Motor Examination single point in time

20. 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

21. Facial expression

0 = Normal

1 = Minimal hypomimia, could be normal, "poker face".

2 = Slight but definitely abnormal diminution of facial expression.

3 = Moderate hypomimia, lips parted some of the time.

4 = Masked or fixed facies with severe or complete loss of facial expression, lips parted 1/4 inch or more.

22. Tremor at rest (rated separately for jaw, right and left upper and lower extremities)

0 = Absent

1 = Slight and infrequently present.

2 = Mild in amplitude and persistent. Or moderate in amplitude, but only inter mittently present.

3 = Moderate in amplitude and present most of the time.

4 = Marked in amplitude and present most of the time.

23. Action or postural tremor of hands (rated for right and left separately)

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.

24. Rigidity (judged on passive movement of major points with patient relaxed in sitting position; cogwheeling to be ignored; rated separately for neck, right and left upper and lower extremities)

0 = Absent

1 = Slight or detectable only when activated by mirror or other movements.

2 = Mild to moderate.

3 = Marked, but full range of motion easily achieved.

4 = Severe, range of motion achieved with difficulty.

25. Finger taps (patient taps thumb with index finger in rapid succession with widest amplitude possible, each hand evaluated and scored separately).

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.

26. Hand movements (patient opens and closes hands in rapid succession with widest amplitude possible, each hand evaluated and scored separately).

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.

27. Hand pronation-supination (pronation-supination movements of hands, vertically or horizontally, with as large as amplitude as possible, both hands evaluated simultaneously and scored separately)

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.

28. Leg agility (patient taps heel on ground in rapid succession, picking up entire leg. Amplitude should be about three inches; rated separately for each side).

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.

29. Arising from chair (patient attempts to arise from a straight-back wood or metal chair with arms folded across chest).

0 = Normal

1 = Slow, or may need more than one attempt.

2 = Pushes self up from arms of seat.

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.

30. Posture

0 = Normal

1 = Not quite erect, slightly stooped posture; could be normal for older person.

2 = Moderately stooped posture, definitely abnormal; can be slightly leaning to one side.

3 = Severely stooped posture with kyphosis; can be moderately leaning to one side.

4 = Marked flexion with extreme abnormality of posture.

31. Removed

32. Gait

0 = Normal

1 = Walks slowly, may shuffle with short steps, but no festination or propulsion.

2 = Walks with difficulty, but requires little or no assistance; may have some fes-

tination, short steps, or propulsion.

3 = Severe disturbance of gait, requiring assistance.

4 = Cannot walk at all, even with assistance.

33. Postural stability (response to sudden posterior displacement produced by pull on shoulders while patient erect with eyes open and feet slightly apart. Patient is prepared.)

0 = Normal

1 = Retropulsion, but recovers unaided.

2 = Absence of postural response, would fall if not caught by examiner.

3 = Very unstable, tends to loose balance spontaneously.

4 = Unable to stand without assistance.

34. Body bradykinesia (combining slowness, hesitancy, decreased armswing, small amplitude, and poverty of movement in general).

1 = Minimal slowness, giving movement a deliberate character; could be normal for s ome persons. Possibly reduced amplitude.

2 = Mild degree of slowness, poverty of movement that is definitely abnormal.

Alternatively, some reduced amplitude.

3 = Moderate slowness, poverty or small amplitude of movement.

4 = Marked slowness, poverty or small amplitude movement.

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