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KEY ARTICLES: CONSCIOUSNESS | DOUBLE BLIND | HEAD INJURY | NARCOLEPSY | PAROXYSMAL DISORDERS | PRESCRIPTION PRINCIPLES | TARDIVE DYSKINESIA

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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 = 10

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 the STRAW).

Activity involves:

T is for tapping for both the right and the left hand out of 10, separately and together.

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 scored.

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.

At Rest

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 100

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)

 

 


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