STRAW: Movement Disorder Evaluation
STRAW is an acronym for a new technique
of evaluating involuntary movements, particularly
tardive dyskinesia. Neppe developed the STRAW in the
early 1990s because of the non-availability of adequate
measures which would reliably differentiate subtle
differences in tardive dyskinesia, and which could
be easily scored within a 10% range by several different
raters. The STRAW has two components, a timing component
and a severity component. The STRAW timing system
involves equal scores of 50 for activation and rest.
The key to the STRAW is the timed component. The timing
component is scored out of 100 based on a time period
using the criterion of presence. Tremor and epileptic
seizure are not included as involuntary movements.
Half the time is at rest is the "S"
for sitting at rest while relaxed, not under stress.
and standing - the score is a rest score.
Convert these rest time measures to
proportion of time out of 50. e.g. 40 seconds of movements
in a selected 300 second interval = 60/300 * 50 =
The five evaluations during activity
are each out of 10 making up 50 for activity (the
TRAW) loaded equally with the 50 for rest (the S of
T is for tapping for both the
right and the left hand out of 10, separately and
R for reading something and
the involuntary movements watched.
A is for arms outstretched and
the movements evaluated under those circumstances.
W is for writing, and a second
10 second measure, W for walking or gait.
The activating procedures also include
evaluate muscle power and gait, tone, and resistance,
mouth opening and tongue protrusion though not specifically
Three body sections are measured for
severity: the head, the axial skeleton, and the limbs.
Each body section is rated between 0 and 10 in severity.
In practice, the most severe of these three rankings
is the one that is most closely followed over a period
of time for tardive dyskinesia.
The STRAW timing system is multiplied
by the STRAW severity, giving a total score out of
1000. It is thereafter divided by 10 to score out
of 100. This gives an index of both severity and duration
of particular physical signs.
STRAW Examination For Involuntary Movements
This is a timed and severity neurologic
evaluation for involuntary movements.
S - SITTING AND STANDING - out of 50
Activation Procedures: scored out of
50 consisting of:
T - TAPPING WITH RIGHT AND LEFT HAND
- out of 10
R - READING - out of 10
A - ARMS OUTSTRETCHED - out of 10
W - WRITING - out of 10
W - WALKING - out of 10
STRAW TIMING SCORE TOTAL is out of
SEVERITY score is out of 10
COMBINED SEVERITY TIMING STRAW SCORE
= TIMING * SEVERITY / 10 = out of 100
When scores increase above zero movements
may be voluntary and related to anxiety.
Further information in the
Neuropsychiatric Evaluation of the Closed Head Injury
of Transient Type (CHIT)