Modified Parkinson Activity Scale

Transcription

1 Modified Parkinson Activity Scale Chair transfers Analyses: Instruction: Chair with 40 cm seat height, or, when at the patient's home, the chair that causes the greatest problems to the patient and is used frequently. Beware to use the same chair at retesting. The patient is seated in the chair, with his hands in his lap. The highest scores are used for rising with or without using hands (maximum 4), and for sitting down with or without using hands (maximum 4). In a moment, I will ask you later to rise from the chair. You may lean with your hands on the arm of the chair or your knees. When standing, you will have to wait a second. 1.A. Rise without using hands Please rise without using your arms on the knees or chair normal, without apparent difficulties mild difficulties (toes dorsiflex to maintain balance, arms swing forward to keep balance or use of consciously performed rocks (compensations) with the trunk difficult, several attempts needed or hesitations, very slow and almost no flexion of the trunk impossible, dependent on physical assistance (perform I-B) A. Sit down without using hands Please, sit down again without using your arms mild difficulties (uncontrolled landing) 3 clear abrupt landing or ending in an uncomfortable position 2 impossible, dependent on physical assistance (perform I-B) 0 1.B. Rise with using hands (only scored if rising without using hands is impossible) Will you try to rise again? When standing, you have to wait a second again. You may use your hands now. normal, without apparent difficulties 2 difficult, several attempts needed or hesitations, very slow and almost no flexion of the trunk 1 impossible, dependent on physical assistance 0 2.B. Sit down with using hands (only scored if rising without using hands is impossible) Please, sit down again. You may use your hands. normal, without apparent difficulties 2 abrupt landing or ending up in an uncomfortable position 1 dependent on physical assistance 0

2 Gait akinesia Chair (see Chair Transfers) Plastic cup, ¾ full with water A U-shape taped on the floor. The middle of the U-shape is situated three meters in front of the middle of the chair. The lengths of the sides of the U are 1 meter. Instruction: The patient is seated in the chair with his hands in his lap. First, the preferred side with regard to turning is determined by asking the patient to walk, turn, and return. The patient has to be able to walk without the help of others. Do you see the tape in U-shape? In a moment, I will ask you to rise. You may, if you want to, use your hands. Then you walk to the U and turn inside the U. It is up to you how you do this. Then you return to the chair and sit down. It is not about doing it as fast as you can. It is about doing it safely. Is that clear? Please rise, walk to the U, turn within the U, and return to sit down in the chair. Non-preferred turning side: Left Right (at items 3 to 8, the patient is asked to turn to this side). 3. Start akinesia without an extra task (possibly assist with rising, which is not scored) 4. Turning 180 without an extra task Now a bit more difficult: while carrying a plastic cup with water. Please rise, walk to the U, turn within the U and return to sit down in the chair. 5. Start akinesia with a motor dual task (possibly assist with rising, which is not scored)

3 6. Turning 180 with a motor dual task Now even more difficult: while counting backwards in threes, starting with 100. Please rise, walk to the U, turn within the U and return to sit down in the chair. (if required, an example of counting backwards is given, starting at 110). 7. Start akinesia with a cognitive dual task (possibly assist with rising, which is not scored) 8. Turning 180 with a cognitive dual task Bed mobility Analyses: Information: Bed, pillow, sheets and blanket or duvet. For the items concerning rolling over (10a/b and 13a/b), the mean of the a and b scores is used The patient is standing in front of the bed on the preferred side. Before rolling over onto the side, the patient is, if required, assisted to lie comfortably on his back. If you are standing in front of your bed at home, at which side is your pillow? 9. Lying down without a cover Please, lie down on your back on the cover, just like you would do at home. Be sure that you end up in a comfortable position. difficulty with lifting legs 1 difficulty 3 difficulty with moving trunk 2 difficulties 2 difficulty with reaching adequate end functionally limiting or uncomfortable* 3 difficulties 1 dependent on physical assistance: patient asks clearly for help or does not reach an acceptable end position dependent 0

4 10. Rolling over without a cover A. Please, roll over onto your side. To the left. Be sure that you end up in a comfortable position. normal, without apparent difficulties Normal 4 difficulty with turning trunk/pelvis 1 difficulty 3 difficulty with moving trunk/pelvis 2 difficulties 2 difficulty with reaching adequate end functionally limiting or uncomfortable** 3 difficulties 1 dependent on physical assistance: patient asks clearly for help or does notreach an acceptable end position dependent 0 B. Please, roll over onto your back. Now, roll over onto your other side. To the right. Be sure that you end up in a comfortable position. difficulty with turning trunk/pelvis 1 difficulty difficulty with moving trunk/pelvis 2 difficulties 3 difficulty with reaching adequate end 3 difficulties 2 functionally limiting or uncomfortable** 1 dependent Getting out of bed without a cover Please, rise and sit on the edge of the bed with both feet on the ground. difficulty with turning trunk/pelvis 1 difficulty 3 difficulty with moving legs 2 difficulty 2 difficulty with reaching adequate end asymmetric, uncomfortable 3 difficulty 1 dependent Lying down with a cover Please, lie down on your back under the cover. Be sure that you end up in a comfortable position under the covers. difficulty with moving trunk or leg 1 difficulty 3 difficulty with adjusting cover*** or reaching no adequate covering, e.g. with part of the back uncovered 2 difficulties 2 3 difficulties 1 difficulty with reaching adequate end functionally limiting or uncomfortable* dependent 0

5 13. Rolling over with a cover A. Please, roll over onto your side. To the left. Be sure that you end up in a comfortable position under the covers. difficulty with turning trunk/pelvis 1 difficulty 3 difficulty with adjusting cover*** or reaching no adequate covering, e.g. with part of the back uncovered 2 difficulties3 difficulties 2 1 difficulty with reaching adequate end functionally limiting or uncomfortable** dependent 0 B. Please, roll over onto your back. Now, roll over onto your other side. To the right. Be sure that you end up in a comfortable position under the covers. difficulty with turning trunk/pelvis 1 difficulty 3 difficulty with adjusting cover*** or reaching no adequate covering, e.g. with part of the back uncovered 2 difficulties3 difficulties 2 1 difficulty with reaching adequate end functionally limiting or uncomfortable** dependent Getting out of bed with a cover Please, rise and sit on the edge of the bed with both feet on the ground. difficulty with moving trunk or leg 1 difficulty 3 difficulty with adjusting cover*** 2 difficulties 2 3 difficulties 1 difficulty with reaching adequate end asymmetric, uncomfortable dependent 0 * Uncomfortable end position when lying on back: e.g. with head uncomfortably against the head of the bed or with legs which are not relaxed due to too much flexion. ** Uncomfortable end position when lying on side: e.g. underlying shoulder and arm insufficiently in protraction and free, head uncomfortably against the head of the bed, or less than 10 cm between trunk and the edge of the bed. *** Difficulty with adjusting cover: three or more adjustments.