Tremor

INDEX

Part C assesses functional disability. Its items evaluate the severity of tremor with speaking, eating (feeding), bringing liquids to the mouth, hygienic care, dressing, and working, including domestic tasks. These scores, with the exception of speaking, are provided by patients, who are asked to evaluate their ability to carry out these tasks by using the definitions provided in the table. Speaking can also be evaluated by the examiner. Since patients (and often physicians) cannot distinguish between dystonic adductor dysphonia and voice tremor, and since occasional patients have both disorders, the speaking score encompassed both difficulties. Definitions for all rated functional tasks are provided in the table. "Working" classifications include home-making, as well as other jobs.

Calculations

Space is provided on the scoring form for calculating subtotal scores, i.e., sums of each separate part (A, B, and C), and an overall score of all three parts.

The maximum possible scores are 80 for Part A, 36 for Part B, and 28 for Part C, making the maximum possible total score 144.  The 2nd page of the scoring form explains how to calculate percent of severity. This is determined by dividing the total score by the maximum score possible and then multiplying by 100.

Global Assessment

In addition to the quantitation of tremor through Parts A, B, and C, the scoring form allows assessment of overall severity by both the patient and the examiner. This subjective global severity is based on the assessment of tremor-related disability, which is calculated according to the percent  of impairment in carrying out all activities of daily living and the cosmetic effect of the tremor, which can be psychologically damaging. Subjective global assessments are quick guides for evaluating patients, but they also provide useful comparisons for the quantitative ratings of Parts A, B, and C. The global assessments can serve as the “gold standard” for validating this clinical rating scale.