2 = Loss of initiative or disinterest in elective (nonroutine) 1 = Mild. Consistent forgetfulness with partial recollection

Transcription

1 Unifie Parkinson s Disease Rating Scale 1 = Milly affecte. No ifficulty being TO unerstoo. DYSKINESIA MANAGEMENT Also, 2. Thought the billing Disorer coe for the (Due entire to PSS ementia project is or rug 2 = Moerately affecte. Sometimes aske to repeat intoxication) statements. We 0 = nee None. to get a graphic going for the online 3 = Severely affecte. Frequently aske to repeat statements. version 1 = Vivi of the reaming. Dyskinesia monograph. Let s try two versions. One that says Dyskinesia an one that says Dyskinesia Workbook, 4 = Unintelligible most of the time. 2 = Benign hallucinations with insight retaine. PD 3 = Workbook. Occasional The to tag frequent line shoul hallucinations rea or elusions; without insight; coul interfere with aily activities. 6. Salivation The Clinicians Guie to Management of Dyskinesia in PD 4 = Persistent hallucinations, elusions, or florri psychosis. Billing Not coe able for to Dyskinesia care for is self. # = Slight but efinite excess of TO saliva DYSKINESIA in mouth; MANAGEMENT may have nighttime rooling. 2 = Moerately excessive saliva; may have minimal rooling. 3. Depression 3 = Marke excess 1 = P erios of saness or guilt greater than normal, never of saliva with some rooling. 4 = Marke rooling, requires constant tissue or sustaine for ays or weeks. hankerchief. 2 = Sustaine epression (1 week or more). 3 = Sustaine epression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest). 4 = Sustaine epression with vegetative symptoms an suicial thoughts or intent. er a spasticity coe #8302. ntire PSS project is g for the online ograph. t says Dyskinesia an one that says Dyskinesia Workbook, oul rea ement of Dyskinesia in PD I. Mentation, Behavior an Moo 4. Motivation/Initiative 1. Intellectual Impairment 1 = Less assertive than usual; more passive. ne. 2 = Loss of initiative or isinterest in elective (nonroutine) 1 = Mil. Consistent forgetfulness with partial recollection activities. of events an no other ifficulties. 3 = Loss of initiative or isinterest in ay to ay (routine) 2 = Moerate memory loss, with isorientation an activities. moerate ifficulty hanling complex problems. Mil 4 = Withrawn, complete p loss of motivation. but efinite impairment of function at home TO POST-STROKE with nee SPASTICITY MANAGEMENT of occasional prompting. 3 = Severe memory loss with isorientation for time an often to place. Severe impairment in hanling problems. 4 = Severe memory loss with orientation preserve to person II. Activities p of Daily Living Thank only. you very Unable much. to make jugements or solve problems. (for both on an off ) Requires much TO POST-STROKE help with personal SPASTICITY care. MANAGEMENT Cannot be Feel free to bill your time uner a spasticity coe #8302. alone at all. 5. Speech 7. Swallowing 1 = Rare choking. 2 = Occasional choking. 3 = Requires soft foo. 4 = Requires ng tube or gastrotomy feeing. Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE ps

2 Unifie Parkinson s Disease Rating Scale 8. Hanwriting 1 = Slightly slow or small. 2 = Moerately slow or small; all wors are legible. 3 = Severely affecte; not all wors are legible. 4 = The majority of wors are not legible. Thank you very much. 9. Cutting Foo an Hanling Utensils 14. Freezing when Walking ne. p 1 = Somewhat slow an clumsy, but no help TO neee. POST-STROKE SPASTICITY MANAGEMENT 1 = Rare freezing when walking; may have start hesitation. 2 = Can cut most foos, although clumsy an slow; some 2 = Occasional freezing when walking. help neee. 3 = Frequent freezing. Occasionally TO DYSKINESIA falls from IN PARKINSON S freezing. DISEASE 3 = Foo must be cut by someone, but can still fee slowly. 4 = Frequent falls from freezing. 4 = Nees to be fe. 10. Dressing Feel free to bill your time uner a spasticity coe # = Mil ifficulty. May not swing arms or may ten to rag 1 = Somewhat slow, but no help neee. leg. 2 Also, = Occasional the billing assistance coe for the with entire buttoning, PSS project getting is arms in sleeves. 2 = Moerate ifficulty, but requires little or no assistance. 3 = Consierable help require, but can o some things 3 = Severe isturbance of walking, requiring assistance. alone. We nee to get a graphic going for the online 4 = Cannot walk at all, even with assistance. 4 version = Helpless. of the Dyskinesia monograph. Let s try two versions. One that says Dyskinesia an one that says Dyskinesia Workbook, 16. Tremor (Symptomatic complaint of tremor in any part PD Workbook. The tag line shoul rea 11. Hygiene of boy.) 0 The = Normal. Clinicians Guie to Management of Dyskinesia in PD 0 = Absent. 1 = Somewhat slow, but no help neee. 1 = Slight an infrequently present. Billing coe for Dyskinesia is # = Nees help to shower or bathe; or very slow in hygienic 2 = Moerate; bothersome to patient. care. 3 = Severe; interferes with many activities. 3 = Requires assistance for washing, brushing teeth, 4 = Marke; interferes with most activities. combing hair, going to bathroom. 4 = Foley catheter or other mechanical ais. 17. Sensory Complaints Relate to Parkinsonism ne. 1 = Occasionally has numbness, tingling, or mil aching. 2 = Frequently has numbness, tingling, or aching; not istressing. 3 = Frequent painful sensations. 4 = Excruciating pain. 12. Turning in Be an Ajusting Be Clothes 1 = Somewhat slow an clumsy, but no help neee. 2 = Can turn alone or ajust sheets, but with great ifficulty. 3 = Can initiate, but not turn or ajust sheets alone. 4 = Helpless. 13. Falling (Unrelate to Freezing) ne. 1 = Rare falling. 2 = Occasionally falls, less than once per ay. 3 = Falls an average of once aily. 4 = Falls more than once aily. 15. Walking Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham 24 PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE 2006

3 Unifie Parkinson s Disease Rating Scale III. Motor Examination 18. Speech 1 = Slight loss of expression, iction an/or volume. 2 = Monotone, slurre but unerstanable; moerately impaire. 3 = Marke impairment, ifficult to unerstan. 4 = Unintelligible. 19. Facial Expression 1 = Minimal hypomimia, coul be normal Poker Face. 2 = Slight but efinitely abnormal iminution of facial expression Thank 3 = Moerate you very much. hypomimia; lips parte some of the time. Feel 4 = free Maske to bill or your fixe time facies uner with a spasticity severe coe or complete #8302. loss of facial expression; lips parte 1 /4 inch or more. Also, the billing coe for the entire PSS project is Rigiity (Juge on passive movement of major joints with patient relaxe in sitting position. Cogwheeling to be ignore.) 0 = Absent. 1 = Slight or etectable only when activate TO RESTLESS by mirror LEG SYNDROME or other movements. 2 = Mil to moerate. 3 = Marke, but full range of motion easily achieve. 4 = Severe, range of motion achieve with ifficulty. p 23. Finger Taps (Patient taps thumb with inex finger in rapi succession.) 1 = Mil slowing an/or reuction in amplitue. 2 = Moerately impaire. Definite an early fatiguing. May have occasional arrests in movement. 3 = Severely impaire. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task. 20. Tremor at Rest (hea, upper an lower extremities) 0 = Absent. We nee to get a graphic going for the online 24. Han Movements (Patient opens an closes hans 1 = Slight an infrequently present. version of the Dyskinesia monograph. in rapi succesion.) Let s 2 = Mil try two in versions. amplitue One an that says persistent. Dyskinesia Or moerate an one that in says Dyskinesia Workbook, both amplitue, ala the but only intermittently present. PD Workbook. The tag line shoul rea 1 = Mil slowing an/or reuction in amplitue. 3 = Moerate in amplitue an present most of the time. 2 = Moerately impaire. Definite an early fatiguing. The 4 = Clinicians Marke in Guie amplitue to Management an present of Dyskinesia most of in PD the time. May have occasional arrests in movement. Billing coe for Dyskinesia is # = Severely impaire. Frequent hesitation in initiating 21. Action or Postural Tremor of Hans movements or arrests in ongoing movement. 0 = Absent. 4 = Can barely perform the task. 1 = Slight; present with action. 2 = Moerate in amplitue, present with action. 25. Rapi Alternating Movements of Hans 3 = Moerate in amplitue with posture holing as well (Pronation-supination movements of hans, vertically as action. an horizontally, with as large an amplitue as possible, 4 = Marke in amplitue; interferes with feeing. both hans simultaneously.) 1 = Mil slowing an/or reuction in amplitue. 2 = Moerately impaire. Definite an early fatiguing. May have occasional arrests in movement. 3 = Severely impaire. Frequent hesitation in initiating movements or arrests in ongoing movement. 4 = Can barely perform the task. Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE

4 Unifie Parkinson s Disease Rating Scale 26. Leg Agility (Patient taps heel on the groun in rapi succession picking up entire leg. Amplitue shoul be at least 3 inches.) 1 = Mil slowing an/or reuction in amplitue. 2 = Moerately impaire. Definite an early fatiguing. May have occasional arrests in movement. 3 = Severely impaire. Frequent hesitation in initiating movements or arrests in ongoing movement. p 4 = Can barely perform the task. 4 = Unable to stan without assistance. 27. Arising from Chair (Patient attempts to rise from a straightbacke chair, with arms fole across chest.) Thank 1 = Slow; you very or may much. nee more than one attempt. 2 = Pushes self up from arms of seat. 1 = Minimal slowness, giving movement a eliberate Feel free to bill your time uner a spasticity coe # = Tens to fall back an may have to try more than one character; coul be normal for some persons. Possibly time, but can get up without help. reuce amplitue. 4 = Unable to arise without help. 2 = Mil egree of slowness an poverty TO DYSKINESIA of movement MANAGEMENT Also, the billing coe for the entire PSS project is which is efinitely abnormal. Alternatively, some reuce amplitue. We 28. nee Posture to get a graphic going for the online 3 = Moerate slowness, poverty or small amplitue of version rmal of the Dyskinesia erect. monograph. Let s try two versions. One that says Dyskinesia an one that says Dyskinesia Workbook, movement. 1 = Not quite erect, slightly stoope posture; coul be 4 = Marke slowness, poverty or small amplitue of PD Workbook. normal for The oler tag line person. shoul rea movement. 2 = Moerately stoope posture, efinitely abnormal; The Clinicians Guie to Management of Dyskinesia in PD can be slightly leaning to one sie. Billing 3 = Severely coe for stoope Dyskinesia posture is #8304. with kyphosis; can be moerately leaning to one sie. 4 = Marke flexion with extreme abnormality of posture. 29. Gait 1 = Walks slowly, may shuffle with short steps, but no festination (hastening steps) or propulsion. 2 = Walks with ifficulty, but requires little or no assistance; may have some festination, short steps, or propulsion. 3 = Severe isturbance of gait, requiring assistance. 4 = Cannot walk at all, even with assistance. 30. Postural Stability (Response to suen, strong posterior isplacement prouce by pull on shoulers while patient erect with eyes open an feet slightly apart. Patient is prepare.) 1 = Retropulsion, but recovers unaie. 2 = Absence of postural response; woul fall if not caught by examiner. 3 = Very unstable, tens to lose balance spontaneously. 31. Boy Braykinesia an Hypokinesia (Combining slowness, hesitancy, ecrease arm swing, small amplitue, an poverty of movement in general.) ne. Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham 26 PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE 2006

5 Unifie Parkinson s Disease Rating Scale IV. Complications of Therapy (In the past week) A. Dyskinesias 32. Duration: What proportion of the waking ay are s present? (Historical information.) ne 1 = 1 25% of ay. 2 = 26 50% of ay. 3 = 51 75% of ay. 4 = % of ay. 33. Disability: How isabling are the s? p Thank (Historical you very much. information; may be moifie by office examination.) Feel free to bill your time uner a spasticity coe #8302. t isabling. 39. What proportion of the waking ay is the patient 1 = Milly isabling. off on average? 2 = Moerately isabling. ne Also, the billing coe for the entire PSS project is = Severely isabling. 1 = 1 25% of ay. 4 = Completely isable. 2 = 26 50% of ay. We nee to get a graphic going for the online 3 = 51 75% of ay. version of the Dyskinesia monograph. Let s try two versions. One that says Dyskinesia an one that says Dyskinesia Workbook, 4 = % of ay. 34. Painful Dyskinesias: How painful are the PD Workbook. s? The tag line shoul rea painful s. The Clinicians Guie to Management of Dyskinesia in PD C. Other Complications 1 = Slight. Billing 2 = Moerate. coe for Dyskinesia is # = Severe. 4 = Marke. 35. Presence of Early Morning Dystonia (Historical information.) B. Clinical Fluctuations 36. Are off perios preictable? 37. Are off perios unpreictable? 38. Do off perios come on suenly, within a few secons? 40. Does the patient have anorexia, nausea, or vomiting? 41. Any sleep isturbances, such as insomnia or hypersomnolence? 42. Does the patient have symptomatic orthostasis? (Recor the patient s bloo pressure, height an weight on the scoring form) Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE

6 Unifie Parkinson s Disease Rating Scale V. Moifie Hoehn an Yahr Staging STAGE signs of isease. STAGE 1 = Unilateral isease. STAGE 1.5 = Unilateral plus axial involvement. STAGE 2 = Bilateral isease, without impairment of balance. STAGE 2.5 = Mil bilateral isease, with recovery on pull test. p STAGE 3 = Mil to moerate bilateral isease; some postural instability; physically inepenent. STAGE 4 = Severe isability; still able to walk or stan unassiste. STAGE 5 = Wheelchair boun or berien unless aie. Thank you very much. Feel free to bill your time uner a spasticity coe #8302. VI. Schwab an Englan Activities of Daily Living Scale Also, the billing coe for the entire PSS project is % = Completely inepenent. Able to o all chores without slowness, ifficulty or impairment. Essentially normal. We nee to get Unaware a graphic of going any ifficulty. for the online version of the Dyskinesia monograph. Let s 90% try two = Completely versions. One inepenent. that says Dyskinesia Able to an o one all that chores says with Dyskinesia some Workbook, egree of slowness, ifficulty an impairment. PD Workbook. Might The tag take line twice shoul as rea long. Beginning to be aware of ifficulty. The 80% Clinicians = Completely Guie to Management inepenent of Dyskinesia most chores. in PD Takes twice as long. Conscious of ifficulty an slowness. Billing 70% coe = Not for Dyskinesia completely is #8304. inepenent. More ifficulty with some chores. Three to four times as long in some. Must spen a large part of the ay with chores. 60% = Some epenency. Can o most chores, but exceeingly slowly an with much effort. Errors; some impossible. 50% = More epenent. Help with half, slower, etc. Difficulty with everything. 40% = Very epenent. Can assist with all chores, but few alone. 30% = With effort, now an then oes a few chores alone or begins alone. Much help neee. 20% = Nothing alone. Can be a slight help with some chores. Severe invali. 10% = Totally epenent, helpless. Complete invali. 0% = Vegetative functions such as swallowing, blaer an bowel functions are not functioning. Berien. Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham 28 PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD RATING SCALE WE MOVE 2006

7 Unifie Parkinson s Disease Data Form Name Unit Number 4. Motivation/Initiative r a spasticity coe #8302. tire PSS project is g for the online 20. Tremor at rest: face,lips,chin ograph. Hans: right t says Dyskinesia an one that says Dyskinesia Workbook, ul rea ement of Dyskinesia in PD opa mg/ay Date hrs opa lasts. Mentation 2. Thought Disorer 3. Depression Subtotal 1 4 (maximum = 16) 5. Speech 6. Salivation. Swallowing. Hanwriting. Cutting foo 0. Dressing. Hygiene 2. Turning in be 3. Falling 4. Freezing 5. Walking 6. Tremor 17. Sensory symptoms Subtotal 5 17 (maximum = 52) Speech. Facial expression Feet: right 21. Action tremor: right 22. Rigiity: neck Upper extremity: right Lower extremity: right on off on off on off on off on off on off on off on off p ps PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD DATA FORM WE MOVE

8 Unifie Parkinson s Disease Data Form Date 23. Finger taps: right 24. Han grips: right 25. Han pronate/supinate: right 26. Leg agility: right 27. Arise from chair 28. Posture 29. Gait 30. Postural stability Thank you very 31. much. Boy braykinesia Sub-total:18 31 (maximum = 108) Feel free to bill your time uner a spasticity coe #8302. Total points: 1 31 (max = 176) 32. Dyskinesia (uration) Also, the billing 33. Dyskinesia coe for the (isability) entire PSS project is Dyskinesia (pain) We nee 35. to Early get a graphic morning going ystonia for the online version of the Dyskinesia monograph. Let s try two 36. versions. Offs One (preictable) that says Dyskinesia an one that says Dyskinesia Workbook, 37. Offs (unpreictable) PD Workbook. The tag line shoul rea 38. Offs (suen) The Clinicians Guie to Management of Dyskinesia in PD 39. Offs (uration) Billing 40. coe Anorexia, for Dyskinesia nausea, is vomiting # Sleep isturbance 42. Symptomatic orthostasis Bloo Pressure: seate supine staning Weight Pulse: seate staning Name of Examiner Hoehn & Yahr Stage % ADL Score (PD) % ADL (with ) on off on off on off on off on off on off on off on off p best worst best worst best worst best worst best worst best worst best worst best worst Fahn S, Elton R, Members of the uprs Development Committee. In: Fahn S, Marsen CD, Calne DB, Golstein M, es. Recent Developments in Parkinson s Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, pp , PD WORKBOOK THE WE MOVE CLINICIANS GUIDE TO PARKINSON S DISEASE UNIFIED PD DATA FORM WE MOVE 2006