Progressive Supranuclear Palsy Rating Scale (PSP-RS)

Original Editor - Rucha Gadgil
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Introduction[edit | edit source]

The Progressive Supranuclear Palsy Rating Scale (PSPRS) is a disease specific measure of severity in patients with progressive supranuclear palsy (PSP). It measures disability across 28 items in six domains: daily activities (by history), behaviour, bulbar, ocular motor, limb motor and gait/midline. It was devised by Golbe and Strickland[1].

It is a quantitative measure of disability and attempts to include all of the important areas of clinical impairment in PSP[2].

Intended Population[edit | edit source]

This scale is targeted toward measuring the severity of clinical impairments in patients with Progressive supranuclear Palsy (PSP).

Method Of Use[edit | edit source]

Equipment:[edit | edit source]

Scale, Pen, Paper.

Cup of water

Training Required:[edit | edit source]

some examination items require prior clinical training

Time Required:[edit | edit source]

10 min[1]

Instrument and Scoring[edit | edit source]

It is a Clinician reported measuring disability across six domains giving a maximum score of 100[3]. It comprises of 28 items in six areas. Six items are rated on a 3-point scale (0–2) and 22 are rated on a 5-point scale (0–4).

  1. The History/Daily Activities area: seven items with a total maximum score of 24,
  2. The Mentation area: four items with a maximum score of 16,
  3. The Bulbar area: two items with a maximum score of 8,
  4. the ocular motor area four items with a maximum score of 16 points,
  5. The limb motor area six items with a maximum score of 16.
  6. The Gait area: five items with a maximum score of 20.
Item name and score definitions Comments, instructions
I. History 1.Withdrawal

0 None

1 Follows conversation in a group, may respond spontaneously, but rarely if ever initiates exchanges

2 Rarely or never follows conversation in a group

2. Irritability

0 No increase in irritability

1 Increased, but not interfering with family interactions

2 Interfering with family interactions

3. Dysphagia for solids

0 Normal; no difficulty with full range of food textures

1 Tough foods must be cut up into small pieces

2 Requires soft solid diet

3 Requires pureed or liquid diet

4 Tube feeding required for some or all feeding

4.Using knife and fork, buttoning clothes, washing hands and face

0 Normal

1 Somewhat slow but no help required

2 Extremely slow; or occasional help needed

3 Considerable help needed but can do some things alone

4 Requires total assistance

5. Falls

0 None in the past year

1 <1 per month; gait may otherwise be normal

2 1-4 per month

3 5-30 per month

4 >30 per month (or chairbound)

6. Urinary incontinence

0 None or a few drops less than daily

1 A few drops staining clothes daily

2 Large amounts, but only when asleep; no pad required during day

3 Occasional large amounts in daytime; pad required

4 Consistent, requiring diaper or catheter awake and asleep

7. Sleep difficulty

0 Neither primary nor secondary insomnia

1 Either primary or secondary insomnia; averages <5 h sleep nightly

2 Both primary and secondary insomnia; averages <5 h sleep nightly

3 Either primary or secondary insomnia; averages <5 h sleep nightly

4 Both primary and secondary insomnia; averages <5 h sleep nightly

primary insomnia is difficulty falling asleep

secondary is difficulty remaining asleep

II. Mentation

Items 8 -11 use this scale:

0 Clearly absent

1 Equivocal or minimal

2 Clearly present, but does not interfere with activities of daily living (ADL)

3 Interferes mildly with ADL

4 Interferes markedly with ADL

8. Disorientation ; Use MMSE items 1^-10 or history to estimate interference in ADLs

9. Bradyphrenia 

10. Emotional incontinence 

11. Grasping/imitative /utilizing behaviour 

III. Bulbar 12. Dysarthria

0 None

1 Minimal; all or nearly all words easily comprehensible

2 Definite, moderate; most words comprehensible

3 Severe; may be fluent but most words incomprehensible

4 Mute; or a few poorly comprehensible words

13. Dysphagia

0 None

1 Single sips, or fluid pools in mouth or pharynx, but no choking/coughing

2 Occasionally coughs to clear fluid; no frank aspiration

3 Frequently coughs to clear fluid; may aspirate slightly; may expectorate frequently rather than swallow secretions

4 Requires artificial measures (oral suctioning, tracheostomy or feeding gastrostomy) to avoid aspiration

IV. Ocular motor

Items 14 -16 use this scale:

0 Saccades not slow or hypometric; 86 -100% of normal excursion

1 Saccades slow or hypometric; 86 - 100% of normal excursion

2 51- 85% of normal excursion

3 16- 50% of normal excursion

4 <15% of normal excursion or worse

14.Voluntary upward command movement

15.Voluntary downward command movement

16.Voluntary left and right command movement

17. Eyelid dysfunction

0 None

1 Blink rate decreased (515/min) but no other abnormality

2 Mild inhibition of opening or closing or mild blepharospasm; no visual disability

3 Moderate lid-opening inhibition or blepharospasm causing partial visual disability

4 Functional blindness or near-blindness because of involuntary eyelid closure

V. Limb motor 18. Limb rigidity

0 Absent

1 Slight or detectable only on activation

2 Definitely abnormal, but full range of motion possible

3 Only partial range of motion possible

4 Little or no passive motion possible

19. Limb dystonia

0 Absent

1 Subtle or present only when activated by other movement

2 Obvious but not continuous

3 Continuous but not disabling

4 Continuous and disabling

20. Finger tapping

0 Normal ( <14 taps/5 s with maximal amplitude)

1 Impaired (6 -14 taps/5 s or moderate loss of amplitude

2 Barely able to perform (0 -5 taps/5 s or severe loss of amplitude)

21. Toe tapping

0 Normal (<14 taps/5 s with maximal amplitude)

1 Impaired (6 -14 taps/5 s or moderate loss of amplitude

2 Barely able to perform (0 -5 taps/5 s or severe loss of amplitude)

22. Apraxia of hand movement

0 Absent

1 Present, not impairing most functions

2 Impairing most functions

23. Tremor in any part

0 Absent

1 Present, not impairing most functions

2 Impairing most functions

VI. Gait and midline 24. Neck rigidity or dystonia

0 Absent

1 Slight or detectable only when activated by other movement

2 Definitely abnormal, but full range of motion possible

3 Only partial range of motion possible

4 Little or no passive motion possible

25. Arising from chair

0 Normal

1 Slow but arises on first attempt

2 Requires more than one attempt, but arises without using hands

3 Requires use of hands

4 Unable to arise without assistance

26. Gait

0 Normal

1 Slightly wide-based or irregular or slight pulsion on turns

2 Must walk slowly or occasionally use walls or helper to avoid falling, especially on turns

3 Must use assistance all or almost all the time

4 Unable to walk, even with walker; may be able to transfer

27. Postural stability

0 Normal (shifts neither foot or one foot)

1 Must shift each foot at least once but recovers unaided

2 Shifts feet and must be caught by examiner

3 Unable to shift feet; must be caught, but does not require assistance to stand still

4 Tends to fall without a pull; requires assistance to stand still

28. Sitting down

0 Normal

1 Slightly stiff or awkward

2 Easily positions self before chair, but descent into chair is uncontrolled

3 Has difficulty finding chair behind him/her and descent is uncontrolled

4 Unable to test because of severe postural instability


This scale is designed to work a a clinical prognostic guide.

Psychometric Properties[edit | edit source]

Reliability: excellent (IRR= 0.86, 95% CI= 0.65–0.98)[1]

Good sensitivity to disease progression[2]

Validity: moderate construct validity[1]

Resources[edit | edit source]

Find detailed information here.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Golbe LI, Ohman-Strickland PA. A clinical rating scale for progressive supranuclear palsy. Brain. 2007 Jun;130(Pt 6):1552-65.
  2. 2.0 2.1 Hewer S, Varley S, Boxer AL, Paul E, Williams DR; AL-108-231 Investigators. Minimal clinically important worsening on the progressive supranuclear Palsy Rating Scale. Mov Disord. 2016 ;31(10):1574-1577.
  3. Hall, D.A., Forjaz, M.J., Golbe, L.I., Litvan, I., Payan, C.A.M., Goetz, C.G.,et al. Scales to Assess Clinical Features of Progressive Supranuclear Palsy: MDS Task Force Report. Mov Disord Clin Pract, 2015. 2: 127-134