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Neurodegenerative Disease Parkinson’s Disease


Table 3: Motor Examination Parameters in the Unified Parkinson’s Disease Rating Scale 01 2


3 Speech Facial expression


Normal Slight loss of expression, diction, and/or volume


Monotone, slurred but understandable.


Moderately impaired


Normal Minimal hypomimia, could Slight but definitely be normal ‘poker face’


diminution of facial expression Tremor at rest1


Absent Slight and infrequently present


Action or postural tremor of hands


Rigidity2


Mild in amplitude and persistent, or moderate in amplitude but only intermittently present


Absent Slight, present with action Moderate in amplitude, present with action


Absent Slight or detectable only when activated by mirror or other movements


Finger taps3


Normal Mild slowing and/or reduction in amplitude


Hand movements4


Normal Mild slowing and/or reduction in amplitude


Rapid alternating movements of hands5


Normal. Mild slowing and/or reduction in amplitude


Leg agility6


Normal Mild slowing and/or reduction in amplitude


Arising from chair7 Mild to moderate Moderately impaired.


Moderate in amplitude and present most of the time


Moderate in amplitude, present with posture


holding as well as action Marked, but full range of motion easily achieved


Severely impaired.


Definite and early fatiguing. Frequent hesitations in May have occasional arrests initiating movements or arrests in movements


in ongoing movements Moderately impaired. Severely impaired. Frequent Can barely perform the task


Definite and early fatiguing. hesitations in initiating May have occasional arrests movements or arrests in movements


Moderately impaired. in ongoing movements Severely impaired. Frequent Can barely perform the task


Definite and early fatiguing. hesitations in initiating May have occasional arrests movements or arrests in movements


Moderately impaired. in ongoing movements Severely impaired. Frequent Can barely perform the task


Definite and early fatiguing. hesitations in initiating May have occasional arrests movementsor arrests in in movements


Normal Slow or may need more Pushes oneself up than one attempt


from arms of seat Posture


Normal Not quite erect, slightly erect


Gait Moderately stooped


Can be slightly leaning to one side


requires little or no


ongoing movements Tends to fall back and


may have to try more than one time, but can get up without help


Severely stooped posture


stooped posture. Could be posture, definitely abnormal. with kyphosis. Can be normal for older person


moderately leaning to one side


Normal Walks slowly, may shuffle Walks with difficulty, but with short steps, but no


festination (hastening steps) assistance. May have some or propulsion


festination, short steps, or propulsion


Postural stability8


Normal Retropulsion, but recovers unaided


Body bradykinesia and hypokinesia9


None Absence of postural


Minimal slowness, giving Mild degree of slowness movement a deliberate


for some persons. Possibly Alternatively, some reduced amplitude


reduced amplitude


1 = head and upper and lower extremities; 2 = judged on passive movement of major joints with patient relaxed in sitting position; cogwheeling to be ignored; 3 = patient taps thumb with index finger in rapid succession; 4 = patient opens and closes hands in rapid succession; 5 = pronation–supination movements of hands, vertically and horizontally, with as large an amplitude as possible, both hands simultaneously; 6 = patient taps heel on the ground in rapid succession, picking up entire leg; amplitude should be at least 3 inches; 7 = patient attempts to rise from a straightbacked chair, with arms folded across chest; 8 = response to sudden, strong posterior displacement produced by pull on shoulders while patient is erect with eyes open and feet slightly apart; patient is prepared; 9 = combining slowness, hesitancy, decreased armswing, small amplitude, and poverty of movement in general. Source: Movement Disorder Virtual University, 2008.72


94 Very unstable, tends to Unable to stand without


response. Would fall if not lose balance spontaneously assistance caught by examiner


and poverty of movement or small amplitude character. Could be normalr that is definitely abnormal. of movement


Moderate slowness, poverty Marked slowness, poverty or small amplitude of movement


Severe disturbance of gait, requiring assistance


Cannot walk at all, even with assistance


Marked flexion with extreme abnormality of posture


Unable to arise without help Moderate hypomimia. Masked or fixed face Lips parted some of the time with severe or complete loss


of facial expression. Lips parted 1/4 inch or more Marked in amplitude and present most of the time


Marked in amplitude. Interferes with feeding


Severe, range of motion achieved with difficulty


Can barely perform the task


Marked impairment, difficult to understand


4 Unintelligible


US NEUROLOGY


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