Conseguiu-se realizar a transmissão do sinal, como proposto. Isso serviu como prova de que a tecnologia é factível e pode ter seus custos reduzidos.
Como passos futuros, deseja-se a miniaturização do sistema por meio do uso de componentes SMD (sigla em inglês para Surface-Mount device), a adição de novos canais, um desenvolvimento mais completo do software e a inserção de novos sensores. Também será necessária a realização de coletas em pacientes com DP para que se possa validar o sistema.
Por fim, percebe-se que essa tecnologia pode ter aplicação em campos diferentes da avaliação da DP, tal como na área de fitness, por exemplo, e em diversos outros procedimentos que demandam coleta de sinais de sEMG na área da saúde.
56
Referências
ALEXANDER, C. K.; SADIKU, M. N. O. Fundamentos de circuitos elétricos. 5a. ed.
Porto Alegre: AMGH Editora Ltda., 2013. ISBN 9788580551730. Citado 7 vezes nas páginas 8,25, 26, 28,29, 30e 31.
ALVES, G. C. et al. Electromyographic assessment on transfemoral amputees to possibly control artificial lower limbs. International Journal of Biomedical
Engineering and Technology, v. 17, n. 1, p. 72, 2015. ISSN 1752-6418. Disponível em:
<http://www.inderscience.com/link.php?id=66969>. Citado na página 16.
ANDRADE, N. A. Desenvolvimento de um Sistema de Aquisição e Processamento de Sinais Eletromiográficos de Superfície para a Utilização no Controle de Próteses Motoras Ativas. 2007. Dissertação (Programa de Pós Gradução em Engenharia Elétrica), UnB (Universidade de Brasília), Brasília, Brasil. Citado 3 vezes nas páginas 15, 20 e46.
Arduino. What’s Arduino? 2017. Disponível em: <https://www.arduino.cc/en/Guide/
Introduction>. Acesso em: 29 novembro 2017. Citado na página 41.
ATMEL. AVR121: Enhancing ADC resolution by oversampling Microcontrollers. 2005.
Citado na página 35.
Atmel. Atmel 8-bit AVR Microcontroller with 2/4/8K Bytes In-System Programmable Flash :ATtiny25/V / ATtiny45/V / ATtiny85/V. 2013. Disponível em <http://www.
atmel.com/images/atmel-2586-avr-8-bit-microcontroller-attiny25-attiny45-attiny85_
datasheet.pdf>. Acesso em: Acesso em: 29 novembro 2017. Citado 3 vezes nas páginas 8, 41e 42.
BRUNO, A. C. et al. Manual de Utilização da Norma IEC 6060. Ribeirão Preto:
[s.n.], 2010. Disponível em: <http://citrus.uspnet.usp.br/ingtec/htdocs/uploads/
8f6bc036-ab5a-3dbd.pdf>. Acesso em: 22 junho 2017. Citado na página 36.
CRAM, J. R.; STEGER, J. C. Muscle scanning and the diagnosis of chronic pain.
Biofeedback Self-Regul., n. 8, p. 229–241, 1983. Citado na página17.
Creative Commons CORPORATION. Creative Commons Legal Code. 2005. Disponível em: <https://creativecommons.org/licenses/by-nc-sa/2.5/legalcode>. Acesso em: 13 julho 2017. Citado na página 47.
CRISWELL, E. Cram’s Introduction to Surface Electromyography. 2a. ed. Sudbury:
Jones and Bartlett Publishers, 2011. Citado 8 vezes nas páginas 14, 16, 17, 18, 19, 20, 27 e 38.
De Luca, J. C. et al. Decomposition of surface EMG signals. J Neurophysiol, v. 96, n. 3, p. 1646–1657, 2006. ISSN 0022-3077. Disponível em: <http://dx.doi.org/10.1152/jn.
00009.2006>. Citado na página 18.
DU BOIS-REYMOND, E. Untersuchungen ueber thiersiche electricitae. Berlin: Teimer Verlag, 1849. v. 2. Citado na página 16.
Referências 57
FERREIRA, A. T. Fisiologia da contração muscular. Revista Neurociências, v. 13, n. 3, p. 60–62, 2005. Citado 2 vezes nas páginas 17 e18.
GAGO, M. Manual para Pessoas com Parkinson. APDPk - Associação Portuguesa de Doentes de Parkinson, 2014. Citado 5 vezes nas páginas 10, 14, 21, 22 e23.
GOPURA, R.; KIGUCHI, K. Application of surface electromyographic signals to control exoskeleton robots. In: Applications of EMG in Clinical and Sports Medicine. [S.l.]:
InTech, 2012. Citado na página 20.
GUEDES, L. U. et al. Electromyographic activity of sternocleidomastoid muscle in patients with Parkinson’s disease. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, v. 19, n. 4, p.
591–597, 2009. ISSN 1873-5711. Citado na página 37.
HOROWITZ, P.; HILL, W. The Art of Electronics. 2a. ed. [S.l.]: Cambridge University Press, 1989. Citado 9 vezes nas páginas 8, 25, 26,27, 28, 29, 30,32 e 35.
Instructables. Acesso em: 4 abril 2017. Disponível em: <http://www.instructables.com>.
Citado na página 47.
JOSHI, D.; KHAJURIA, A.; JOSHI, P. An automatic non-invasive method for Parkinson’s disease classification. Computer Methods and Programs in Biomedicine, Elsevier Ireland Ltd, v. 145, p. 135–145, 2017. ISSN 18727565. Citado na página 21.
KAMINSKI, B.DIY Muscle Sensor / EMG Circuit for a Microcontroller. 2011. Disponível em: <http://www.instructables.com/id/Muscle-EMG-Sensor-for-a-Microcontroller/>.
Acesso em: 4 abril 2017. Citado 2 vezes nas páginas 15e 47.
LACANETTE, K. A Basic Introduction to Filters - Active, Passive, and Switched-Capacitor. National Semiconductor: Application Note, p. 1–22, 1991. Citado 5 vezes nas páginas 8,31, 32, 33e 34.
LUCA, C. J. D. S Urface E Lectromyography : D Etection and R Ecording. DelSys Incorporated, v. 10, n. 2, p. 1–10, 2002. Disponível em: <http://scholar.google.com/
scholar?hl=en{&}btnG=Search{&}q=intitle:SURFACE+ELECTROMYOGRAPHY+:
+DETECTION+AND+RECOR>. Citado 3 vezes nas páginas 20, 36e 37.
LUKHANINA, E.; KARABAN, I.; BEREZETSKAYA, N. Diagnosis of parkinson’s disease by electrophysiological methods. In:Diagnostics and Rehabilitation of Parkinson’s Disease. [S.l.]: InTech, 2011. Citado na página24.
MARINO, S. et al. Early marker for the diagnosis of parkinson’s disease. In: Diagnostics and Rehabilitation of Parkinson’s Disease. [S.l.]: InTech, 2011. Citado 2 vezes nas páginas 21e 22.
MARSDEN, C. D. Parkinson’s Disease. Journal of Neurology, Neurosurgery, and Psychiatry, v. 57, p. 672–681, 1994. Citado 2 vezes nas páginas 21 e 22.
MARUSIAK, J. et al. EMG and MMG activities of agonist and antagonist muscles in Parkinson’s disease patients during absolute submaximal load holding. Journal of Electromyography and Kinesiology, v. 19, n. 5, p. 903–914, 2009. ISSN 10506411. Citado na página 37.
Referências 58
MEIGAL, A. I. et al. Novel parameters of surface EMG in patients with Parkinson’s disease and healthy young and old controls.Journal of Electromyography and Kinesiology, v. 19, n. 3, p. 206–213, 2009. ISSN 10506411. Citado 3 vezes nas páginas 14, 24 e37.
NELSON, J. S.; GRANDE, T. C.; WILSON, M. V. H. Fishes of the World. 5a. ed. New Jersey: Jhon Wiley & Sons, 2016. 82 p. ISBN 9781118342336. Citado na página 16.
Netter Anatomy Illustration Collection. [S.l.]: Elsevier, Inc. Citado 2 vezes nas páginas 8 e 18.
Nordic Semiconductor. nRF24L01+: Single Chip 2.4GHz Transceiver. 2008. Disponível em: <https://www.sparkfun.com/datasheets/Components/SMD/nRF24L01Pluss_
Preliminary_Product_Specification_v1_0.pdf>. Acesso em: 25 novembro 2017. Citado na página 42.
Open Bionics. Disponível em: <http://www.openbionics.com>. Acesso em: 22 junho 2017. Citado na página 20.
PERRY, J.; BURNFIELD, J. M. GAIT ANALYSIS: Normal and Pathological Function.
2a. ed. [S.l.]: SLACK Incorporated, 2010. Citado 2 vezes nas páginas 16e 38.
PFANN, K. D. et al. Control of movement distance in Parkinson’s disease. Movement Disorders, v. 16, n. 6, p. 1048–1065, 2001. ISSN 08853185. Citado na página 37.
PRUTCHI, D.; NORRIS, M. Design and Development of Medical Electronic Instrumentation: A Practical Perspective of the Design, Construction, and Test of Medical Devices. [S.l.]: Jhon Wiley & Sons, 2005. Citado na página 20.
RISSANEN, S. et al. Analysis of surface EMG signal morphology in Parkinson’s disease. Physiological Measurement, v. 28, n. 12, p. 1507–1521, 2007. ISSN 0967-3334.
Disponível em: <http://stacks.iop.org/0967-3334/28/i=12/a=005?key=crossref.
f2ddbdc01404929905f9c951f8c79939>. Citado 4 vezes nas páginas21, 22, 23e 37.
ROBICHAUD, J. A. et al. Variability of EMG patterns: A potential neurophysiological marker of Parkinson’s disease? Clinical Neurophysiology, International Federation of Clinical Neurophysiology, v. 120, n. 2, p. 390–397, 2009. ISSN 13882457. Disponível em:
<http://dx.doi.org/10.1016/j.clinph.2008.10.015>. Citado na página 37.
RUONALA, V. et al. EMG signal morphology and kinematic parameters in essential tremor and Parkinson’s disease patients. Journal of Electromyography and Kinesiology, Elsevier Ltd, v. 24, n. 2, p. 300–306, 2014. ISSN 18735711. Disponível em:
<http://dx.doi.org/10.1016/j.jelekin.2013.12.007>. Citado 3 vezes nas páginas14, 23 e 24.
SENIAM. 1999. Disponível em: <http://www.seniam.org>. Acesso em: 29 novembro 2017. Citado 4 vezes nas páginas 8, 19, 38e 39.
SPOLAOR, F. et al. Surface Emg Analysis in Parkinson Disease Patients Before and After Underwater Gait Training.Gait & Posture, Elsevier, n. xxxx, p. 1–2, 2017. ISSN 09666362.
Disponível em: <http://linkinghub.elsevier.com/retrieve/pii/S0966636217305088>.
Citado na página 37.
Referências 59
Texas Instruments. Precision Gain = 10 DIFFERENTIAL AMPLIFIER. 2003.
Disponível em: <http://www.ti.com/lit/ds/symlink/ina106.pdf>. Acesso em: 4 abril 2017. Citado 2 vezes nas páginas 8 e47.
Texas Instruments. Choose the right A / D converter for your application Agenda. 2009.
Disponível em: <https://www.ti.com/europe/downloads/Choose%20the%20right%
20data%20converter%20for%20your%20application.pdf>. Acesso em: 20 setembro 2017.
Citado 2 vezes nas páginas 10 e35.
Texas Instruments. LMx24-N, LM2902-NLow-Power, Quad-Operational Amplifiers.
2015. Disponível em: <http://www.ti.com/lit/ds/snosc16d/snosc16d.pdf>. Acesso em:
16 dezembro 2017. Citado na página 50.
Texas Instruments. INA118 Precision, Low Power Instrumentation Amplifier. 2016.
Disponível em: <http://www.ti.com/lit/ds/symlink/ina118.pdf>. Acesso em: 23 outubro 2017. Citado 3 vezes nas páginas 8, 39e 40.
Varta. CR 2025. 2006. Disponível em: <https://products.varta-microbattery.com/
/applications/mb_data/documents/data_sheets/DS6025.pdf>. Acesso em: 16 dezembro 2017. Citado na página 53.
WE MOVE . PD WORKBOOK - The WE MOVE Clinician’s guide to Parkinson’s Disease: UNIFIED PD SCALE. v. 2, p. 23–30, 2006. Disponível em: <http:
//img.medscape.com/fullsize/701/816/58977_UPDRS.pdf>. Acesso em: 2 dezembro 2017. Citado 2 vezes nas páginas 23e 61.
WU, C. Electric fish and the discovery of animal electricity. Am Scientist, n. 72, p.
598–607, 1984. Citado na página 16.
Anexos
61
ANEXO A – Escala UPDRS
Escala UPDRS para classificação da DP, também inclui a escala de Hoehn & Yahr.
Retirada de (WE MOVE , 2006).
TO POST-STROKE SPASTICITY MANAGEMENT
TO RESTLESS LEG SYNDROME
pssm
TO DYSKINESIA MANAGEMENT
dyskinesia
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
TO RESTLESS LEG SYNDROME
TO DYSKINESIA MANAGEMENT IN PD
dyskinesia dyskinesia
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
Thank you very much.
Feel free to bill your time under a spasticity code #8302.
Also, the billing code for the entire PSS project is 8305.
We need to get a graphic going for the online version of the Dyskinesia monograph.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
both ala the
PD Workbook. The tag line should read
The Clinicians’ Guide to Management of Dyskinesia in PD Billing code for Dyskinesia is #8304.
Unified Parkinson’s Disease Rating Scale
PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006 23
TO POST-STROKE SPASTICITY MANAGEMENT
TO RESTLESS LEG SYNDROME
pssm
TO DYSKINESIA MANAGEMENT
dyskinesia
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
TO RESTLESS LEG SYNDROME
TO DYSKINESIA MANAGEMENT IN PD
dyskinesia dyskinesia
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
Thank you very much.
Feel free to bill your time under a spasticity code #8302.
Also, the billing code for the entire PSS project is 8305.
We need to get a graphic going for the online version of the Dyskinesia monograph.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
both ala the
PD Workbook. The tag line should read
The Clinicians’ Guide to Management of Dyskinesia in PD Billing code for Dyskinesia is #8304.
I. Mentation, Behavior and Mood
1. Intellectual Impairment 0 = None.
= 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 of occasional prompting.
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.
Requires much help with personal care. Cannot be left alone at all.
2. Thought Disorder (Due to dementia or drug intoxication)
0 = None.
= Vivid dreaming.
2 = “Benign” hallucinations with insight retained.
3 = Occasional to frequent hallucinations or delusions;
without insight; could interfere with daily activities.
4 = Persistent hallucinations, delusions, or florrid psychosis.
Not able to care for self.
3. Depression
= P eriods of sadness or guilt greater than normal, never sustained for days or weeks.
2 = Sustained depression ( week or more).
3 = Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest).
4 = Sustained depression with vegetative symptoms and suicidal thoughts or intent.
4. Motivation/Initiative 0 = Normal.
= Less assertive than usual; more passive.
2 = Loss of initiative or disinterest in elective (nonroutine) activities.
3 = Loss of initiative or disinterest in day to day (routine) activities.
4 = Withdrawn, complete loss of motivation.
II. Activities of Daily Living
(for both “on” and “off”) 5. Speech
0 = Normal.
= Mildly affected. No difficulty being understood.
2 = Moderately affected. Sometimes asked to repeat statements.
3 = Severely affected. Frequently asked to repeat statements.
4 = Unintelligible most of the time.
6. Salivation 0 = Normal.
= Slight but definite excess of saliva in mouth; may have nighttime drooling.
2 = Moderately excessive saliva; may have minimal drooling.
3 = Marked excess of saliva with some drooling.
4 = Marked drooling, requires constant tissue or handkerchief.
7. Swallowing 0 = Normal.
= Rare choking.
2 = Occasional choking.
3 = Requires soft food.
4 = Requires ng tube or gastrotomy feeding.
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 , 53-63, 23-304.
TO POST-STROKE SPASTICITY MANAGEMENT
TO RESTLESS LEG SYNDROME
pssm
TO DYSKINESIA MANAGEMENT
dyskinesia
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
TO RESTLESS LEG SYNDROME
TO DYSKINESIA MANAGEMENT IN PD
dyskinesia dyskinesia
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
Thank you very much.
Feel free to bill your time under a spasticity code #8302.
Also, the billing code for the entire PSS project is 8305.
We need to get a graphic going for the online version of the Dyskinesia monograph.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
both ala the
PD Workbook. The tag line should read
The Clinicians’ Guide to Management of Dyskinesia in PD Billing code for Dyskinesia is #8304.
8. Handwriting 0 = Normal.
= 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.
9. Cutting Food and Handling Utensils 0 = Normal.
= Somewhat slow and clumsy, but no help needed.
2 = Can cut most foods, although clumsy and slow; some help needed.
3 = Food must be cut by someone, but can still feed slowly.
4 = Needs to be fed.
10. Dressing 0 = Normal.
= Somewhat slow, but no help needed.
2 = Occasional assistance with buttoning, getting arms in sleeves.
3 = Considerable help required, but can do some things alone.
4 = Helpless.
11. Hygiene 0 = Normal.
= Somewhat slow, but no help needed.
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.
= 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.
13. Falling (Unrelated to Freezing) 0 = None.
= Rare falling.
2 = Occasionally falls, less than once per day.
3 = Falls an average of once daily.
4 = Falls more than once daily.
14. Freezing when Walking 0 = None.
= Rare freezing when walking; may have start hesitation.
2 = Occasional freezing when walking.
3 = Frequent freezing. Occasionally falls from freezing.
4 = Frequent falls from freezing.
15. Walking 0 = Normal.
= Mild difficulty. May not swing arms or may tend to drag leg.
2 = Moderate difficulty, but requires little or no assistance.
3 = Severe disturbance of walking, requiring assistance.
4 = Cannot walk at all, even with assistance.
16. Tremor (Symptomatic complaint of tremor in any part of body.)
0 = Absent.
= Slight and infrequently present.
2 = Moderate; bothersome to patient.
3 = Severe; interferes with many activities.
4 = Marked; interferes with most activities.
17. Sensory Complaints Related to Parkinsonism 0 = None.
= Occasionally has numbness, tingling, or mild aching.
2 = Frequently has numbness, tingling, or aching; not distressing.
3 = Frequent painful sensations.
4 = Excruciating pain.
Unified Parkinson’s Disease Rating Scale
24 PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006 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 , 53-63, 23-304.
TO POST-STROKE SPASTICITY MANAGEMENT
TO RESTLESS LEG SYNDROME
pssm
TO DYSKINESIA MANAGEMENT
dyskinesia
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
TO RESTLESS LEG SYNDROME
TO DYSKINESIA MANAGEMENT IN PD
dyskinesia dyskinesia
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
Thank you very much.
Feel free to bill your time under a spasticity code #8302.
Also, the billing code for the entire PSS project is 8305.
We need to get a graphic going for the online version of the Dyskinesia monograph.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
both ala the
PD Workbook. The tag line should read
The Clinicians’ Guide to Management of Dyskinesia in PD Billing code for Dyskinesia is #8304.
III. Motor Examination
18. Speech 0 = Normal.
= Slight loss of expression, diction and/or volume.
2 = Monotone, slurred but understandable; moderately impaired.
3 = Marked impairment, difficult to understand.
4 = Unintelligible.
19. Facial Expression 0 = Normal.
= 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 /4 inch or more.
20. Tremor at Rest (head, upper and lower extremities) 0 = Absent.
= Slight and infrequently present.
2 = Mild in amplitude and persistent. Or moderate in amplitude, but only intermittently present.
3 = Moderate in amplitude and present most of the time.
4 = Marked in amplitude and present most of the time.
21. Action or Postural Tremor of Hands 0 = Absent.
= 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.
22. Rigidity (Judged on passive movement of major joints with patient relaxed in sitting position. Cogwheeling to be ignored.)
0 = Absent.
= 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.
23. Finger Taps (Patient taps thumb with index finger in rapid succession.)
0 = Normal.
= 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.
24. Hand Movements (Patient opens and closes hands in rapid succesion.)
0 = Normal.
= 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.
25. Rapid Alternating Movements of Hands (Pronation-supination movements of hands, vertically and horizontally, with as large an amplitude as possible, both hands simultaneously.)
0 = Normal.
= 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.
PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006 25
Unified Parkinson’s Disease Rating Scale
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 , 53-63, 23-304.
TO POST-STROKE SPASTICITY MANAGEMENT
TO RESTLESS LEG SYNDROME
pssm
TO DYSKINESIA MANAGEMENT
dyskinesia
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
TO RESTLESS LEG SYNDROME
TO DYSKINESIA MANAGEMENT IN PD
dyskinesia dyskinesia
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO POST-STROKE SPASTICITY MANAGEMENT
pssm
TO DYSKINESIA IN PARKINSON’S DISEASE
dpd
Thank you very much.
Feel free to bill your time under a spasticity code #8302.
Also, the billing code for the entire PSS project is 8305.
We need to get a graphic going for the online version of the Dyskinesia monograph.
Let’s try two versions. One that says “Dyskinesia” and one that says “Dyskinesia Workbook,”
both ala the
PD Workbook. The tag line should read
The Clinicians’ Guide to Management of Dyskinesia in PD Billing code for Dyskinesia is #8304.
26. Leg Agility (Patient taps heel on the ground in rapid succession picking up entire leg. Amplitude should be at least 3 inches.)
0 = Normal.
= 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. Arising from Chair (Patient attempts to rise from a straightbacked chair, with arms folded across chest.) 0 = Normal.
= 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.
28. Posture 0 = Normal erect.
= 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.
29. Gait 0 = Normal.
= 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.
30. Postural Stability (Response to sudden, strong posterior displacement produced by pull on shoulders while patient erect with eyes open and feet slightly apart.
Patient is prepared.) 0 = Normal.
= 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.
31. Body Bradykinesia and Hypokinesia (Combining slowness, hesitancy, decreased arm swing, small amplitude, and poverty of movement in general.) 0 = None.
= Minimal slowness, giving movement a deliberate character; could be normal for some persons. Possibly reduced amplitude.
2 = Mild degree of slowness and poverty of movement which is definitely abnormal. Alternatively, some reduced amplitude.
3 = Moderate slowness, poverty or small amplitude of movement.
4 = Marked slowness, poverty or small amplitude of movement.
26 PD WORKBOOK — THE WE MOVE CLINICIANS’ GUIDE TO PARKINSON’S DISEASE | UNIFIED PD RATING SCALE | ©WE MOVE 2006
Unified Parkinson’s Disease Rating Scale
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 , 53-63, 23-304.