Patient name: | Date: |
Simpson-Angus Extrapyramidal Side Effects Scale | |
The exam should be conducted in a room where the subject can walk a sufficient distance to allow him/her to get into a natural rhythm (eg, 15 paces). Each side of the body should be examined. If one side shows more pronounced pathology than the other, this score should be noted and this taken. Cogwheel rigidity may be palpated when the examination is carried out for items 3, 4, 5, and 6. It is not rated separately and is merely another way to detect rigidity. It would indicate that a minimum score of 1 would be mandatory. | |
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0 – Normal | 0 – The legs swing freely |
1 – Diminution in swing while the patient is walking | 1 – Slight diminution in the swing of the legs |
2 – Marked diminution in swing with obvious rigidity in the arm | 2 – Moderate resistance to swing |
3 – Stiff gait with arms held rigidly before the abdomen | 3 – Marked resistance and damping of swing |
4 – Stooped shuffling gait with propulsion and retropulsion | 4 – Complete absence of swing |
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0 – Normal, free fall with loud slap and rebound | 0 – The head falls completely with a good thump as it hits the table |
1 – Fall slowed slightly with less audible contact and little rebound | 1 – Slight slowing in fall, mainly noted by lack of slap as head meets the table |
2 – Fall slowed, no rebound | 2 – Moderate slowing in the fall quite noticeable to the eye |
3 – Marked slowing, no slap at all | 3 – Head falls stiffly and slowly |
4 – Arms fall as though against resistance; as though through glue | 4 – Head does not reach the examining table |
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0 – Normal | 0 – 0 to 5 blinks |
1 – Slight stiffness and resistance | 1 – 6 to 10 blinks |
2 – Moderate stiffness and resistance | 2 – 11 to 15 blinks |
3 – Marked rigidity with difficulty in passive movement | 3 – 16 to 20 blinks |
4 – Extreme stiffness and rigidity with almost a frozen shoulder | 4 – 21 and more blinks |
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0 – Normal | 0 – Normal |
1 – Slight stiffness and resistance | 1 – Mild finger tremor, obvious to sight and touch |
2 – Moderate stiffness and resistance | 2 – Tremor of hand or arm occurring spasmodically |
3 – Marked rigidity with difficulty in passive movement | 3 – Persistent tremor of one or more limbs |
4 – Extreme stiffness and rigidity with almost a frozen elbow | 4 – Whole body tremor |
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0 – Normal | 0 – Normal |
1 – Slight stiffness and resistance | 1 – Excess salivation to the extent that pooling takes place if the mouth is open and the tongue raised |
2 – Moderate stiffness and resistance | 2 – When excess salivation is present and might occasionally result in difficulty speaking |
3 – Marked rigidity with difficulty in passive movement | 3 – Speaking with difficulty because of excess salivation |
4 – Extreme stiffness and rigidity with almost frozen wrist | 4 – Frank drooling |
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