Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Webster Rating Scale for Parkinson’s Disease

    Quantifies degree of disability in Parkinson’s disease.
    When to Use
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    None
    0
    Detectable slowing of supination-pronation rate; beginning difficulty in hand dexterity
    +1
    Moderate slowing of supination-pronation rate (1 or both sides); moderately impaired hand function; micrographia present
    +2
    Severe slowing of supination-pronation rate; unable to write; marked difficulty w/utensils
    +3
    Non-detectable
    0
    Detectable rigidity in neck and shoulders; activation phenomenon present; mild negative resting arm rigidity (1 or both)
    +1
    Moderate rigidity (neck + shoulders); resting rigidity present if not on meds
    +2
    Severe rigidity (neck + shoulders); resting rigidity cannot be reversed by meds
    +3
    Normal posture; head flexed forward <4”
    0
    Beginning poker spine; head flexed forward >5”
    +1
    Beginning arm flexion; head flexed up ≤6”; 1 or both arms raised but still below waist
    +2
    Simian posture onset; head flexed forward >6”; 1 or both hands elevated above waist; hands sharply flexed; beginning interphalangeal extension, knees flexed
    +3
    Swings both arm well
    0
    One arm swing definitely decreased
    +1
    One arm fails to swing
    +2
    Both arms fail to swing
    +3
    Steps out will with 18-30” stride, turns about effortlessly
    0
    Gait shortened to 12-18” stride; beginning to strike 1 heel; turnaround time slowing; requires several steps
    +1
    Stride moderately shortened to 6-12”; both heels starting 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
    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; retains some hand control
    +2
    Tremor envelope >4”; constant severe tremor; persistent while awake unless pure cerebellar type; writing, feeding self impossible
    +3
    Normal; full animation; no stare
    0
    Detectable immobility; mouth closed; beginning anxiety/depression features
    +1
    Moderate immobility; emotion breaks thru at markedly increased threshold; lips parted sometimes; moderate appearance of anxiety/depression; drooling may be present
    +2
    Frozen facies; mouth opens ≥0.25”; severe drooling
    +3
    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
    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
    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

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. David Webster

    About the Creator

    David D. Webster, MD, (d. 1998) was a neurologist and internationally-known Parkinson's disease specialist. He was a professor and later the chief of neurology at the University of Minnesota. Dr. Webster was also a World War II veteran, serving as a lieutenant after studying radar, a then-new technology, at MIT and Harvard.

    To view Dr. David Webster's publications, visit PubMed

    About the Creator
    Dr. David Webster