Progressive Supranuclear Palsy Rating Scale (PSP-RS)

Original Editor - Rucha Gadgil
Top Contributors - Rucha Gadgil

Introduction

The Progressive Supranuclear Palsy Rating Scale (PSPRS) is a disease specific measure of severity in patients with progressive supranuclear palsy (PSP). It measures disability across 28 items in six domains: daily activities (by history), behaviour, bulbar, ocular motor, limb motor and gait/midline. It was devised by Golbe and Strickland.

It is a quantitative measure of disability and attempts to include all of the important areas of clinical impairment in PSP.

Intended Population

This scale is targeted toward measuring the severity of clinical impairments in patients with Progressive supranuclear Palsy (PSP).

Method Of Use

Equipment:

Scale, Pen, Paper.

Cup of water

Training Required:

some examination item require prior clinical training

Time Required:

10 min

Instrument and Scoring

It is a Clinician reported measuring disability across six domains giving a maximum score of 100. It comprises of 28 items in six areas. Six items are rated on a 3-point scale (0–2) and 22 are rated on a 5-point scale (0–4).

1. The History/Daily Activities area: seven items with a total maximum score of 24,
2. The Mentation area: four items with a maximum score of 16,
3. The Bulbar area: two items with a maximum score of 8,
4. the ocular motor area four items with a maximum score of 16 points,
5. The limb motor area six items with a maximum score of 16.
6. The Gait area: five items with a maximum score of 20.

Item name and score definitions Comments, instructions
I. History	1.Withdrawal 0 None 1 Follows conversation in a group, may respond spontaneously, but rarely if ever initiates exchanges 2 Rarely or never follows conversation in a group 2. Irritability 0 No increase in irritability 1 Increased, but not interfering with family interactions 2 Interfering with family interactions 3. Dysphagia for solids 0 Normal; no difficulty with full range of food textures 1 Tough foods must be cut up into small pieces 2 Requires soft solid diet 3 Requires pureed or liquid diet 4 Tube feeding required for some or all feeding 4.Using knife and fork, buttoning clothes, washing hands and face 0 Normal 1 Somewhat slow but no help required 2 Extremely slow; or occasional help needed 3 Considerable help needed but can do some things alone 4 Requires total assistance 5. Falls 0 None in the past year 1 <1 per month; gait may otherwise be normal 2 1-4 per month 3 5-30 per month 4 >30 per month (or chairbound) 6. Urinary incontinence 0 None or a few drops less than daily 1 A few drops staining clothes daily 2 Large amounts, but only when asleep; no pad required during day 3 Occasional large amounts in daytime; pad required 4 Consistent, requiring diaper or catheter awake and asleep 7. Sleep difficulty 0 Neither primary nor secondary insomnia 1 Either primary or secondary insomnia; averages <5 h sleep nightly 2 Both primary and secondary insomnia; averages <5 h sleep nightly 3 Either primary or secondary insomnia; averages <5 h sleep nightly 4 Both primary and secondary insomnia; averages <5 h sleep nightly primary insomnia is difficulty falling asleep secondary is difficulty remaining asleep
II. Mentation Items 8 -11 use this scale: 0 Clearly absent 1 Equivocal or minimal 2 Clearly present, but does not interfere with activities of daily living (ADL) 3 Interferes mildly with ADL 4 Interferes markedly with ADL	8. Disorientation ; Use MMSE items 1^-10 or history to estimate interference in ADLs 9. Bradyphrenia  10. Emotional incontinence  11. Grasping/imitative /utilizing behaviour
III. Bulbar	12. Dysarthria 0 None 1 Minimal; all or nearly all words easily comprehensible 2 Definite, moderate; most words comprehensible 3 Severe; may be fluent but most words incomprehensible 4 Mute; or a few poorly comprehensible words 13. Dysphagia 0 None 1 Single sips, or fluid pools in mouth or pharynx, but no choking/coughing 2 Occasionally coughs to clear fluid; no frank aspiration 3 Frequently coughs to clear fluid; may aspirate slightly; may expectorate frequently rather than swallow secretions 4 Requires artificial measures (oral suctioning, tracheostomy or feeding gastrostomy) to avoid aspiration
IV. Ocular motor Items 14 -16 use this scale: 0 Saccades not slow or hypometric; 86 -100% of normal excursion 1 Saccades slow or hypometric; 86 - 100% of normal excursion 2 51- 85% of normal excursion 3 16- 50% of normal excursion 4 <15% of normal excursion or worse	14.Voluntary upward command movement 15.Voluntary downward command movement 16.Voluntary left and right command movement 17. Eyelid dysfunction 0 None 1 Blink rate decreased (515/min) but no other abnormality 2 Mild inhibition of opening or closing or mild blepharospasm; no visual disability 3 Moderate lid-opening inhibition or blepharospasm causing partial visual disability 4 Functional blindness or near-blindness because of involuntary eyelid closure
V. Limb motor	18. Limb rigidity 0 Absent 1 Slight or detectable only on activation 2 Definitely abnormal, but full range of motion possible 3 Only partial range of motion possible 4 Little or no passive motion possible 19. Limb dystonia 0 Absent 1 Subtle or present only when activated by other movement 2 Obvious but not continuous 3 Continuous but not disabling 4 Continuous and disabling 20. Finger tapping 0 Normal ( <14 taps/5 s with maximal amplitude) 1 Impaired (6 -14 taps/5 s or moderate loss of amplitude 2 Barely able to perform (0 -5 taps/5 s or severe loss of amplitude) 21. Toe tapping 0 Normal (<14 taps/5 s with maximal amplitude) 1 Impaired (6 -14 taps/5 s or moderate loss of amplitude 2 Barely able to perform (0 -5 taps/5 s or severe loss of amplitude) 22. Apraxia of hand movement 0 Absent 1 Present, not impairing most functions 2 Impairing most functions 23. Tremor in any part 0 Absent 1 Present, not impairing most functions 2 Impairing most functions
VI. Gait and midline	24. Neck rigidity or dystonia 0 Absent 1 Slight or detectable only when activated by other movement 2 Definitely abnormal, but full range of motion possible 3 Only partial range of motion possible 4 Little or no passive motion possible 25. Arising from chair 0 Normal 1 Slow but arises on first attempt 2 Requires more than one attempt, but arises without using hands 3 Requires use of hands 4 Unable to arise without assistance 26. Gait 0 Normal 1 Slightly wide-based or irregular or slight pulsion on turns 2 Must walk slowly or occasionally use walls or helper to avoid falling, especially on turns 3 Must use assistance all or almost all the time 4 Unable to walk, even with walker; may be able to transfer 27. Postural stability 0 Normal (shifts neither foot or one foot) 1 Must shift each foot at least once but recovers unaided 2 Shifts feet and must be caught by examiner 3 Unable to shift feet; must be caught, but does not require assistance to stand still 4 Tends to fall without a pull; requires assistance to stand still 28. Sitting down 0 Normal 1 Slightly stiff or awkward 2 Easily positions self before chair, but descent into chair is uncontrolled 3 Has difficulty finding chair behind him/her and descent is uncontrolled 4 Unable to test because of severe postural instability

Management / Interventions

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Differential Diagnosis

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Resources

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