Progressive Supranuclear Palsy Rating Scale (PSP-RS)
Introduction[edit | edit source]
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[edit | edit source]
This scale is targeted toward measuring the severity of clinical impairments in patients with Progressive supranuclear Palsy (PSP).
Method Of Use[edit | edit source]
Equipment:[edit | edit source]
Scale, Pen, Paper.
Cup of water
Training Required:[edit | edit source]
some examination item require prior clinical training
Time Required:[edit | edit source]
10 min
Instrument and Scoring[edit | edit source]
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).
- The History/Daily Activities area: seven items with a total maximum score of 24,
- The Mentation area: four items with a maximum score of 16,
- The Bulbar area: two items with a maximum score of 8,
- the ocular motor area four items with a maximum score of 16 points,
- The limb motor area six items with a maximum score of 16.
- 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 1 nor 2� insomnia
1 Either 1� or 2� insomnia; averages 55 h sleep nightly
2 Both 1� and 2� insomnia; averages 55 h sleep nightly
3 Either 1� or 2� insomnia; averages55 h sleep nightly
4 Both 1� and 2� insomnia; averages55 h sleep nightly
1� insomnia is difficulty falling asleep
2� is difficulty remaining asleep
Ignore trips to bathroom after which pt. returns to sleep easily
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
Estimate the degree to which each deficit would interfere with
performance of daily cognitive tasks
8. Disorientation Use MMSE items 1^10 or history to estimate interference in ADLs
9. Bradyphrenia
10. Emotional incontinence If there is a history of inappropriate laughing or crying but none
at the time of the examination, rate a ‘1’ or ‘2’, depending on its
frequency
11. Grasping/imitatative/utilizing behaviour If none is displayed spontaneously (e.g. grabbing your coat or arm, or the wheelchair arm), ask patient to rest hands on thighs,
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[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis[edit | edit source]
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Resources[edit | edit source]
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