Rubric Guide

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Unified Parkinson’s
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4 = Withdrawn, complete loss of motivation.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 PARKINSON’S 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 PARKINSON’S DISEASE
DYSKINESIA MANAGEMENT
1 = Mildly affected. No difficulty beingTOunderstood.
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.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
2 = “Benign” hallucinations with insight retained.
both ala the
3 =Workbook.
Ocode
ccasional
frequent
hallucinations
or delusions;
PD
Theto
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
#8304.
Not
able
care forisself.
1 = Slight but definite excess ofTOsaliva
in mouth;
may have
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 = Periods 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

dpd

II. Activities of Daily Living

dyskinesia

pss
pssm
dyskinesia

pssm

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

TO POST-STROKE SPASTICITY MANAGEMENT

Unified Parkinson’s Disease Rating Scale
8. Handwriting

13. Falling (Unrelated to Freezing)

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.

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.

pssm

9. Cutting Food and Handling Utensils

14. Freezing when Walking

dpd

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 PARKINSON’S
help needed.
3 = Frequent freezing. Occasionally
falls from
freezing.DISEASE
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.

15. Walking

10.
FeelDressing
free to bill your time under a spasticity code #8302.
0 = Normal.
1 = Somewhat slow, but no help needed.
2Also,
= Occasional
buttoning,
getting
the billingassistance
code for thewith
entire
PSS project
is 8305.arms in sleeves.
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.

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.

dyskinesia

Let’s 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.

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.

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

pssm

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.

PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006

pss

Unified Parkinson’s Disease Rating Scale
III. Motor Examination

22. Rigidity (Judged on passive movement of major joints

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.

pssm

19. Facial Expression

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.

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
severecode
or complete
loss of
Feel
to billor
your
timefacies
underwith
a spasticity
#8302.
facial expression; lips parted 1/4 inch or more.
Also, the billing code for the entire PSS project is 8305.

dpd

23. Finger Taps (Patient taps thumb with index finger in
TO DYSKINESIA IN PARKINSON’S 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.

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
inversions.
amplitude
persistent.
Or moderate
Let’s
tryild
two
One and
that says
“Dyskinesia”
and one thatinsays “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

dyskinesia

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.

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.

pss

pssm

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.

Unified Parkinson’s Disease Rating Scale
26. Leg Agility (Patient taps heel on the ground in rapid

30. Postural Stability (Response to sudden, strong

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.

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.

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

DYSKINESIA IN PARKINSON’S
DISEASE
31. Body Bradykinesia andTOHypokinesia
(Combining

pssm

TO POST-STROKE SPASTICITY MANAGEMENT

dpd

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.need
Posture
We
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.
Let’s 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
person.
PD Workbook.
Theolder
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
Dyskinesiaposture
is #8304.with kyphosis; can be
3 = Severely
moderately leaning to one side.
4 = Marked flexion with extreme abnormality of posture.

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

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

TO POST-STROKE SPASTICITY MANAGEMENT

PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006

pss

Unified Parkinson’s Disease Rating Scale
IV. Complications of Therapy
(In the past week)

36. Are “off ” periods predictable?

A. Dyskinesias

0 = No
1 = Yes

32. Duration: What proportion of the waking day are
dyskinesias present? (Historical information.)
0 = None
1 = 1–25% of day.
2 = 26–50% of day.
3 = 51–75% of day.
4 = 76–100% of day.

B. Clinical Fluctuations

pssm

37. Are “off ” periods unpredictable?
0 = No
1 = Yes

TO POST-STROKE SPASTICITY MANAGEMENT

33. Disability: How disabling are the dyskinesias?
information; may be modified by office
Thank(Historical
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.

TO RESTLESS LEG SYNDROME

38. Do “off ” periods comeTOon
suddenly,
withinDISEASE
a
DYSKINESIA
IN PARKINSON’S
few seconds?
0 = No
1 = Yes

dyskinesia
39. What proportion
of the waking day is the patient
“off ” on average?

0 = None
1 = 1–25% of day.
2 = 26–50% of day.
We need to get a graphic going for the online
3 = 51–75% of day.
version of the Dyskinesia monograph.
4 = 76–100% of day.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”

34. Painful Dyskinesias: How painful are the

both ala the
dyskinesias?
PD Workbook.
The tag line should read

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

35. Presence of Early Morning Dystonia
(Historical information.)
0 = No
1 = Yes

dpd

TO DYSKINESIA MANAGEMENT

dyskinesia
TO DYSKINESIA MANAGEMENT IN PD

C. Other Complications

40. Does the patient have anorexia, nausea, or vomiting?
0 = No
1 = Yes

pss

pssm

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

42. Does the patient have symptomatic orthostasis?
(Record the patient’s 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 Parkinson’s Disease, Vol 2. Florham
Park, NJ. Macmillan Health Care Information 1987, 153-163, 293-304.
PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006

Unified Parkinson’s Disease Rating Scale
V. Modified Hoehn and Yahr Staging
STAGE 0 = No signs of disease.
STAGE 1 = Unilateral disease.
TO RESTLESS LEG SYNDROME

STAGE 1.5 = Unilateral plus axial involvement.
STAGE 2 = Bilateral disease, without impairment of balance.

pssm

STAGE 2.5 = Mild bilateral disease, with recovery on pull test.

dpd

STAGE 3 = Mild to moderate bilateral disease; some postural instability; physically independent.
TO POST-STROKE SPASTICITY MANAGEMENT

STAGE 4 = Severe disability; still able to walk or stand unassisted.

TO DYSKINESIA IN PARKINSON’S DISEASE

STAGE 5 = Wheelchair bound or bedridden unless aided.
Thank you very much.

dyskinesia

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

VI. Schwab and England Activities of Daily Living Scale

TO DYSKINESIA MANAGEMENT

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

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

dyskinesia

version of the Dyskinesia monograph.
Let’s
try two
Oneindependent.
that says “Dyskinesia”
sayswith
“Dyskinesia
90%
= Cversions.
ompletely
Able toand
doone
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

= Completely
independent
in most chores.
The80%
Clinicians’
Guide to Management
of Dyskinesia
in PD Takes twice as long. Conscious of difficulty and slowness.
Billing
code
is #8304.
70%
= Nfor
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

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.

PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006

pss

Unified Parkinson’s
Disease Data Form
Name __________________________________________________________________________________ Unit Number ______________________________________________________
Date
dopa mg/day

hrs dopa lasts
on

off

on off

off

1. Mentation

off

on off

off

TO RESTLESS LEG SYNDROME

2. Thought Disorder
3. Depression
4. Motivation/Initiative

pssm

Subtotal 1 – 4 (maximum = 16)
5. Speech

6. Salivation

7.
Swallowing
TO POST-STROKE
SPASTICITY MANAGEMENT
8. Handwriting

dpd

9. Cutting food

TO DYSKINESIA IN PARKINSON’S DISEASE

10. Dressing
11. Hygiene
12. Turning in bed
13. Falling
14. Freezing

15.
Walking
er a spasticity
code #8302.
16. Tremor

dyskinesia

17. Sensory symptoms

TO DYSKINESIA MANAGEMENT

Subtotal 5 – 17 (maximum = 52)

ntire PSS project is 8305.

18 Speech
19. Facial expression

20. Tremor at rest: face,lips,chin
ng for the online
nograph.
Hands: right
at says “Dyskinesia” and one that says
left“Dyskinesia Workbook,”
Feet: right

ould read

left

TO DYSKINESIA MANAGEMENT IN PD

21. Action tremor: right

gement of Dyskinesia in PD

#8304.

dyskinesia

left

22. Rigidity: neck
Upper extremity: right
left
Lower extremity: right
left

pssm

TO POST-STROKE SPASTICITY MANAGEMENT

Unified Parkinson’s Disease Data Form
Date
on

off

on off

off

on off

off

23. Finger taps: right
left
24. Hand grips: right

TO RESTLESS LEG SYNDROME

left
25. Hand pronate/supinate: right

pssm

left

26. Leg agility: right
left
27. Arise from chair

TO POST-STROKE SPASTICITY MANAGEMENT

28. Posture

dpd
TO DYSKINESIA IN PARKINSON’S DISEASE

29. Gait
30. Postural stability
31.much.
Body bradykinesia
Thank you very
Sub-total:18 –31 (maximum = 108)

dyskinesia

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

Total points: 1 –31 (max = 176)

32. Dyskinesia (duration)

TO DYSKINESIA MANAGEMENT

Also, the billing
code for the
entire PSS project is 8305.
33. Dyskinesia
(disability)

34. Dyskinesia (pain)
We need
toEarly
get a graphic
going
for the online
35.
morning
dystonia
version of the Dyskinesia monograph.
“Offs”One
(predictable)
Let’s try two 36.
versions.
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,isvomiting

41. Sleep disturbance
42. Symptomatic orthostasis
Blood Pressure: seated
supine
standing
Weight

pssm
TO POST-STROKE SPASTICITY MANAGEMENT

Pulse: seated
standing
Name of Examiner
best worst best worst best worst best worst best worst best worst best worst best worst

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 Parkinson’s Disease, Vol 2. Florham Park, NJ.
Macmillan Health Care Information 1987, pp 153-163, 293-304

pss

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