Subject(s)
Movement Disorders/history , Neurology/history , Europe , Exhibitions as Topic , History, 19th Century , History, 20th Century , Humans , SpainABSTRACT
Our objective was to test whether at-home videotapes yield enhanced information on tics compared to office-based videotapes and a patient questionnaire on the current anatomical distribution of tics. Ten subjects with Gilles de la Tourette syndrome (age range 8-49 years) who were seen for initial evaluation completed a check list of anatomical areas currently affected with tics, and underwent a videotape examination according to the Rush Videotape Protocol. Each patient/family conducted the same protocol at home at the same time of day within 48 hours. We rated two tapes in random order using the modified published scoring method for the Rush Video-based Tic Rating Scale. Two environments were compared, the doctor's office and at home, with videotapes taken in three conditions: patient engaged in relaxed conversation, patient quietly seated with filmer in the room, and patient quietly seated alone in the room. Data were analyzed using a 2-factor repeated-measures analysis of variance (ANOVA), followed by Wilcoxon signed rank tests. All patients provided excellent quality videotapes that could be scored without difficulty. Environment (office vs. home) and Condition (conversation, quiet with observer, quiet and alone) were both highly significant (P < .0001) and did not interact (P = .54). The highest tic scores for total tic impairment occurred at home with the patient alone (mean score 14.5), and the lowest yield occurred in the office with an observer present (mean score 5.4), the setting closest to the clinical neurological examination. The Home/Alone video segments revealed tics not otherwise seen. Patient questionnaires on body regions recorded more areas than observed in the office videotape, but patients were unaware of several tics captured on the Home/Alone segment. Patients can produce videotapes for objective tic assessments. Because at-home videotapes consistently yield higher tic expressions than in-office films and capture tics that are not appreciated by patients, this methodology is well-suited for enhanced retrieval of objective data on tic expression.
Subject(s)
Social Environment , Tics/diagnosis , Tourette Syndrome/diagnosis , Videotape Recording , Adolescent , Adult , Ambulatory Care , Child , Female , Humans , Male , Middle Aged , Neurologic Examination , Observer Variation , Physicians' OfficesSubject(s)
Electrodiagnosis/history , Movement Disorders/history , Myography/history , Neurologic Examination/history , Tremor/history , Electrodiagnosis/instrumentation , Exhibitions as Topic , History, 19th Century , History, 20th Century , Humans , Movement Disorders/diagnosis , Myography/instrumentation , Spain , Tremor/diagnosisSubject(s)
Movement Disorders/history , Canada , Exhibitions as Topic , History, 19th Century , History, 20th Century , Humans , Spain , United StatesSubject(s)
Movement Disorders/history , England , Eponyms , France , History, 17th Century , History, 19th Century , Humans , Movement Disorders/therapy , Neurology/historySubject(s)
Chorea/history , Exhibitions as Topic , Movement Disorders/history , Chorea/diagnosis , Chorea/therapy , England , History, 15th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Medieval , Humans , Neurology/history , Spain , Terminology as Topic , United StatesABSTRACT
The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) assesses the character and severity of cervical dystonia (CD). We developed a teaching tape of the TWSTRS scoring for the motor symptoms of CD. The tape provides investigators with visual representations of each component of the motor section of the TWSTRS as agreed upon by three independently scoring raters. The rate of agreement for the nondichotomous components was always significant, with a Kendall's coefficient of concordance W ranging between 0.98 and 0.76 (p < 0.01 for all measures). For the two dichotomous components, a weighted kappa coefficient was also significant at 0.86 for lateral shift and 0.89 for sagittal shift (p < 0.01 for both measures). Scale deficiencies identified by the raters were an explicit definition of midline for assessment of range of motion, the absence of a separate scoring category assessing dystonic tremor, and the specification of duration for the effect of sensory tricks. These observations should be taken into account in future revisions of the TWSTRS and in refinements of other rating scales for CD.
Subject(s)
Dystonia/diagnosis , Motor Activity/physiology , Neck/physiopathology , Neurologic Examination/standards , Task Performance and Analysis , Torticollis/diagnosis , Videotape Recording , Dystonia/physiopathology , Humans , Neurologic Examination/methods , Observer Variation , Reproducibility of Results , Severity of Illness Index , Teaching/methods , Torticollis/physiopathologyABSTRACT
We developed a teaching tape of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) to provide investigators with a visual document of three raters' interpretations of the scoring system for each item except rigidity. The rate of agreement for the selected samples was always significant, with Kendall's coefficient of concordance W ranging between 0.97 and 0.62. We also provided full UPDRS ratings on sample patients that may be used for training and for multicenter studies to assure uniformity of rating. The study identified several items of the UPDRS motor examination for which written instructions were vague, including speech, action tremor, finger taps, rapid alternating movements, and postural stability. Future versions of the scale should address these problems and correct ambiguities. This project offers the first attempt to provide a visual analog for the UPDRS.
Subject(s)
Audiovisual Aids , Neurologic Examination/statistics & numerical data , Parkinson Disease/diagnosis , Disability Evaluation , Humans , Observer Variation , Parkinson Disease/classification , Reproducibility of Results , SoftwareABSTRACT
Although dyskinesia is a frequent and important problem in Parkinson's disease (PD), a reliable assessment measure has not been thoroughly developed and tested. We modified the Obeso dyskinesia scale to create an objective rating scale for dyskinesia assessment during activities of daily living. Thirteen physicians and 15 study coordinators involved in a clinical trial independently reviewed videotape segments of PD patients performing three tasks: walking, putting on a coat, and lifting a cup to the lips for drinking. Raters evaluated the severity of worst dyskinesia seen, the types of all dyskinesias seen, and the type of dyskinesia most associated with motoric disability. For all assessments, the total group showed statistically significant inter- and intrarater reliability. Physicians had a higher consistency than did coordinators, but for most measures the difference was not statistically significant. Physicians and coordinators found the scale easy to use and especially practical for rating dyskinesia severity and for identifying the most disabling dyskinesia. Dyskinesias can be assessed in clinical trials and warrant regular documentation.
