EXTRAPYRAMIDAL SYMPTOM RATING SCALE

(Soeparman)
Sistem motorik dalam susunan syaraf pusat terdiri dari system pyramidal dan system
ekstrapiramidal. Sistem pyramidal adalah tractus corticospinal..
Sistem ekstrapiramidal suatu satuan fungsional yang terdiri diantaranya :
1. corpus striatum (nucleus caudatus dan putamen)
2. nucleus lentiformis (putamen dan globus palidus)
3. nucleus subtalamus
4. substanstia nigra
5. nucleus rubber.
ungsi system pyramidal sebagai perancang gerakan (planning) sedangkan system ekstra
pyramidal mengatur tonus agar gerakan men!adi lebih harmonis. "angguan dalam
system ekstrapiramidal menyebabkan trasmisi rangsangan tidak terkontrol akibatnya
kontraksi otot abnormal seperti rigid# akinesia# tremor# distonia.
$ada umumnya dikatakan bah%a putamen# nucleus caudatus dan substantia nigra
mempunyai pengaruh inhibisi terhadap impuls# dan globus palidus mempunyai
pengaruh fasilitasi dalam system ekstrapiramidal.
Secara sederhana penyakit atau kelainan system motorik dapat dibagi sebagai berikut :
1. $iramidal & kelumpuhan disertai refle' tendon meningkat dan refle' superficial
abnormal.
2. (kstrapiramidal& didominasi oleh adanya gerakan in)olenter (tidak terkendali)
3. Serebelar& adanya ata'ia
4. *euromuskuler & kelumpuhan# atrofi otot dan refle' tendon menurun.
"angguan system ekstrapiramidal dapat dibagi men!adi dua klompok :
1. Sindroma hipokinetik+hipertonik (sindroma $arkinson)
2. Sindroma hiperkinetik+hipotonik (chorea# athetose# ballismus# dystonia)
"angguan system ekstrapiramidal didominasi oleh sindroma $arkinson# sehingga
sindroma ekstrapiramidal identik dengan sindroma $arkinson. Oki, (kstrapiramidal
symptom ,ating Scale adalah identik dg $arkinson-s .isease ,ating Scale.
Sumber lain mengatakan sindrom ganglia basalia atau sindrom ekstrapiramidal
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PARKINSONS DISEASE RATING SCALE
(Extrapyramidal Symptom Rating Scale)
1. Bradykineia !" #and $in%&'din( )and*ri+in(
/ 0 *o in)ol)ement
1 0 detactable slo%ing of supination+pronation rate e)idenced by beginning
difficulty in handling tools# buttoning clothes# 1nd hand%riting.
2 0 moderate slo%ing supination+pronation rate# one or both side# e)idenced by
moderate impairment of hand function. 2and %riting is greaty impaired#
micrographia present.
3 0 se)ere slo%ing supination+pronation rate. 3nable to %rite or button clothes.
4arked difficulty in handling utensils.
,. Ri(idi+y.
/ 0 nondetectable
1 0 .etectable rigidityin neck and shoulders. 1cti)atyion phenomenon is present.
5ne or both arms sho% mild# negati)e# resting rigidity.
2 0 4oderate rigidity in neck and shoulders. ,esting rigidity is positi)e %hen
patient is not on medication.
3 0 Se)ere rigidity in neck and shoulders# resting rigidity cannot be re)ersed by
medication.
-. P!+'re
/ 0 *ormal posture. 2ead fle'ed for%ard less than 4 inches.
1 0 beginning poker spine. 2ead fle'ed for%ard up to 5 inches.
2 0 beginning arm fle'ion. 2ead fle'ed for%ard up to 6 inches. 5ne or both arms
raised but still belio% %aist.
3 0 onset or simian posture. 2ead fle'ed for%ard more than 6 inches. 5ne or both
uands ele)ated abo)e %aist. Sharp fle'ion of hand# beginning interphalangeal
e'tension. 7eginning fle'ion of knee.
.. /00er e1+re2i+y *in(.
/ 0 s%ing both arms %ell
1 0 one arm definitely decreased in amount of s%ing.
2 0 one arm fails to s%ing.
3 0 both arms fails to s%ing
3. Gai+
/ 0 steps out %ell %ith 18+3/ inch stride. 9urn about effortlessly.
1 0 gait shorthened to 12+18 inch stride. 7eginning to strike one heel. 9urn
around time slo%ing. ,e:uires se)eral steps.
2 0 Stride moderately shorthened ; no% 6+12 inches. 7oth heel beginning to
strike floor forcefully.
3 0 onset of shuffling gait# steps less than 3 inches. 5ccasional stuttering+type or
blocking gait. <alk on toes+turn around )ery slo%ly.
2
4. Tre2!r
/ 0 no detectable tremor found.
1 0 less than one inch of peak to peak tremor mo)ement obser)ed in limbs or
head at restor in either hand %hile %alking or during finger to nose testing.
2 0 ma'imum tremor en)elop fails to e'ceed 4 inches. 9remor is se)ere but not
constant and patient retains some controle of hands.
3 0 tremor en)elope e'ceed 4 inches. 9remor is constant and se)ere. $atient
cannot get free of tremor %hile a%ake unless it is a pure cerebellar type. <riting
and feeding are impossible.
5. 6a%ie.
/ 0 normal
1 0 detectable immobility. 4outh remains closed. 7eginning features of an'iety
or depression.
2 0 moderate immobility. (motion breaks through at markedly increased
threshold. =ips parted some of the time. 4oderate appearance of an'iety or
depression. .rooling may be present.
3 0 ro>en facies. 4outh open ? inch or more. .rooling may be se)ere.
7. Se8!rr#ea
/ 0 none
1 0 increased perspiration# secretion remaining thin
2 0 ob)ious oiliness present. Secretion much thicker
3 0 marked seborrhea# entire face and hand co)ered by thick secretion.
9. S0ee%#
/ 0 @lear# loud# resonant# easily understood.
1 0 beginning of haarseness %ith loss of inflection and resonance. "ood )olume
and still easily understood.
2 0 moderate haarseness and %eakness. @onstan monotone# un)aried pitch.
7eginning of dysarthria# hesitancy# stuttering# difficult to understood.
3 0 marked harshness and %eakness. Aery difficult to hear and understood.
1: Se&" %are.
/ 0 no impairment
1 0 Still pro)ides full self care but rate of dressing definitely impeded.
2 0 re:uires help in certain critical areas# such as turning in bed# rising from
chairs# etc. Aery slo% in performingmost acti)ites but manages by taking much
time.
3 0 continous disabled. 3nable to dress# feed him or herself# or %alk alone.
5A(,1== .BS17B=B9C (total )alue of) :
1+1/ 0 early illness
11+2/ 0 moderate disability
21+3/ 0 se)ere disability
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