Schwab and England Activities of Daily Living (ADL) Scale

Schwab & England ADL
Schwab and England ADL Score
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Grades functional status in patients with Parkinson’s disease.

Why Use

Allows clinicians to track disease progression and measure response to therapy. Recommended for clinical and research use by the International Parkinson and Movement Disorder Society. Included as a component (part VI) of the Unified Parkinson’s Disease Rating Scale (UPDRS).

When to Use

Use to quantify everyday function in patients with Parkinson disease during initial and follow-up visits.

Formula

Select patient’s level of independence: Completely independent: able to do all chores without difficulty; essentially normal; unaware of any difficulty 100% Completely independent: able to do all chores with some difficulty (may take twice as long); beginning to be aware of difficulty 90% Mostly independent: chores takes twice as long; conscious of difficulty 80% Not completely independent: more difficulty with some chores; takes 3-4x longer for some 70% Some dependency: can do most chores but exceedingly slowly and with much effort; makes errors; some chores impossible 60% More dependent: needs help with half of chores; is slower and has difficulty with everything 50% Heavily dependent: can assist with all chores but does few alone 40% Mostly dependent: with effort, can sometimes do a few chores alone or begin alone; much help needed 30% Severely dependent: can help slighly with some chores but nothing alone 20% Completely dependent: helpless; complete invalid 10% Bedridden: vegetative functions such as swallowing, bladder and bowel functions impaired 0%

Pearls / Pitfalls

Scoring is subjective and insight-dependent; corroborate with caregiver observations to reduce over- or under-estimation. A ceiling effect can obscure subtle early impairment. Consider the impact of both motor and non-motor symptoms on daily function before assigning a percentage.

Advice

A decline of ≥10% between visits generally reflects a clinically meaningful loss of independence. As scores fall, consider: Physical/occupation therapy programs. Fall-prevention measures. Home safety evaluations. Optimizing medication timing. Referral for advanced therapies (e.g., deep-brain stimulation). Palliative care consultation. Long-term care planning. Caregiver support services. Trend results over time to document disease progress.

More Information

Interpretation: Higher score indicates greater functional independence.

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