The Hoehn and Yahr scale (HY) is a widely used clinical rating scale, which de fines broad categories of motor function in Parkinson’s disease (PD). Among its. versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB). Appendix 8Hoehn and Yahr stages. Front Biosci (Landmark Ed). Mar 1; Hoehn and Yahr staging of Parkinson’s disease in relation to neuropsychological measures. Modestino.
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The method of designating the severity of Parkinsonism by what is now known as the Hoehn and Yahr Scale was published in The original definition underlined of the FIVE stages of severity is as follows:.
For example when the diagnosis is made at a more advanced Stage, the patient may remember having noticed an intermittent tremor of one hand many years before.
One hand or foot may have been clumsier than the other may have. Often these symptoms are so mild that no formal medical attention is sought.
If sought it is not uncommon that the physician is unable to make a diagnosis, either by the most assiduous and astute physical examination or by the most advanced technology. Sometimes the disease must evolve over many years before a diagnosis can be made with certainty. Most doctors worry about a stroke or tumor — which they should.
When all necessary tests show nothing, one must wait and observe. Eventually Stage II may emerge. Usually the diagnosis is easy at this Stage if it has been preceded by a clear cut tremor or other symptom on one side.
Diagnosis – Rating Scales |
But not all Parkinson’s patients have tremor or other definite signs of Stage I unilateral Parkinsonism. If Stage I was missed and the predominant symptoms at Stage II are only slowness and a lack of spontaneous movement, the diagnosis may still be in doubt.
For example, even in Stage II, Parkinsonism may be interpreted as only advancing age. Loss of balance, with the inability to make the rapid, automatic and involuntary movements necessary to protect against falling, is one of the most troubling and dangerous aspects of Parkinsonism and one of the least easily treated.
All other aspects of Parkinsonism are evident and usually diagnosis is not in doubt.
Hoehn and Yahr scale – Wikipedia
However, the most important factor identifying Stage III as opposed to stage IV is that the patient is still fully independent in all activities of daily living dressing, hygiene, eating, etc. Although somewhat restricted, has work potential depending upon the type of employment. A normal life can be. The patient is unable to lead an independent life because of the need for help with some activities of daily living. The patient at Stage IV however, does remain able to stand and walk unassisted.
The patient may exhibit: Without someone immediately present to provide assistance, the patient is in danger of falling. A typical example of diagnosis using this method of staging would be: In some instances, it is not applicable.
For example, while general experience has been that is the onset of disturbances of balance that heralds future disability, some patients may have such severe tremor that they are incapacitated even though balance in intact. Others may have mild disturbance of balance for many years without losing independence.
There are occasional patients who are more incapacitated by severe unilateral disease than are others by milder bilateral disease.
Five Stages of Parkinson’s
Sometimes Stage I is skipped and the onset is bilateral or generalized. Similarly, many patients never reach Stage V.
Patients should not fearfully conclude that when their balance becomes unstable they should immediately start watching for signs indicating that they soon will be dependent upon others.
The scale is not linear; that is the patient does not remain at each stage for the same number of years; nor does any stage necessarily represent a given amount of pathology in the brain. In spite of these drawbacks, this method of grading severity has proved practical over many years. It is a simple method, allowing for easily reproducible assessments of the general status and functional level of the patient by independent examiners.
Because the definitions of the Stages are very precise, the scale obviates the confusion arising from such poorly defined terms as mild, moderate or severe disease.
This has been particularly useful in assessing the reported results of new treatments and in designing research projects, because patients respond differently depending on the disease, age of the patient and other factors. A patient at Stage II can become almost normal with adequate therapy; a patient at Stage IV will have residual symptoms, and improvement stagng never as marked or dramatic.