Movement Disorder Assessment: Bedside Exam Note

What it does

The Movement Disorder Assessment is a structured bedside phenomenology exam. Its rule is "describe before you diagnose": name what the movement looks like first, and add a disease label later using drugs, time course and associated signs. It is built on The Movement Disorder Examination: A Region-by-Region Phenomenology Atlas. It is a documentation aid, not a diagnostic device.

How the exam is organized

The exam moves through a series of stations:

• Context. Age, gender and handedness only, examiner initials and credentials, current drugs (with quick picks such as haloperidol, risperidone, lithium, valproate, an SSRI and benztropine), and the time relationship to drug exposure.
• Ten regions. Eyes, tongue, mouth, face, hands, arms, neck, feet, trunk and gait. Each has its own short protocol and region-specific signs to check.
• Note. A description-first summary ready to copy.

Each observed movement is described on seven axes: rhythmicity, speed, amplitude, distribution, activation (rest, posture, action, intention and others), suppressibility (including urge, sensory trick, distractibility and entrainment), and direction or pattern. Severity is rated 0-4 (none, minimal, mild, moderate, severe). Frequency can be entered in Hz, including by clinician tap-along.

Category matching

From the seven axes, the tool suggests a phenomenology category with its reasoning: tremor, myoclonus, asterixis, chorea, athetosis, ballism, dystonia, tic, stereotypy, akathisia, fasciculation, myokymia, myorhythmia, bradykinesia, functional features, or uncertain. When the axes are incomplete or mixed, it says so rather than forcing a label. Reference panels cover the "EPS clock" (hours for acute dystonia, days for akathisia, days to weeks for parkinsonism, months to years for tardive syndromes) and the circuit-level physiology behind each.

What the note includes

The chart note lists each examined region and its findings in plain descriptive terms. Skipped regions are written as not examined and are never implied to be normal. Examined regions without findings are written as examined and quiet. The note states that categories are signature matches, not etiologic diagnoses.