Hoehn and Yahr Scale

Original Editor - Shreya Pavaskar

Top Contributors - Aminat Abolade

Introduction[edit | edit source]

Hoehn and Yahr was originally published in 1967 in the journal Neurology by Margaret Hoehn and Melvin Yahr and included stages 1 through 5[1]. In 1983 Larsen et al. [2] published an article entitled "Theoretical and practical issues in assessment of deficits and therapy in Parkinsonism," wherein they included a modification of the original Hoehn and Yahr scale. They added some minor alterations which did not substantially change the basic classification published in 1967. This scale is used along with Unified Parkinson's Disease Rating Scale for a better assessment of Parkinson's disease.

Purpose[edit | edit source]

The scale has been used for the staging of the functional disability associated with Parkinson's disease. It helps in describing the progression of the disease through various stages, thus allowing us to measure the severity of the case.

Technique[edit | edit source]

The assessment requires a medical examination and according to the history given by the patients and their caregivers, the scoring is done.

Stage Hoehn and Yahr Scale Modified Hoehn and Yahr Scale
1 Unilateral involvement only usually with minimal or no functional disability Unilateral involvement only
1.5 - Unilateral and axial involvement
2 Bilateral or midline involvement without impairment of balance Bilateral involvement without impairment of balance
2.5 - Mild bilateral disease with recovery on pull test
3 Bilateral disease: mild to moderate disability with impaired postural reflexes; physically independent Mild to moderate bilateral disease; some postural instability; physically independent
4 Severely disabling disease; still able to walk or stand unassisted Severe disability; still able to walk or stand unassisted
5 Confinement to bed or wheelchair unless aided Wheelchair bound or bedridden unless aided

Evidence[edit | edit source]

In a review of the use of Hoehn and Yahr staging, the Movement Disorder Society concluded that the modified scale should not be used due to a lack of clinimetric testing, and that the broad categories of the original scale do not allow for detection of effective interventions[3]. For these reasons, the scale is used in clinical trials to define inclusion and exclusion criteria, but not typically as an outcome measure.

Resources[edit | edit source]

Parkinson's - Key Evidence and Resources

Parkinson's - Anatomy, Pathology, Prognosis and Diagnosis

Parkinson's Clinical Presentation

Parkinson's Case Study

Unified Parkinson's Disease Rating Scale (UPDRS)

Parkinson's Disease - Management

References[edit | edit source]

  1. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology. 1998 Feb 1;50(2):318-.
  2. Larsen TA, LeWitt PA, Calne DB. Theoretical and practical issues in assessment of deficits and therapy in parkinsonism. Lisuride and other dopamine agonists. 1983:363-73.
  3. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations the Movement Disorder Society Task Force on rating scales for Parkinson's disease. Movement disorders. 2004 Sep;19(9):1020-8.