Rating extrapyramidal signs

The items from the Unified Parkinson's Disease Rating Scale that we have used to rate the presence or absence of extrapyramidal signs are reproduced below. For the purposes of prediction, the patient is considered to have extrapyramidal signs if any one sign is present and has a severity rating of 2 or more. Patients with drug-induced extrapyramidal signs cannot be evaluated with our prediction technique. When deciding whether a sign is drug induced, consider primarily psychotropics, particularly phenothiazines and tricyclic antidepressants.

1 Speech
Normal 0
Slight loss of expression, diction and/or volume. 1
Monotone, slurred but understandable; moderately impaired 2
Marked impairment, difficult to understand 3
Unintelligible 4
2 Facial Expression
Normal 0
Slight hypomimia, could be normal "Poker Face" 1
Slight but definitely abnormal diminution of facial expression 2
Moderate hypomimia; lips parted some of the time 3
  Masked or fixed face with severe or complete loss of
facial expression; lips parted 1/4 inch or more
4
3 Tremor at Rest
Absent 0
Slight and infrequently present 1
Mild in amplitude and present most of the time 2
Moderate in amplitude and present most of the time 3
  Marked in amplitude and present most of the time_ 4

Rigidity (Judged on passive movement of major joint with patient relaxed in sitting position. Cogwheeling to be ignored.)

4 Neck
Absent 0
Slight or detectable only when activated by mirror
orother movements
1
Mild to moderate 2
Marked, but full range of motion easily achieved 3
  Severe, range of motion achieved with difficulty_ 4
5 Right arm
Absent 0
Slight or detectable only when activated by mirror
orother movements
1
Mild to moderate 2
Marked, but full range of motion easily achieved 3
  Severe, range of motion achieved with difficulty_ 4
6 Left arm
Absent 0
Slight or detectable only when activated by mirror
or other movements
1
Mild to moderate 2
Marked, but full range of motion easily achieved 3
  Severe, range of motion achieved with difficulty_ 4
7 Right leg
Absent 0
Slight or detectable only when activated by mirror
orother movements
1
Mild to moderate 2
Marked, but full range of motion easily achieved 3
  Severe, range of motion achieved with difficulty_ 4
8 Left leg
Absent 0
Slight or detectable only when activated by mirror
orother movements
1
Mild to moderate 2
Marked, but full range of motion easily achieved 3
  Severe, range of motion achieved with difficulty_ 4
9 Posture
Normal erect. 0
Not quite erect, slightly stooped posture;
could be normalfor older person
1
Moderately stooped posture, definitely abnormal;
can be leaning slightly to one side
2
Severely stooped posture with kyphosis;
can be leaning moderately to one side
3
  Marked flexion with extreme abnormality of posture_ 4
10 Body Bradykinesia and Hypokinesia:
Combining slowness, hesitancy, decreased arm swing,
small amplitude, and poverty of movement in general.
None 0
Minimal slowness, giving movement a
deliberate character; could be normal for some
persons. Possibly reduced amplitude.
1
Mild degree of slowness and poverty of movement
which is definitely abnormal.
Alternatively, some reduced amplitude
2
Moderate slowness, poverty
or small amplitude of movement
3
  Marked slowness, poverty
or small amplitude of movement_
4
11 Gait:
Normal 0
Walks slowly, may shuffle with short steps,
but no festination or propulsion
1
Walks with difficulty, but requires little or
no assistance; may have some festination,
short steps or propulsion
2
Severe disturbance of gait;
requiring assistance
3
  Cannot walk at all, even with assistance_ 4

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Web page maintained by Gary Wilson gew3 at columbia.edu) Last updated 1/21/2004