PD Exam & Intervention Flashcards
Unified PD Rating Scale (UPDRS)
Developed by an international group of neurologists; Revision launched in 2009 Total score Subscales Mentation, behavior, mood ADL Motor Complications of (drug) therapy Other issues
Schwab & England
Rates overall function on a ten point scale 100 = completely independent 0 = totally dependent, vegetative functions are not working (e.g., bowel, bladder, swallowing)
PROFILE PD
24 item scale; 96 points total
11 items: Body systems (e.g., rigidity, tremor, postural instability)
10 items: Activities (e.g., turn in bed, adjust bed
sheets, transfer, gait)
3 items: memory, depression, involvement
0-4 for each item
0= no difficulty to 4 = marked/severe difficulty
Data obtained by interview & examination
Psychometrics of PROFILE PD
Inter-rater reliability ICC = .97
Factor Analysis – single scale
Validity
Regression with CS-PFP and covariates:R-sq = .78
Correlation with UDPRS: .86
Strong correlation even after adjusting for
other factors
Continuous Scale Physical Functional
Performance – CS-PFP
Performance based test 15 real life task (e.g., carry pot, make bed, laundry, vacuuming) Performed continuously High reliability, sensitivity to change Realiable and valid for people with PD
Continuous Scale Physical Functional
Performance – CS-PFP Cutoff Scores
Transition from
independence, about 57
H&Y 3 - 30
Functional Reach Cutoff Score
Cut off, falls risk: 12.5 inches
Timed Up & Go Cutoff Score
Cut off, falls risk: 7.95 sec
Six Minute Walk Scores
Expected range 60-69 yrs. 460-609 m.
Increased mortality 350 m.
Two Minute Walk Scores
Expected mean: 185.3
Impairments of Typical Importance - PD
Posture Range of motion and flexibility E.g., hamstring muscles, gastrocnemius / soleus, shoulder flexion, axial Strength Quads, dorsiflexors, hip extensors, axial Pain Cardiovascular condition
Clinician’s Bottom Line - T&M
Functional decline begins very early – most measures aren’t sensitive Two measures detected deficits early CS-PFP Functional reach Choose measures, based on stage of PD and expected progression For all patients – overall summary (e.g., PROFILE PD or UPDRS)
Early Stage T&M
Balance Postural pull test Functional reach iTUG – Horak et al Gait Six Minute Walk test (SMW) 10 meter walk Impairments FAR Muscle length: Hamstrings, gastroc/soleus
Middle Stage - Balance T&M
Postural pull test Activities Balance Confidence Scale (ABC) Estimate of likelihood of falling Berg Balance Dynamic Gait Index Timed Up and Go Functional reach Late Middle Stage Falls diary
Middle Stage - Gait T&M
Six Minute Walk 10 meter walk (gait speed) Clinical issues: Level walking, inclines, stairs Turns – difference according to side of turn Cluttered areas Late Middle Stage Freezing of gait Two Minute versus Six Minute walk test