[Cherie]

"Ok then, what is Multiple Sclerosis?"

[Cherie]

Thought this might be a good place to post basics of MS.


KURTZKE EDSS (EXPANDED DISABILITY STATUS SCALE)
0 Normal neurological exam (all grade 0 in Functional Systems (FS); cerebral grade 1 acceptable).

1 No disability, minimal signs in one FS (i.e., one grade 1 excluding cerebral grade 1).

1.5 No disability, minimal signs in more than one FS (more than one grade 1 excluding cerebral grade 1).

2.0 Minimal disability in one FS (one FS grade 2, others 0 or 1).

2.5 Minimal disability in two FS (two FS grade 2, others 0 or 1).

3.0 Moderate disability in one FS (one FS grade 3, others 0 or 1), or mild disability in three or four FS (three-four FS grade 2, others 0 or 1).

3.5 Fully ambulatory but with moderate disability in one FS (one grade 3 and one or two FS grade 2) or two FS grade 3, others 0 or 1, or five FS grade 2, others 0 or 1.

4.0 Fully ambulatory without aid, self-sufficient, up and about some 12 hours a day despite relatively severe disability consisting of one FS grade 4 (others 0 or 1), or combinations of lesser grades exceeding limits of previous steps. Able to walk without aid or rest some 500 meters. (0.3 miles)

4.5 Fully ambulatory without aid, up and about much of the day, able to work a full day, may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability, usually consisting of one FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps. Able to walk without aid or rest for some 300 meters. (975 ft)

5.0 Ambulatory without aid or rest for about 200 meters (650 feet); disability severe enough to impaire full daily activities (e.g., to work full day without special provisions). (Usual FS equivalents are one grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)

5.5 Ambulatory without aid or rest for about 100 meters (325 ft); disability severe enough to impair full daily activities. (Usual FS equivalents are one grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)

6.0 Intermittent or constant unilateral assistance (cane, crutch, brace)required to walk about 100 meters (325 ft) with or without resting. (Usual FS equivalents are combinations with more than two FS grade 3+)

6.5 Constant bilateral assistance (canes, crutches, braces) required to walk about 20 meters (65 ft). (Usual FS equivalents are combinations with more than two FS grade 3+)

7.0 Unable to walk beyond about 5 meters (16 ft) even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair a full day and transfers alone; up and about in wheelchair some 12 hours a day. Usual FS equivalents are combinations with more than one FS grade 4+; very rarely pyramidal grade 5 alone.

7.5 Unable to take more than a few steps; restricted to wheelchair; may need aid in transfers, wheels self but cannot carry on in standard wheelchair a full day; may require motorized wheelchair; usual FS equivalents are combinations with more than one FS grade 4+

8.0 Essentially restricted to bed or chair or perambulated in wheelchair; but may be out of bed much of the day; retains many self-care functions; generally has effective use of arms. Usual FS equivalents are combinations, generally grade 4+ in several systems.

8.5 Essentially restricted to bed for much of the day; has some effective use of arm(s); retains some self-care functions. Usual FS equivalents are combinations, generally grade 4+ in several systems.

9.0 Helpless bed patient; can communicate and eat. Usual FS equivalents are combinations, mostly grade 4.

9.5 Totally helpless bed patient; unable to communicate effectively or eat/swallow. Usual FS equivalents are combinations, almost all grade 4+

10 Death due to MS. (cherie's note: death due to MS means death due to complications like sepsis from an untreated UTI or bed sore or pneumonia)

[lady_express_44]

Functional Systems

Kurtzke, Neurology, 1983, 33:1444-52

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The EDSS is based upon Neurological testing of Functional Systems (CNS areas regulating body functions): Pyramidal (ability to walk), Cerebellar (Coordination), BrainStem (Speech and Swallowing), Sensory (Touch and Pain), Bowel and Bladder; Visual; Mental; and "Other" (includes any other Neurological findings due to Multiple Sclerosis).

Each Functional System (FS) is graded to the nearest possible grade, and V indicates an unknown abnormality; these are not additive scores and are only used for comparison of individual items.

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Pyramidal Function
0 - Normal
1 - Abnormal Signs without Disability
2 - Minimal disability
3 - Mild/Moderate ParaParesis of HemiParesis; Severe MonoParesis
4 - Marked ParaParesis or HemiParesis; Moderate QuadraParesis or MonoParesis
5 - Paraplegia, Hemiplegia, or Marked ParaParesis
6 - Quadriplegia
V - Unknown


Cerebellar Function
0 - Normal
1 - Abnormal Signs without disability
2 - Mild Ataxia
3 - Moderate Truncal or Limb Ataxia
4 - Severe Ataxia
5 - Unable to perform Coordinated Movements
V - Unknown
X - Weakness


BrainStem Function
0 - Normal
1 - Signs only
2 - Moderate Nystagmus or other mild disability
3 - Severe Nystagmus, Marked ExtraOcular Weakness or moderate disability of other Cranial Nerves
4 - Marked Dysarthria or other marked disability
5 - Inability to Speak or Swallow
V - Unknown


Sensory Function
0 - Normal
1 - Vibration or Figure - Writing decrease only, in 1 or 2 limbs
2 - Mild decrease in Touch or Pain or Position Sense, and/or moderate decrease in Vibration in 1 or 2 limb, or Vibration in 3 or 4 limbs
3 - Moderate decrease in Touch or Pain or Proprioception, and/or essentially lost Vibration in 1 or 2 limbs; or mild decrease in Touch or Pain and/or moderate decrease in all Proprioceptive tests in 3 or 4 limbs
4 - Marked decrease in Touch or Pain or loss of Proprioception, alone or combined in 1 or 2 limbs; or moderate decrease in Touch or Pain and/or severe Proprioceptive decrease in more than two limbs
5 - Loss of Sensation in 1 or 2 limbs; or moderate decrease in Touch or Pain and/or loss of Proprioception for most of the body below the head
6 - Sensation essentially lost below the head
V - Unknown


Bowel and Bladder Function
0 - Normal
1 - Mild Urinary Hesitancy, Urgency, or Retention
2 - Moderate Hesitancy, Urgency, or Retention of Bowel or Bladder, or rare Urinary InContinence
3 - Frequent Urinary InContinence
4 - Almost constant Cathaterization.
5 - Loss of Bladder function
6 - Loss of Bowel function
V - Unknown


Visual Function
0 - Normal
1 - Scotoma with Visual Acuity > 20/30 (corrected)
2 - Worse Eye with Scotoma with maximal Acuity 20/30 to 20/59
3 - Worse Eye with large Scotoma or decrease in fields, Acuity 20/60 to 20/99
4 - Marked decrease in fields, Acuity 20/100 to 20/200; grade 3 plus maximal Acuity of better Eye < 20/60
5 - Worse Eye Acuity < 20/200; grade 4 plus better Eye Acuity < 20/60
V - Unknown


Cerebral Function
0 - Normal
1 - Mood alteration
2 - Mild decrease in Mentation
3 - Moderate decrease in Mentation
4 - Marked decrease in Mentation
5 - Dementia
V - Unknown


Other Function
0 - Normal
1 - Other Neurological finding

http://www.thjuland.net/edss-fs.html#Pyramidal

[wannabe]

Nice posts Cherie(s). Good basis to have on the forum.

Did you write them yourself? I didn't see any attribution or link to a source if someone else authored them like ladyexpress gave. I hope you're not taking credit for someone else's work.

[Cherie]

Not taking credit for anyone's work. These were copied from the old forum and in my files. If I wrote It, I'd say I wrote it. The resources and links that I posted here was something I have compiled over the years so I will take credit for putting those together. Kurtzze has been around for years and set the standard for MS disability scale in the early 80's. Anyone who thought I'd written that has not been in the MS community long.

I would encourage anyone who has reliable information to post it here so that it benefits all.
Cherie

[DBG's]

Great info ladies. Nice to have for newbies who need a quick resource.

Christine

[wannabe]

Originally Posted by Cherie

Not taking credit for anyone's work. These were copied from the old forum and in my files. If I wrote It, I'd say I wrote it. The resources and links that I posted here was something I have compiled over the years so I will take credit for putting those together. Kurtzze has been around for years and set the standard for MS disability scale in the early 80's. Anyone who thought I'd written that has not been in the MS community long.

Actually, you seem to be writing this for those unfamiliar with MS, so yes, people MIGHT have thought you'd written it since you are not sharing this info for those who have "been in the MS community long". But since we can't always get into the minds or backgrounds of our audience, general rules and guidelines have been developed so that there is no misunderstanding.

My concern is not that you take credit for your work Cherie. My concern is that you MUST provide credit if you did NOT write something yourself. Or not post it at all.

If you did not write something yourself (or acknowledge any material IN your written work to the appropriate sources), then you MUST NOT post it.

You said: "These were copied from the old forum and in my files". Unfortunately, that does not give specific credit to the specific authors and is insufficient. Copyright and plagiarism and all that silly stuff that lets people get the credit they deserve for writing somethin...

It's just important in health reporting (especially on forums where who said what might get mixed up) that you understand sourcing and attribution. And don't post if you are unable to provide the original source for the material. Lots of stuff regardless of attribution or sourcing STILL may not be posted by others without express permission of the author. It's important to know the rules.

Thanks.

[Tree55]

If I was a new member, I would stay away from this forum because of this thread. An informative thread was reduced to a personal attack. Cherie was trying to post important info. This was blown way out of proportion.

[agate]

Tree55, welcome!

How about a few words of introduction from you?

I don't see how this thread degenerated into a personal attack. Cherie posted most of an entire Webpage that turned out to be (probably) by Paul Jones, who has an MS Website. She was probably in a hurry and neglected to dig up the relevant information on the source.

Other people came along and felt that giving the source is important for a number of reasons.

It was suggested that Cherie re-post the information and cite the Webpage (the Paul Jones Website) URL as the probable source.

I'm still waiting for an e-mail reply from Paul Jones about whether it's OK with him to use his material on another board like this, provided he's given the credit.

Since he is slow to reply (and it says he is on the Webpage), the best thing to do is probably to re-quote the material with the link to his URL. The material could always be deleted later if he doesn't consent to this use.

That's just my opinion, though. I don't think anyone meant to attack Cherie (clinical1) personally.

[Cherie]

Joan (agate),
I have to disagree. It was clearly a personal attack by two posters. And I could not delete the thread and start a fresh one so I let the information stand as it was added and expressed gratitude that people had located the source and given credit to it.