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[1].
It is a quantitative measure of disability and attempts to include all of the important areas of clinical impairment in PSP[2].
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 items require prior clinical training
Time Required:[edit | edit source]
10 min[1]
Instrument and Scoring[edit | edit source]
It is a Clinician reported measuring disability across six domains giving a maximum score of 100[3]. 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 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 |
This scale is designed to work a a clinical prognostic guide.
Psychometric Properties[edit | edit source]
Reliability: excellent (IRR= 0.86, 95% CI= 0.65–0.98)[1]
Good sensitivity to disease progression[2]
Validity: moderate construct validity[1]
Resources[edit | edit source]
Find detailed information here.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Golbe LI, Ohman-Strickland PA. A clinical rating scale for progressive supranuclear palsy. Brain. 2007 Jun;130(Pt 6):1552-65.
- ↑ 2.0 2.1 Hewer S, Varley S, Boxer AL, Paul E, Williams DR; AL-108-231 Investigators. Minimal clinically important worsening on the progressive supranuclear Palsy Rating Scale. Mov Disord. 2016 ;31(10):1574-1577.
- ↑ Hall, D.A., Forjaz, M.J., Golbe, L.I., Litvan, I., Payan, C.A.M., Goetz, C.G.,et al. Scales to Assess Clinical Features of Progressive Supranuclear Palsy: MDS Task Force Report. Mov Disord Clin Pract, 2015. 2: 127-134