In Thomas et al.,1 on page 1297, the heading “POSTURAL TREMOR OF THE HANDS” under “Assessment of Parkinsonism (5-item UPDRS) in Appendix 1 is incorrect and should have read “REST TREMOR OF THE HANDS”. The same heading in the corresponding “Instructions for Assessing Parkinsonism from (UPDRS)” section on page 1298 should also have read “REST TREMOR OF THE HANDS”.

Below is the corrected version:

Appendix: Instructions for Assessing Parkinsonism (from UPDRS) REST TREMOR OF THE HANDS

Score the maximum amplitude that is seen at any time during the interview. As part of this rating the patient should sit quietly in a chair with the hands placed on the arms of the chair for 10 seconds with no other directives.

KINETIC TREMOR OF THE HANDS

This is tested by the finger-to-nose maneuver. With the arm starting from the outstretched position, have the patient perform at least three finger-to-nose maneuvers with each hand reaching as far as possible to touch the examiner’s finger. The finger-to-nose maneuver should be performed slowly enough not to hide any tremor that could occur with very fast arm movements.

Repeat with the other hand, rating each hand separately. The tremor can be present throughout the movement or as the tremor reaches either target (nose or finger). Rate the highest amplitude seen.

FACIAL EXPRESSION

Observe the patient sitting at rest for 10 seconds, without talking and also while talking. Observe eye-blink frequency, masked facies or loss of facial expression, spontaneous smiling and parting of lips.

GLOBAL SPONTANEITY OF MOVEMENT (BODY BRADYKINESIA)

This global rating combines all observations on slowness, hesitancy, and small amplitude and poverty of movement in general, including a reduction of gesturing and of crossing the legs. This assessment is based on the examiner’s global impression after observing for spontaneous gestures while sitting, and the nature of arising and walking.

RIGIDITY

Instructions to examiner: Rigidity is judged on slow passive movement of major joints with the patient in a relaxed position and the examiner manipulating the limbs and neck. First, test without an activation maneuver. Test and rate neck and each limb separately. For arms, test the wrist and elbow joints simultaneously. For legs, test the hip and knee joints simultaneously. If no rigidity is detected, use an activation maneuver such as tapping fingers, fist opening/closing, or heel tapping in a limb not being tested. Explain to the patient to go as limp as possible as you test for rigidity.