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Barry-Albright Dystonia (BAD) Scale

Barry-Albright Dystonia (BAD) Scale - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires


Barry-Albright Dystonia (BAD) Scale

Directions:
Assess the patient for dystonia in each of the following regions: eyes, mouth, neck, trunk, and each upper and lower
extremity (8 body regions). Write the scores on the lines provided. Rate severity based only on dystonia as
evidenced by abnormal movements or postures. When assessing functional limitations, do not score dystonia based
on other factors, such as weakness, lack of motor control, cognitive deficits, primitive reflexes, and/or other
movement disorders as defined below.
Dystonia: Sustained muscle contractions causing twisting and repetitive movements or abnormal postures
Spasticity: Velocity-dependent resistance to passive stretch
Athetosis: Distal writhing or contorting movements
Chorea: Brief, rapid, unsustained, irregular movements
Ataxia: Incoordination of movement characterized by wide-based unsteady gait, flailing movements.



Eyes: signs of dystonia of the eyes include: prolonged eyelid spasms, and/or forced eye deviations
0 – Absence of eye dystonia
1 – Slight. Dystonia less than 10% of the time and does not interfere with tracking
2 – Mild. Frequent blinking without prolonged spasms of eye closure, and/or eye movements less than 50% of the
time.
3 – Moderate. Prolonged spasms of eyelid closure, but eyes open most of the time, and/or eye movements more
than 50% of the time that interfere with tracking, but able to resume tracking
4 – Severe. Prolonged spasms of eyelid closure, with eyes closed at least 30% of the time, and/or eye movements
more than 50% of the time that prevent tracking
* – Unable to assess eye movements
Eyes: _____

Mouth: signs of dystonia of the mouth include: grimacing, clenched or deviated jaw, forced open mouth, and/or
forceful tongue thrusting
0 – Absence of mouth dystonia
1 – Slight. Dystonia less than 10% of the time and does not interfere with speech and/or feeding
2 – Mild. Dystonia less than 50% of the time and does not interfere with speech and/or feeding
3 – Moderate. Dystonia more than 50% of the time, and/or dystonia that interferes with speech and/or feeding
4 – Severe. Dystonia more than 50% of the time, and/or dystonia that prevents speech and/or feeding
* – Unable to assess mouth movements
Mouth: _____

Neck: signs of dystonia of the neck include: pulling of the neck into any plane of motion: extension, flexion, lateral
flexion or rotation
0 – Absence of neck dystonia
1 – Slight. Pulling less than 10% of time and does not interfere with lying, sitting, standing and/or walking
2 – Mild. Pulling less than 50% of the time and does not interfere with lying, sitting, standing and/or walking
3 – Moderate. Pulling more than 50% of the time and/or dystonia that interferes with lying, sitting, standing and/or
walking
4 – Severe. Pulling more than 50% of the time and/or dystonia that prevents sitting in standard wheelchair, standing
and/or walking (e.g. requires more than standard head rest for seating)
* – Unable to assess neck movements
Neck: _____



Trunk: signs of dystonia of the trunk include: pulling of the trunk into any plane of motion: extension, flexion, lateral
flexion or rotation
0 – Absence of trunk dystonia
1 – Slight. Pulling less than 10% of the time and does not interfere with lying, sitting, standing and/or walking
2 – Mild. Pulling less than 50% of the time and does not interfere with lying, sitting, standing and/or walking
3 – Moderate. Pulling more than 50% of the time, and/or dystonia that interferes with lying, sitting, standing and/or
walking
4 – Severe. Pulling more than 50% of the time, and/or dystonia that prevents positioning in standard wheelchair,
standing and/or walking (e.g. requires adapted seating system to control posturing, such as ASIS bar)
* – Unable to assess trunk movements
Trunk: _____


Upper extremities: signs of dystonia of the upper extremities include: sustained muscle contractions causing
abnormal posturing of the upper extremities
0 – Absence of upper extremity dystonia
1 – Slight. Dystonia less than 10% of the time and does not interfere with normal positioning and/or functional
activities
2 – Mild. Dystonia less than 50% of the time and does not interfere with normal positioning and/or functional activities
3 – Moderate. Dystonia more than 50% of the time and/or dystonia that interferes with normal positioning and/or
upper extremity function
4 – Severe. Dystonia more than 50% of the time and/or dystonia that prevents normal positioning and/or upper
extremity function (e.g. arms restrained in wheelchair to prevent injury)
* – Unable to assess upper extremity movements
Left upper extremity: _____
Right upper extremity: _____

Lower extremities: signs of dystonia of the lower extremities include: sustained muscle contractions causing
abnormal posturing of the lower extremities
0 – Absence of lower extremity dystonia
1 – Slight. Dystonia less than 10% of the time and does not interfere with normal positioning and/or functional
activities
2 – Mild. Dystonia less than 50% of the time and does not interfere with normal positioning and/or functional activities
3 – Moderate dystonia more than 50% of the time and/or dystonia that interferes with normal positioning and/or lower
extremity weight bearing or function
4 – Severe dystonia more than 50% of the time and/or dystonia that prevents normal positioning and/or lower
extremity weight bearing and/or function (e.g. cannot maintain standing due to severe dystonia at ankles)
* – Unable to assess lower extremity movements
Left lower extremity: _____
Right lower extremity: _____

Total score: _____