Unified Parkinsons Disease Rating Scale

I. Mentation, Behavior and Mood

1.  Intellectual Impairment 4. Motivation/Initiative
0 = Normal. 1 = Less assertive than usual; more passive. TO RESTLESS LEG SYNDROME 2= Loss of initiative or disinterest in elective (nonroutine) activities. 3= Loss of initiative or disinterest in day to day (routine) activities. TO RESTLESS LEG SYNDROME 4 = Withdrawn, complete loss of motivation.

0 = None. 1= Mild. Consistent forgetfulness with partial recollection of events and no other difficulties. 2= Moderate memory loss, with disorientation and moderate difficulty handling complex problems. Mild but definite impairment of function at home with need TO POST-STROKE SPASTICITY MANAGEMENT of occasional prompting. TO DYSKINESIA IN PARKINSONS DISEASE 3= Severe memory loss with disorientation for time and often to place. Severe impairment in handling problems. 4= Severe memory loss with orientation preserved to person only. Unable to make judgements or solve problems. (for both on and off ) Thank you very much. TO POST-STROKE SPASTICITY MANAGEMENT Requires much help with personal care. Cannot be left Feel free to bill your time under a spasticity code #8302. dyskinesia alone at all. 5. Speech 0 = Normal. TO DYSKINESIA IN PARKINSONS DISEASE DYSKINESIA MANAGEMENT 1 = Mildly affected. No difficulty beingTO understood. 2.  Thought dementia or drug Also, the billing Disorder code for the(Due entireto PSS project is 8305. 2= Moderately affected. Sometimes asked to repeat intoxication) statements. 0 =need None. We to get a graphic going for the online 3 = Severely affected. Frequently asked to repeat statements. version of the Dyskinesia monograph. 1 = Vivid dreaming. 4 = Unintelligible most of the time. Lets try two versions. One that says Dyskinesia and one that says Dyskinesia Workbook, 2 = Benign hallucinations with insight retained. both ala the 3= Ocode  ccasional to frequent hallucinations or delusions; PD Workbook. The tag line should read der a spasticity #8302. TO DYSKINESIA MANAGEMENT IN PD without insight; could interfere with daily activities. 6. Salivation The Clinicians Guide to Management of Dyskinesia in PD 4= Persistent hallucinations, delusions, or florrid psychosis. 0 = Normal. Billing code for to Dyskinesia isself. #8304. Not able care for 1= Slight but definite excess of saliva in mouth; may have TO DYSKINESIA MANAGEMENT nighttime drooling. entire PSS project is 8305. 2 = Moderately excessive saliva; may have minimal drooling. 3. Depression 3 = Marked excess of saliva with some drooling. 1 = P eriods of sadness or guilt greater than normal, never 4= Marked drooling, requires constant tissue or ng for the online sustained for days or weeks. nograph. handkerchief. 2 = Sustained depression (1 week or more). at says Dyskinesia and one that says Dyskinesia Workbook, TO POST-STROKE SPASTICITY MANAGEMENT 3= Sustained depression with vegetative symptoms 7. Swallowing hould read (insomnia, anorexia, weight loss, loss of interest). 4= Sustained depression with vegetative symptoms and 0 = Normal. TO DYSKINESIA MANAGEMENT IN PD suicidal thoughts 1 = Rare choking. gement of Dyskinesia in PD or intent. 2 = Occasional choking. 3 = Requires soft food. #8304. 4 = Requires ng tube or gastrotomy feeding.

pssm

pssm

dpd

II.  Activities of Daily Living

dpd

dyskinesia

dyskinesia

pss pssm dyskinesia

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.
PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

pssm

23

ps

TO POST-STROKE SPASTICITY MANAGEMENT

Unified Parkinsons Disease Rating Scale

8. Handwriting
0 = Normal. 1 = Slightly slow or small. 2 = Moderately slow or small; all words are legible. 3 = Severely affected; not all words are legible. 4 = The majority of words are not legible.

13. Falling (Unrelated to Freezing)

0 = None. 1 = Rare falling. 2 = Occasionally falls, less than once per day. 3 = Falls an average of once daily. TO RESTLESS LEG SYNDROME 4 = Falls more than once daily.

9. Cutting Food and Handling Utensils

0 = Normal. 0 = None. 1 = Somewhat slow and clumsy, but no help TO needed. 1 = Rare freezing when walking; may have start hesitation. POST-STROKE SPASTICITY MANAGEMENT 2= Can cut most foods, although clumsy and slow; some 2 = Occasional freezing when walking. TO DYSKINESIA IN PARKINSONS DISEASE help needed. 3 = Frequent freezing. Occasionally falls from freezing. 3 = Food must be cut by someone, but can still feed slowly. 4 = Frequent falls from freezing. 4 = Needs to be fed.
Thank you very much.

pssm

14. Freezing when Walking

dpd

15.  Walking
0 = Normal. dyskinesia 1= Mild difficulty. May not swing arms or may tend to drag leg. TO DYSKINESIA MANAGEMENT 2 = Moderate difficulty, but requires little or no assistance. 3 = Severe disturbance of walking, requiring assistance. 4 = Cannot walk at all, even with assistance.

10. FeelDressing free to bill your time under a spasticity code #8302.
0 = Normal. 1 = Somewhat slow, but no help needed. 2Also, = Occasional with buttoning, getting arms in sleeves. the billingassistance code for the entire PSS project is 8305. 3 = Considerable help required, but can do some things alone. We need to get a graphic going for the online of the Dyskinesia monograph. 4version = Helpless.

Lets try two versions. One that says Dyskinesia and one that says Dyskinesia Workbook, both ala the 16. Tremor (Symptomatic complaint of tremor in any part PD Workbook. The tag line should read 11. Hygiene of body.) TO DYSKINESIA MANAGEMENT IN PD Clinicians Guide to Management of Dyskinesia in PD 0The = Normal. 1 = Somewhat slow, but no help needed. Billing code for Dyskinesia is #8304. 2= Needs help to shower or bathe; or very slow in hygienic care. 3= Requires assistance for washing, brushing teeth, combing hair, going to bathroom. 4 = Foley catheter or other mechanical aids.

dyskinesia

0 = Absent. 1 = Slight and infrequently present. 2 = Moderate; bothersome to patient. 3 = Severe; interferes with many activities. 4 = Marked; interferes with most activities.

17. Sensory Complaints Related to Parkinsonism

0 = None. TO POST-STROKE SPASTICITY MANAGEMENT 1 = Occasionally has numbness, tingling, or mild aching. 2= Frequently has numbness, tingling, or aching; not distressing. 3 = Frequent painful sensations. 4 = Excruciating pain.

pssm

pss

12. Turning in Bed and Adjusting Bed Clothes

0 = Normal. 1 = Somewhat slow and clumsy, but no help needed. 2 = Can turn alone or adjust sheets, but with great difficulty. 3 = Can initiate, but not turn or adjust sheets alone. 4 = Helpless.

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.

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PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

Unified Parkinsons Disease Rating Scale

III. Motor Examination
18. Speech
0 = Normal. 1 = Slight loss of expression, diction and/or volume. 2= Monotone, slurred but understandable; moderately impaired. 3 = Marked impairment, difficult to understand. 4 = Unintelligible.

22.  Rigidity (Judged on passive movement of major joints

with patient relaxed in sitting position. Cogwheeling to be ignored.) 0 = Absent. 1= Slight or detectable only when activated by mirror or TO RESTLESS LEG SYNDROME other movements. 2 = Mild to moderate. 3 = Marked, but full range of motion easily achieved. 4 = Severe, range of motion achieved with difficulty.

pssm

19. Facial Expression

TO POST-STROKE SPASTICITY MANAGEMENT

0 = Normal. 1 = Minimal hypomimia, could be normal Poker Face. 2= Slight but definitely abnormal diminution of facial expression Thank you very much. 3 = Moderate hypomimia; lips parted some of the time. 4 = free Masked  fixed facies severe or complete loss of Feel to billor your time underwith a spasticity code #8302. facial expression; lips parted 1/4 inch or more.
Also, the billing code for the entire PSS project is 8305.

23.  Finger Taps (Patient taps thumb with index finger in

TO DYSKINESIA IN PARKINSONS DISEASE rapid succession.) 0 = Normal. 1 = Mild slowing and/or reduction in amplitude. 2= Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement. dyskinesia 3= Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement. TO DYSKINESIA MANAGEMENT 4 = Can barely perform the task.

dpd

20. Tremor at Rest (head, upper and lower extremities)

0 = Absent.

24.  Hand Movements (Patient opens and closes hands We need to get a graphic going for the online 1 = Slight and infrequently present. version of the Dyskinesia monograph. in rapid succesion.) 2= M in amplitude persistent. Or moderate in Lets tryild two versions. One and that says Dyskinesia and one that says Dyskinesia Workbook, 0 = Normal. bothamplitude, ala the but only intermittently present. 1 = Mild slowing and/or reduction in amplitude. PD Workbook. The tag line should read 3 = Moderate in amplitude and present most of the time. TO DYSKINESIA MANAGEMENT IN PD
The Guide to Management of Dyskinesia in PD 4 = Clinicians Marked in amplitude and present most of the time. Billing code for Dyskinesia is #8304.

dyskinesia

21.  Action or Postural Tremor of Hands

0 = Absent. 1 = Slight; present with action. 2 = Moderate in amplitude, present with action. 3= Moderate in amplitude with posture holding as well as action. 4 = Marked in amplitude; interferes with feeding.

2= Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement. 3= Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task.

25.  Rapid Alternating Movements of Hands

(Pronation-supination movements of hands, vertically TO POST-STROKE SPASTICITY MANAGEMENT and horizontally, with as large an amplitude as possible, both hands simultaneously.) 0 = Normal. 1 = Mild slowing and/or reduction in amplitude. 2= Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement. 3= Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task.

pssm

pss

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.
PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

25

Unified Parkinsons Disease Rating Scale

26.  Leg Agility (Patient taps heel on the ground in rapid
succession picking up entire leg. Amplitude should be at least 3 inches.) 0 = Normal. 1 = Mild slowing and/or reduction in amplitude. 2 = Moderately impaired. Definite and early fatiguing. May have occasional arrests in movement. 3= Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task.

30.  Postural Stability (Response to sudden, strong

posterior displacement produced by pull on shoulders while patient erect with eyes open and feet slightly apart. Patient is prepared.) 0 = Normal. TO RESTLESS LEG SYNDROME 1 = Retropulsion, but recovers unaided. 2= Absence of postural response; would fall if not caught by examiner. 3 = Very unstable, tends to lose balance spontaneously. 4 = Unable to stand without assistance.

pssm

TO POST-STROKE SPASTICITY MANAGEMENT

dpd

27.  Arising from Chair (Patient attempts to rise from a

straightbacked chair, with arms folded across chest.) 0 = Normal. 1 = Slow; or may need more than one attempt. Thank you very much. 2 = Pushes self up from arms of seat. Feel free to bill your time under a spasticity code #8302. 3= Tends to fall back and may have to try more than one time, but can get up without help. 4 = Unable to arise without help.

DYSKINESIA IN PARKINSONS DISEASE 31.  Body Bradykinesia andTO Hypokinesia (Combining

slowness, hesitancy, decreased arm swing, small amplitude, and poverty of movement in general.) 0 = None. 1= Minimal slowness, giving movement a deliberate dyskinesia character; could be normal for some persons. Possibly reduced amplitude. TO DYSKINESIA MANAGEMENT 2= Mild degree of slowness and poverty of movement Also, the billing code for the entire PSS project is 8305. which is definitely abnormal. Alternatively, some reduced amplitude. 28. Posture We need to get a graphic going for the online 3= Moderate slowness, poverty or small amplitude of version of the Dyskinesia monograph. 0 = Normal erect. movement. Lets try two versions. One that says Dyskinesia and one that says Dyskinesia Workbook, 1= Not quite erect, slightly stooped posture; could be both ala the 4= Marked slowness, poverty or small amplitude of normal for older person. PD Workbook. The tag line should read movement. TO DYSKINESIA MANAGEMENT IN PD 2= Moderately stooped posture, definitely abnormal; The Clinicians Guide to Management of Dyskinesia in PD can be slightly leaning to one side. Billing code forstooped Dyskinesia is #8304. 3= Severely posture with kyphosis; can be moderately leaning to one side. 4 = Marked flexion with extreme abnormality of posture.

dyskinesia

29. Gait
0 = Normal. 1= Walks slowly, may shuffle with short steps, but no festination (hastening steps) or propulsion. 2= Walks with difficulty, but requires little or no assistance; may have some festination, short steps, or propulsion. 3 = Severe disturbance of gait, requiring assistance. 4 = Cannot walk at all, even with assistance.

pssm

pss

TO POST-STROKE SPASTICITY MANAGEMENT

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.

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PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

Unified Parkinsons Disease Rating Scale

IV.  Complications of Therapy
(In the past week)

B. Clinical Fluctuations
36. Are off periods predictable?
0 = No 1 = Yes
TO RESTLESS LEG SYNDROME

A. Dyskinesias
32.  Duration: What proportion of the waking day are dyskinesias present? (Historical information.)
0 = None 1 = 125% of day. 2 = 2650% of day. 3 = 5175% of day. 4 = 76100% of day.

pssm

37. Are off periods unpredictable?

0 = No 1 = Yes

TO POST-STROKE SPASTICITY MANAGEMENT

38.  Do off periods comeTO on suddenly, withinDISEASE a DYSKINESIA IN PARKINSONS few seconds?
0 = No 1 = Yes

dpd

33.  Disability: How disabling are the dyskinesias?

(Historical information; may be modified by office Thank you very much. examination.) 0 = Not disabling. 1 = Mildly disabling. 2 = Moderately disabling. Also, the billing code for the entire PSS project is 8305. 3 = Severely disabling. 4 = Completely disabled.
Feel free to bill your time under a spasticity code #8302.

dyskinesia 39.  What proportion of the waking day is the patient off on average?
TO DYSKINESIA MANAGEMENT

0 = None 1 = 125% of day. 2 = 2650% of day. We need to get a graphic going for the online 3 = 5175% of day. version of the Dyskinesia monograph. 4 = 76100% of day. Lets try two versions. One that says Dyskinesia and one that says Dyskinesia Workbook,
both ala the dyskinesias? PD Workbook. The tag line should read

34.  Painful Dyskinesias: How painful are the

dyskinesia
TO DYSKINESIA MANAGEMENT IN PD

0 = No painful dyskinesias. 1 = Slight. Billing code for Dyskinesia is #8304. 2 = Moderate. 3 = Severe. 4 = Marked.

The Clinicians Guide to Management of Dyskinesia in PD

C. Other Complications
0 = No 1 = Yes

40.  Does the patient have anorexia, nausea, or vomiting?

35.  Presence of Early Morning Dystonia

(Historical information.) 0 = No 1 = Yes

41.  Any sleep disturbances, such as insomnia or hypersomnolence? TO POST-STROKE SPASTICITY MANAGEMENT
0 = No 1 = Yes

pssm

pss

42.  Does the patient have symptomatic orthostasis?

(Record the patients blood pressure, height and weight on the scoring form) 0 = No 1 = Yes
Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.
PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

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Unified Parkinsons Disease Rating Scale

V. Modified Hoehn and Yahr Staging
STAGE 0 = No signs of disease. STAGE 1 = Unilateral disease. STAGE 1.5 = Unilateral plus axial involvement. STAGE 2 = Bilateral disease, without impairment of balance. STAGE 2.5 = Mild bilateral disease, with recovery on pull test.
TO POST-STROKE SPASTICITY MANAGEMENT

TO RESTLESS LEG SYNDROME

STAGE 3 = Mild to moderate bilateral disease; some postural instability; physically independent. STAGE 4 = Severe disability; still able to walk or stand unassisted. STAGE 5 = Wheelchair bound or bedridden unless aided.
Thank you very much. Feel free to bill your time under a spasticity code #8302.

pssm

dpd
TO DYSKINESIA IN PARKINSONS DISEASE

dyskinesia
TO DYSKINESIA MANAGEMENT

Also, the billing code for the entire PSS project is 8305.

VI. Schwab and England Activities of Daily Living Scale

100% =  Completely independent. Able to do all chores without slowness, difficulty or impairment. Essentially normal. Unaware ofgoing any difficulty. We need to get a graphic for the online

version of the Dyskinesia monograph. Lets try two One that says Dyskinesia and one sayswith Dyskinesia 90% = Cversions. ompletely independent. Able to do all that chores some Workbook, degree of slowness, difficulty and impairment. both ala the Might take twice as long. Beginning to be aware of difficulty. PD Workbook. The tag line should read TO DYSKINESIA MANAGEMENT IN PD

dyskinesia

80% = Completely independent in most chores. The Clinicians Guide to Management of Dyskinesia in PD Takes twice as long. Conscious of difficulty and slowness.
Billing code for is #8304. 70% = N otDyskinesia completely independent. More difficulty with some chores. Three to four times as long in some.

Must spend a large part of the day with chores. 60% = Some dependency. Can do most chores, but exceedingly slowly and with much effort. Errors; some impossible. 50% = More dependent. Help with half, slower, etc. Difficulty with everything. 40% = Very dependent. Can assist with all chores, but few alone.

pssm

pss

TO POST-STROKE SPASTICITY MANAGEMENT

30% = With effort, now and then does a few chores alone or begins alone. Much help needed. 20% = Nothing alone. Can be a slight help with some chores. Severe invalid. 10% = Totally dependent, helpless. Complete invalid. 0% = Vegetative functions such as swallowing, bladder and bowel functions are not functioning. Bedridden.

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.

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PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD RATING SCALE | WE MOVE 2006

Unified Parkinsons Disease Data Form

Name __________________________________________________________________________________ Unit Number ______________________________________________________ dopa mg/day Date hrs dopa lasts on
1. Mentation 2. Thought Disorder 3. Depression 4. Motivation/Initiative 5. Speech Subtotal 14 (maximum = 16) 6. Salivation

off

on

off

on

off

on off

on

off

on

off

on off

on

off

TO RESTLESS LEG SYNDROME

pssm

7. Swallowing TO POST-STROKE SPASTICITY MANAGEMENT 8. Handwriting 9. Cutting food 10. Dressing 11. Hygiene 12. Turning in bed 13. Falling 14. Freezing 16. Tremor 17. Sensory symptoms Subtotal 517 (maximum = 52) 18 Speech 19. Facial expression

dpd
TO DYSKINESIA IN PARKINSONS DISEASE

15. Walking er a spasticity code #8302.

dyskinesia
TO DYSKINESIA MANAGEMENT

ntire PSS project is 8305.

20. Tremor at rest: face,lips,chin ng for the online nograph. Hands: right at says Dyskinesia and one that says leftDyskinesia Workbook, Feet: right left 21. Action tremor: right left 22. Rigidity: neck Upper extremity: right left Lower extremity: right left

dyskinesia
TO DYSKINESIA MANAGEMENT IN PD

ould read

gement of Dyskinesia in PD

#8304.

PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD DATA FORM | WE MOVE 2006

pssm
TO POST-STROKE SPASTICITY MANAGEMENT

29

ps

Unified Parkinsons Disease Data Form

Date on
23. Finger taps: right left 24. Hand grips: right left left left 27. Arise from chair 28. Posture 29. Gait 30. Postural stability
TO RESTLESS LEG SYNDROME

off

on

off

on

off

on off

on

off

on

off

on off

on

off

25. Hand pronate/supinate: right 26. Leg agility: right

pssm
TO POST-STROKE SPASTICITY MANAGEMENT

dpd
TO DYSKINESIA IN PARKINSONS DISEASE

31. Body bradykinesia Thank you very much.

Feel free to bill your time under a spasticity code #8302.

Sub-total:1831 (maximum = 108) Total points: 131 (max = 176) 32. Dyskinesia (duration) 34. Dyskinesia (pain)

dyskinesia
TO DYSKINESIA MANAGEMENT

Also, code for the entire PSS project is 8305. the billing 33. Dyskinesia (disability) We toEarly get a graphic going for the online need 35. morning dystonia version of the Dyskinesia monograph. try two 36. Offs (predictable) Lets versions. One that says Dyskinesia and one that says Dyskinesia Workbook, both ala the 37. Offs (unpredictable) PD Workbook. The tag line should read

dyskinesia
TO DYSKINESIA MANAGEMENT IN PD

38. Offs (sudden)

The Clinicians Guide to Management of Dyskinesia in PD

39. Offs (duration)

Billing for Dyskinesia #8304. 40.code Anorexia, nausea,is vomiting

41. Sleep disturbance 42. Symptomatic orthostasis Blood Pressure: seated supine standing Weight Pulse: seated standing Name of Examiner
best worst best worst best worst best worst best worst best worst best worst best worst

pssm
TO POST-STROKE SPASTICITY MANAGEMENT

pss

Hoehn & Yahr Stage % ADL Score (PD) % ADL (with dyskinesia)

Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinsons Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, pp 153-163, 293-304

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PD WORKBOOKTHE WE MOVE CLINICIANS GUIDE TO PARKINSONS DISEASE | UNIFIED PD DATA FORM | WE MOVE 2006