no help needed
2-occasional help with buttons or arms in sleeves
3-considerable help required but can do something alone
4-helpless
Hygiene
0-normal
1-somewhat slow but no help needed
2-needs help with shower or bath or very slow in hygienic
care
3-requires assistance for washing, brushing teeth, going to
bathroom
4-helpless
Turning in Bed/ Adjusting Bed Clothes
0-normal
1-somewhat slow no help needed
2-can turn alone or adjust sheets but with great difficulty
3-san initiate but not turn or adjust alone
4-helpless
Falling-Unrelated to Freezing
0-none
1-rare falls
2-occasional, less than one per day
3-average of once per day
4->1 per day
Freezing When Walking
0-normal
1-rare, may have start hesitation
2-occasional falls from freezing,
3-frequent freezing, occasional falls
4-frequent falls from freezin
Walking
0-normal
1-mild difficulty, day drag legs or decrease arm swing
2-moderate difficultly requires no assist
3-severe disturbance requires assistance
4-cannot walk at all even with assist
Tremor
0-absent
1-slight and infrequent, not bothersome to patient
2-moderate, bothersome to patient
3-severe, interfere with many activities
4-marked, interferes with many activities
Sensory Complaints Related to Parkinsonism
0-none
1-occasionally has numbness, tingling, and mild aching
2-frequent, but not distressing
3-frequent painful sensation
4-excruciating pain
III.Motor Exam
Speech
0-normal
1-slight loss of expression, diction,volume
2-monotone, slurred but understandable, mod. impaired
3-marked impairment, difficult to understand
4-unintelligible
Facial Expression
0-Normal
1-slight hypomymia, could be poker face
2-slight but definite abnormal diminution in expression
3-mod. hypomimia, lips parted some of time
4-masked or fixed face, lips parted 1/4 of inch or more with
complete loss of expression
Tremor at Rest
Face
0-absent
1-slight and infrequent
2-mild and present most of time
3-moderate and present most of time
4-marked and present most of time
Right Upper Extremity (RUE)
0-absent
1-slight and infrequent
2-mild and present most of time
3-moderate and present most of time
4-marked and present most of time
LUE
0-absent
1-slight and infrequent
2-mild and present most of time
3-moderate and present most of time
4-marked and present most of time
RLE
0-absent
1-slight and infrequent
2-mild and present most of time
3-moderate and present most of time
4-marked and present most of time
LLE
0-absent
1-slight and infrequent
2-mild and present most of time
3-moderate and present most of time
4-marked and present most of time
Action or Postural Tremor
RUE
0-absent
1-slight, present with action
2-moderate, present with action
3-moderate present with action and posture holding
4-marked, interferes with feeding
LUE
0-absent
1-slight, present with action
2-moderate, present with action
3-moderate present with action and posture holding
4-marked, interferes with feeding
Rigidity
Neck
0-absent
1-slight or only with activation
2-mild/moderate
3-marked, full range of motion
4-severe
RUE
0-absent
1-slight or only with activation
2-mild/moderate
3-marked, full range of motion
4-severe
LUE
0-absent
1-slight or only with activation
2-mild/moderate
3-marked, full range of motion
4-severe
RLE
0-absent
1-slight or only with activation
2-mild/moderate
3-marked, full range of motion
4-severe
LLE
0-absent
1-slight or only with activation
2-mild/moderate
3-marked, full range of motion
4-severe
Finger taps
Right
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Left
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Hand Movements (open and close hands in rapid succession)
Right
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Left
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Rapid Alternating Movements (pronate and supinate hands)
Right
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Left
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Leg Agility (tap heel on ground, amp should be 3 inches)
Right
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Left
0-normal
1-mild slowing, and/or reduction in amp.
2-moderate impaired. Definite and early fatiguing, may
have
occasional arrests
3-severely impaired. Frequent hesitations and arrests.
4-can barely perform
Arising From Chair (pt. arises with arms folded across chest)
0-normal
1-slow, may need more than one attempt
2-pushes self up from arms or seat
3-tends to fall back, may need multiple tries but can arise
without assistance
4-unable to arise without help
Posture
0-normal erect
1-slightly stooped, could be normal for older person
2-definitely abnormal, mod. stooped, may lean to one side
3-severely stooped with kyphosis
4-marked flexion with extreme abnormality of posture
Gait
0-normal
1-walks slowly, may shuffle with short steps, no festination
or
propulsion
2-walks with difficulty, little or no assistance, some
festination, short steps or propulsion
3-severe disturbance, frequent assistance
4-cannot walk
Postural Stability (retropulsion test)
0-normal
1-recovers unaided
2-would fall if not caught
3-falls spontaneously
4-unable to stand
Body Bradykinesia/ Hypokinesia
0-none
1-minimal slowness, could be normal, deliberate character
2-mild slowness and poverty of movement, definitely
abnormal, or dec. amp. of movement
3-moderate slowness, poverty, or small amplitude
4-marked slowness, poverty, or amplitude
Previously sent to the list by
(Margaret Tuchman (55yrs, Dx 1980)
[log in to unmask] )
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