SCOPA
A short scale for the assessment of motor impairments and disabilities in Parkinson’s disease:
The SPES/SCOPA
A. MOTOR EVALUATION
Clinical examination
1. Rest tremor
Assess each arm separately during 20 seconds; hands rest on thighs; if tremor is not evident at rest, try to keep the patient attentive—for example, by having them count backwards with eyes closed
0=absent
1=small amplitude (1 cm) occurring spontaneously, or obtained only while keeping patient attentive (any amplitude)
2=moderate amplitude (1–4 cm), occurring spontaneously
3=large amplitude (>4 cm), occurring spontaneously.
2. Postural tremor
Check with arms outstretched, pronated and semipronated, and with index fingers of both hands almost touching each other (elbows flexed); assess each position during 20 seconds.
0=absent
1=small amplitude (1 cm)
2=moderate amplitude (1–4 cm)
3=large amplitude (>4 cm).
3. Rapid alternating movements of hands
Rapid alternating pronation/supination movements of upper hand, each time slapping the palm of the horizontally held lower hand during 20 seconds; each hand separately
0=normal
1=slow execution, or mild slowing and/or reduction in amplitude; may have occasional arrests
2=moderate slowing and/or reduction in amplitude or hesitations in initiating movements or frequent arrests in ongoing movements
3=can barely perform task.
4. Rigidity
Assess passive movements of elbow and wrist over full range, with the patient relaxed in sitting position; ignore cogwheeling; check each arm separately
0=absent
1=mild rigidity over full range, no difficulty reaching end positions
2=moderate rigidity, some difficulties reaching end positions
3=severe rigidity, considerable difficulties reaching end positions.
5. Rise from chair
Patient is instructed to fold arms across chest; use straight back chair
0=normal
1=slowly; does not need arms to get up
2=needs arms to get up (can get up without help)
3=unable to rise (without help).
6. Postural stability
Stand behind the patient and pull patient backwards, while patient is standing erect with eyes open and feet spaced slightly apart; patient is not prepared
0=normal, may take up to two steps to recover
1=takes three or more steps; recovers unaided
2=would fall if not caught
3=spontaneous tendency to fall or unable to stand unaided.
7. Gait
Assess gait pattern; use walking aid or offer assistance, if necessary
0=normal
1=mild slowing and/or reduction of step height or length; does not shuffle
2=severe slowing, or shuffles, or has festination
3=unable to walk.
8. Speech
0=normal
1=slight loss of expression, diction, and/or volume
2=slurred; not always intelligible
3=unintelligible always or most of the time.
9. Freezing during ‘‘on’’
Freezing is characterised by hesitation when trying to start walking or being ‘‘glued’’ to the ground while walking
0=absent
1=start hesitation only, occasionally present
2=frequently present, may have freezing when walking
3=severe freezing when walking.
10. Swallowing
0=normal
1=some difficulty or slow; does not choke; normal diet
2=sometimes chokes; may require soft food
3=chokes frequently; may require soft food or alternative method of food intake.
B. ACTIVITIES OF DAILY LIVING
11. Speech
0=normal
1=some difficulty; may sometimes be asked to repeat sentences
2=considerable difficulty; frequently asked to repeat sentences
3=unintelligible most of the time.
12. Feeding (cutting, filling cup, etc.)
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance
3=needs almost complete or complete assistance.
13. Dressing
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance—for instance, buttoning, getting arms into sleeves
3=needs almost complete or complete assistance.
14. Hygiene (washing, combing hair, shaving, brushing teeth, using toilet)
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance
3=needs almost complete or complete assistance.
15. Changing position (turning over in bed, getting up out of bed, getting up out of a chair, turning around when standing)
0=normal
1=some difficulty or slow; does not need assistance with any change of position
2=considerable difficulty; may need assistance with one or more changes of position
3=needs almost complete or complete assistance with one or more changes of position.
16. Walking
0=normal
1=some difficulty or slow; does not need assistance or walking aid
2=considerable difficulty; may need assistance or walking aid
3=unable to walk, or walks only with assistance and great effort.
17. Handwriting
0=normal
1=some difficulty—for instance, slow, small letters; all words legible
2=considerable difficulty; not all words legible; may need to use block letters
3=majority of words are illegible.
C. MOTOR COMPLICATIONS
18. Dyskinesias (presence)
0=absent
1=present some of the time
2=present a considerable part of the time
3=present most or all of the time.
19. Dyskinesias (severity)
0=absent
1=small amplitude
2=moderate amplitude
3=large amplitude.
20. Motor fluctuations (presence of ‘‘off’’ periods)
What proportion of the waking day is patient ‘‘off’’ on average?
0=none
1=some of the time
2=a considerable part of the time
3=most or all of the time.
21. Motor fluctuations (severity of ‘‘off’’ periods)
0=absent
1=mild end-of-dose fluctuations
2=moderate end-of-dose fluctuations; unpredictable fluctuations may occur occasionally
3=severe end-of-dose fluctuations; unpredictable on–off oscillations occur frequently.
The SPES/SCOPA
A. MOTOR EVALUATION
Clinical examination
1. Rest tremor
Assess each arm separately during 20 seconds; hands rest on thighs; if tremor is not evident at rest, try to keep the patient attentive—for example, by having them count backwards with eyes closed
0=absent
1=small amplitude (1 cm) occurring spontaneously, or obtained only while keeping patient attentive (any amplitude)
2=moderate amplitude (1–4 cm), occurring spontaneously
3=large amplitude (>4 cm), occurring spontaneously.
2. Postural tremor
Check with arms outstretched, pronated and semipronated, and with index fingers of both hands almost touching each other (elbows flexed); assess each position during 20 seconds.
0=absent
1=small amplitude (1 cm)
2=moderate amplitude (1–4 cm)
3=large amplitude (>4 cm).
3. Rapid alternating movements of hands
Rapid alternating pronation/supination movements of upper hand, each time slapping the palm of the horizontally held lower hand during 20 seconds; each hand separately
0=normal
1=slow execution, or mild slowing and/or reduction in amplitude; may have occasional arrests
2=moderate slowing and/or reduction in amplitude or hesitations in initiating movements or frequent arrests in ongoing movements
3=can barely perform task.
4. Rigidity
Assess passive movements of elbow and wrist over full range, with the patient relaxed in sitting position; ignore cogwheeling; check each arm separately
0=absent
1=mild rigidity over full range, no difficulty reaching end positions
2=moderate rigidity, some difficulties reaching end positions
3=severe rigidity, considerable difficulties reaching end positions.
5. Rise from chair
Patient is instructed to fold arms across chest; use straight back chair
0=normal
1=slowly; does not need arms to get up
2=needs arms to get up (can get up without help)
3=unable to rise (without help).
6. Postural stability
Stand behind the patient and pull patient backwards, while patient is standing erect with eyes open and feet spaced slightly apart; patient is not prepared
0=normal, may take up to two steps to recover
1=takes three or more steps; recovers unaided
2=would fall if not caught
3=spontaneous tendency to fall or unable to stand unaided.
7. Gait
Assess gait pattern; use walking aid or offer assistance, if necessary
0=normal
1=mild slowing and/or reduction of step height or length; does not shuffle
2=severe slowing, or shuffles, or has festination
3=unable to walk.
8. Speech
0=normal
1=slight loss of expression, diction, and/or volume
2=slurred; not always intelligible
3=unintelligible always or most of the time.
9. Freezing during ‘‘on’’
Freezing is characterised by hesitation when trying to start walking or being ‘‘glued’’ to the ground while walking
0=absent
1=start hesitation only, occasionally present
2=frequently present, may have freezing when walking
3=severe freezing when walking.
10. Swallowing
0=normal
1=some difficulty or slow; does not choke; normal diet
2=sometimes chokes; may require soft food
3=chokes frequently; may require soft food or alternative method of food intake.
B. ACTIVITIES OF DAILY LIVING
11. Speech
0=normal
1=some difficulty; may sometimes be asked to repeat sentences
2=considerable difficulty; frequently asked to repeat sentences
3=unintelligible most of the time.
12. Feeding (cutting, filling cup, etc.)
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance
3=needs almost complete or complete assistance.
13. Dressing
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance—for instance, buttoning, getting arms into sleeves
3=needs almost complete or complete assistance.
14. Hygiene (washing, combing hair, shaving, brushing teeth, using toilet)
0=normal
1=some difficulty or slow; does not need assistance
2=considerable difficulty; may need some assistance
3=needs almost complete or complete assistance.
15. Changing position (turning over in bed, getting up out of bed, getting up out of a chair, turning around when standing)
0=normal
1=some difficulty or slow; does not need assistance with any change of position
2=considerable difficulty; may need assistance with one or more changes of position
3=needs almost complete or complete assistance with one or more changes of position.
16. Walking
0=normal
1=some difficulty or slow; does not need assistance or walking aid
2=considerable difficulty; may need assistance or walking aid
3=unable to walk, or walks only with assistance and great effort.
17. Handwriting
0=normal
1=some difficulty—for instance, slow, small letters; all words legible
2=considerable difficulty; not all words legible; may need to use block letters
3=majority of words are illegible.
C. MOTOR COMPLICATIONS
18. Dyskinesias (presence)
0=absent
1=present some of the time
2=present a considerable part of the time
3=present most or all of the time.
19. Dyskinesias (severity)
0=absent
1=small amplitude
2=moderate amplitude
3=large amplitude.
20. Motor fluctuations (presence of ‘‘off’’ periods)
What proportion of the waking day is patient ‘‘off’’ on average?
0=none
1=some of the time
2=a considerable part of the time
3=most or all of the time.
21. Motor fluctuations (severity of ‘‘off’’ periods)
0=absent
1=mild end-of-dose fluctuations
2=moderate end-of-dose fluctuations; unpredictable fluctuations may occur occasionally
3=severe end-of-dose fluctuations; unpredictable on–off oscillations occur frequently.
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