Webster Rating Scale for Parkinson’s Disease

Addition of the selected points: Parameter Finding Points Bradykinesia of hands None 0 Detectable slowing of supination-pronation rate; beginning difficulty in handling tools, buttoning clothes, handwriting +1 Moderate slowing of supination-pronation rate (one or both sides); moderate impairment of hand function; handwriting greatly impaired, micrographia present +2 Severe slowing of supination-pronation rate; unable to write or button clothes; marked difficulty in handling utensils +3 Rigidity Non-detectable 0 Detectable rigidity in neck and shoulders; activation phenomenon present; mild negative resting arm rigidity (one or both) +1 Moderate rigidity (neck and shoulders); resting rigidity present if not on meds +2 Severe rigidity (neck and shoulders); resting rigidity cannot be reversed by meds +3 Posture Normal posture; head flexed forward <4” 0 Beginning poker spine; head flexed forward >5” +1 Beginning arm flexion; head flexed up ≤6”; arms raised (one or both) but still below waist +2 Onset of simian posture; head flexed forward >6”; hands elevated above waist (one or both); sharp flexion of hands; beginning interphalangeal extension; beginning flexion of knees +3 Upper extremity swing Swings both arms well 0 One arm swing definitely decreased +1 One arm fails to swing +2 Both arms fail to swing +3 Gait Steps out will with 18-30” stride, turns about effortlessly 0 Gait shortened to 12-18” stride; beginning to strike one heel; turnaround time slowing; requires several steps +1 Stride moderately shortened to 6-12”; both heels beginning to strike floor forcefully +2 Onset of shuffling gait; steps <3”; occasional stuttering-type or blocking gait; walks on toes; turns around very slowly +3 Tremor No detectable tremor 0 <1” of peak-to-peak tremor movement (limbs or head) at rest, or in either hand while walking or during finger-to-nose test +1 Maximum tremor envelope fails to exceed 4”;. severe but not constant tremor; patient retains some control of hands +2 Tremor envelope >4”; constant severe tremor; persistent while awake unless pure cerebellar type; writing and feeding self are impossible +3 Facies Normal; full animation; no stare 0 Detectable immobility; mouth closed; beginning anxiety/depression features +1 Moderate immobility; emotion breaks through at markedly increased threshold; lips parted some of the time; moderate appearance of anxiety or depression; drooling may be present +2 Frozen facies; mouth opens ≥ 0.25”; severe drooling +3 Seborrhea None 0 Increased perspiration, secretions thin +1 Obvious oiliness present, secretion much thicker +2 Marked seborrhea, entire face and head covered by thick secretions +3 Speech Clear, loud, resonant, easily understood 0 Beginning of hoarseness, loss of inflection and resonance; good volume, still easily understood +1 Moderate hoarseness/weakness; constant monotone unvaried pitch; beginning of dysarthria, hesitance, stuttering, difficult to understand +2 Marked harshness/weakness, very difficult to hear and understand +3 Self-care No impairment 0 Still provides full self-care but rate of dressing definitely impeded; able to live alone, may be employable +1 Requires help in certain critical areas; very slow in performing most activities but manages by taking much time +2 Continuously disabled; unable to dress/feed self or walk alone +3