These are specifically reduced and/or lost in Parkinson Disease.
The patient rarely blinks; his/her face appears with no expression. Hand movements and the swinging associated with walking are absent.
Automatic saliva swallowing is also altered so that very frequently they present with an involuntary continuous dribbling.
Cough as a reflex answer to an external agent can be deficient, thus presenting the risk of respiratory infection.
Rigidity:
Muscular tone is increased presenting resistance during passive movement in the whole length of said movement.
Two types of parkinsonian rigidity are described: "lead tube” when resistance is uniform or plastic; and “cogged wheel” when it is intermittent.
It may be asymmetrical or even unilateral. It may affect occasionally only a group of muscles to a significant degree such as the neck muscles.
In this way, rigidity contributes to poor movements and is in part responsible for muscular pain.
Tremor:
The tremor is usually asymmetrical or unilateral. It involves an alternate contraction of opposed muscular groups producing a rhythmic movement of about 4 to 6 cycles per second. It is commonly maximum at periphery and it affects more the arms than the legs.
It is more a feeling of discomfort for the patient than a disability, given that it appears at complete rest and it diminishes or disappears with voluntary movement.
Awareness or self-anxiety increases the tremor, so that the disturbance on any social occasion can become unendurable.
Although the already mentioned manifestations may not imply inability in themselves, they have a disabling effect for the patient when carrying out many of the everyday activities.
Haehn and Yahr used the following scale as a means to record the degree of disability and the speed of its evolution:
Given that this gradation scale is not operationally defined, Webster design a more detailed gradation scale in order to summarize the results of the assessment in ten gradation areas. In each area, the aspects are sequenced in a progression typical of the disability, allowing a general quantitative gradation. Said scale is the following:
Graduation Scale for Parkinson Disease
- Hand Bradycinesia
0.- Not affected
1.- Appreciable slowness in prone supination manifested by initial difficulty to handle tools, button up clothes and hand writing.
2.- Slight slowness in prone supination, in one or both sides, manifested by moderate alteration of the manual function; handwriting is disturbed and there is micrography.
3.- Extreme slowness in prone supination; the patient is unable to write or button up clothes; there is a marked difficulty in handling utensils.
- Rigidity
0.- Not detectable.
1.- Rigidity detectable in neck and shoulders.
2.- Slight rigidity in neck and shoulders. Rigidity at rest is positive when the patient is without medication.
3.- Severe neck and shoulder rigidity. Rigidity at rest cannot be corrected with medication.
- Posture
0.- Normal posture
1.- Head bends forward less than ten centimetres.
2.- Arm flexion begins. Head bends forward more than fifteen centimetres.
3.- Apelike posture begins. Head bends forward more than fifteen centimetres. One or both hands raised higher than the waist line. Knee flexion begins.
- Superior extremity swinging
0.- Arms swing normally.
1.- The amount of arm swinging is definitely reduced.
2.- One arm does not swing.
3.- Both arms do not swing.
- Walking
0.- Walks well, steps between 45 to 75 centimetres. Turns with no effort.
1.- Shortened walk with steps between 30 to 45 centimetres. Begins to tap with one heel. Turning is slow, requiring several steps.
2.- Moderately shortened steps (between 15 to 30 centimetres). Both heels begin to tap the floor with force.
3.- Beginning of dragging of feet while walking , with steps shorter than 15 centimetres. Walks on her/his toes and turns very slowly.
- Tremor
0.- No tremor is detectable.
1.- Less than 2.5 centimetres of amplitude in the tremor movement observed in the limbs or head at rest or in any hand while walking or during the “finger to nose” test.
2.- The maximum amplitude of the tremor is no larger than 10 centimetres. Tremor is intense, though not permanent and the patient keeps certain control of her/his hands.
3.- The amplitude of the tremor is larger than 10 centimetres. Tremor is intense and permanent. The patient is unable to get rid of the tremor while s/he is awake. It is impossible for her/him to write or eat by her/himself.
- Facies
0.- Normal. Complete animation, There is no fixed facies.
1.- Noticeable immobility. Mouth remains closed. Anxiety or depression features begin.
2.- Slight immobility. Emotions are shown at an averagely increased threshold. Lips are separate part of the time. Moderate appearance of anxiety or depression. Dribbling may be intense.
- Seborrhea
0.- None present.
1.- Increased perspiration, secretion is still abundant.
2.- There is evident fat increase. Secretion is much thicker.
3.- Marked seborrhoea, the whole face and head are covered with thick secretion.
- Self-attention
0.- Not altered.
1.- Self-attention is present, but speed in dressing is definitely diminished. Still able to live by her/himself.
2.- Assistce is needed in certain areas, such as turning in bed, rising from chairs, etc. Very slow in performing most activities, though s/he can handle them taking a lot of time.
3.- Permanently disabled. Unable to dress, feed or walk by her/himself.
- Then the total gradation is established and the interpretation is as follows:
0 – There is no affection.
1 - 10: Early disease.
11 -20: Slight disability.
21 -30: Severe disability.
Although the already mentioned manifestations may not imply inability in themselves, they have a disabling effect for the patient when carrying out many of the everyday activities. 
