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Protocol - Parkinsonism Symptoms

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Description:

The Motor Exam portion of the United Parkinsons Disease Rating Scale is a 27 item examiner-administered test that measures the severity of symptoms in resting tremor, resistance to movement and abnormal gait and posture.

Specific Instructions:

None

Protocol:

Motor Exam portion of the United Parkinsons Disease Rating Scale

1. 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

2 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

3 Tremor at Rest

3.1 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

3.2 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

3.3 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

3.4 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

3.5 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

4 Action or Postural Tremor

4.1 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

4.2 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

5 Rigidity

5.1 Neck

0[ ]absent

1[ ]slight or only with activation

2[ ]mild/moderate

3[ ]marked, full range of motion

4[ ]severe

5.2 RUE

0[ ]absent

1[ ]slight or only with activation

2[ ]mild/moderate

3[ ]marked, full range of motion

4[ ]severe

5.3 LUE

0[ ]absent

1[ ]slight or only with activation

2[ ]mild/moderate

3[ ]marked, full range of motion

4[ ]severe

5.4 RLE

0[ ]absent

1[ ]slight or only with activation

2[ ]mild/moderate

3[ ]marked, full range of motion

4[ ]severe

5.5 LLE

0[ ]absent

1[ ]slight or only with activation

2[ ]mild/moderate

3[ ]marked, full range of motion

4[ ]severe

6 Finger taps

6.1 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

6.2 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

7 Hand Movements (open and close hands in rapid succession)

7.1 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

7.2 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

8 Rapid Alternating Movements (pronate and supinate hands)

8.1 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

8.2 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

9 Leg Agility (tap heel on ground, amp should be 3 inches)

9.1 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

9.2 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

10 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

11 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

12 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

13 Postural Stability (retropulsion test)

0[ ]normal

1[ ]recovers unaided

2[ ]would fall if not caught

3[ ]falls spontaneously

4[ ]unable to stand

14 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

RLE = right lower extremity

RUE = right upper extremity

LLE = left lower extremity

LUE = left upper extremity

Scoring

Add up scores from the individual questions. A score of 108 represents extreme disability. A score of 0 represents little / no disability.

Protocol Name from Source:

Availability:

Publicly available

Personnel and Training Required

The interviewer must be trained to and found competent to conduct motor examinations, as well as be competent to recognize the impact of co-morbidities (such as stroke, arthritis, etc.) on motor movements. Additionally the interviewer must be trained and found competent in the recognition of motor movements and ratings listed in this protocol, such as the signs and degree of tremor and rigidity and the presence of bradykinesia/hypokinesia

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Major equipment No
Specialized training No
Specialized training No
Specialized requirements for biospecimen collection No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Examination

Life Stage:

Adult, Adult, Senior, Senior, Pregnancy, Pregnancy

Participants:

Adult, aged 18 or older

Selection Rationale

The United Parkinsons Disease Rating Scale was selected because it is the standard, validated protocol that is the most-widely used method to follow the progression of Parkinsons Disease over time.

Language

English, English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Parkinson's Disease Assessment Score 3076084 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Parkinsonian proto 62757-0 LOINC
Derived Variables

None

Process and Review

Not applicable.

Source

Fahn S, Elton RL, UPDRS program members. Unified Parkinsons Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, editors. Recent developments in Parkinsons disease, vol 2. Florham Park; NJ: Macmillan Healthcare Information: 1987. p 153-163.

General References

Aminoff MJ, Greenberg DA, & Simon RP (2005). Clinical Neurology (6th ed.). Lange: McGraw-Hill Medical. pp. 241–5.

Protocol ID:

130101

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX130101_Action_Or_Postural_Tremor_LUE PX130101040200 LUE N/A
PX130101_Action_Or_Postural_Tremor_RUE PX130101040100 RUE N/A
PX130101_Arising_From_Chair PX130101100000 Arising From Chair (pt. arises with arms more
folded across chest) show less
N/A
PX130101_Body_Bradykinesia_Hypokinesia PX130101140000 Bradykinesia/Hypokinesia N/A
PX130101_Face PX130101030100 Face N/A
PX130101_Facial_Expression PX130101020000 Facial Expression N/A
PX130101_Finger_Taps_Left PX130101060200 Left N/A
PX130101_Finger_Taps_Right PX130101060100 Right N/A
PX130101_Gait PX130101120000 Gait N/A
PX130101_Hand_Movements_Left PX130101070200 Left N/A
PX130101_Hand_Movements_Right PX130101070100 Right N/A
PX130101_Leg_Agility_Left PX130101090200 Left N/A
PX130101_Leg_Agility_Right PX130101090100 Right N/A
PX130101_Postural_Stability PX130101130000 Postural Stability (retropulsion test) N/A
PX130101_Posture PX130101110000 Posture N/A
PX130101_Rapid_Alternating_Movements_Left PX130101080200 Left N/A
PX130101_Rapid_Alternating_Movements_Right PX130101080100 Right N/A
PX130101_Rigidity_LLE PX130101050500 LLE N/A
PX130101_Rigidity_LUE PX130101050300 LUE N/A
PX130101_Rigidity_Neck PX130101050100 Neck N/A
PX130101_Rigidity_RLE PX130101050400 RLE N/A
PX130101_Rigidity_RUE PX130101050200 RUE N/A
PX130101_Speech PX130101010000 Speech N/A
PX130101_Tremor_At_Rest_LLE PX130101030500 Left Lower Extremities (LLE) N/A
PX130101_Tremor_At_Rest_LUE PX130101030300 Left Upper Extremities (LUE) N/A
PX130101_Tremor_At_Rest_RLE PX130101030400 Right Lower Extremities (RLE) N/A
PX130101_Tremor_At_Rest_RUE PX130101030200 Right Upper Extremities (RUE) N/A
Neurology
Measure Name:

Parkinsonism Symptoms

Release Date:

May 12, 2010

Definition

A physical examination to assess Parkinsonism symptoms, including resting tremor, resistance to movement, slowed voluntary and automatic movement, and abnormal gait and posture.

Purpose

This measure is used to screen an individual for the symptoms of Parkinsonism. Parkinsonism occurs in about 0.2% of the population and the risk increases with age. Parkinsonism can be caused by genetics, vascular disease, certain medications and environmental contaminants such as manganese dust, carbon monoxide or pesticides (Aminoff et al., 2005).

Keywords

Parkinsonism, Parkinson's Disease, movement disorders, ataxia, Unified Parkinson's Disease Rating Scale, UPDRS, resting tremor, tremor, gait, posture, Neurology