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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

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

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

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.

4.5

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

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

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

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

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

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.

O

Asymptomatic; fully active.

1

Walks normally but reports fatigue which interferes with athletic or other demanding activities.

2

Abnormal gait or episodic imbalance; gait disorder is noticeable to family and friends.Able to walk 25 feet in 10 seconds or less.

3

Walks independently; able to walk 25 feet in between 11-20 seconds

4

Requires unilateral support (cane, single crutch) to walk. Walks 25 feet in 20 seconds or less.

5

Requires unilateral support but walks 25 feet in greater than 20 seconds or requires bilateral support (canes, crutches, walker) and walks 25 feet in 20 seconds or less

6

Requires bilateral support and walks 25 feet in greater than 20 seconds. (May use wheelchair on occasion)*

7

Walking limited to several steps with bilateral support; unable to walk 25 feet. (May use wheelchair most of the time)

8

Restricted to wheelchair; able to transfer independently.

9

Restricted to wheelchair; unable to transfer independently.

10

Bedridden.

O

Normal

Functionally normal; no limitations on activity or lifestyle; RR; EDSS=0-1.5; AI=0; may have minor abnormality on exam (eg nystagmus, extensor plantar); attack frequency <1/year; return to baseline with/without treatment and generally not treated.

1

Mild Disability 

Minor, but noticeable signs and/or symptoms (eg. sensory symptoms, minor bladder problems, fatigue);RR or very early CP; EDSS=2-2.5; AI=0-1 (ie-no visible abnormality of gait); attack frequency=1-2/year.

2

Moderate Disability 

Main feature=abnormality of gait; AI=2-3; EDSS=2-4.5; able to work full day, but may find athletic activities difficult; RR-P or early CP; may need cane with attack but recover to independent ambulation.

3

Early Cane 

EDSS=6; RR-P or CP; AI=2-3; may use a cane/unilateral support (eg spouse’s arm) outside for greater distances, but can walk 25 feet in 20 seconds or less without a cane.

4

Late Cane

EDSS=6; RR-P or CP; AI=4-5; unable to walk 25 ft. without a cane/unilateral support(eg may hang on to furniture inside home or touch wall in clinic; use cane outside; may need a scooter for greater distances (eg in malls).

5

Bilateral Support

EDSS=6.5; AI=5-6; require bilateral support to walk 25 feet (eg 2 canes or crutches or walker); may use a scooter for greater distances.

6

Wheelchair

EDSS > 7; AI > 7; confined to wheelchair; may be able to take 1 or 2 steps, but cannot ambulate 25 feet even with bilateral support; may have further progression including problems with use of hands, inability to transfer.

U

Unclassifiable

Used for patients who do not fit above classification; eg-significant cognitive or visual impairment.

FUNCTIONAL STATUS

O

Normal

1

Abnormal signs without disability

2

Minimal disability

3

Mild or moderate paraparesis or hemiparesis; severe monoparesis

4

Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia

5

Paraplegia, hemiplegia, or marked quadriparesis

6

Quadriplegia

O

Normal

1

Abnormal signs without disability

2

Mild ataxia

3

Moderate truncal or limb ataxia

4

Severe ataxia all limbs

5

Unable to do coordinated movements due to ataxia

X

Is used after each number when weakness (grade 3 or more on pyramidal) interferes with testing

O

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 swallow or speak

O

Normal vibration (VIB)/position sense (PS)

1

Mild l VIB in 1 or 2 limbs; PS normal

2

Moderate l VIB &/or mild l PS in 1 or 2 limbs OR mild l VIB in 3 or 4 limbs; PS normal

3

Lost VIB &/or moderate l PS in 1 or 2 limbs OR moderate l PS in 3 or 4 limbs

4

Lost PS in 1 or 2 limbs OR severe l PS in 3 or 4 limbs

5

Lost PS in 3 or 4 limbs

6

Sensation lost below the head

O

Normal

1

Mild hesitancy, urgency, or retention

2

Moderate hesitancy, urgency, or retention, or rare urinary incontinence

3

Frequent incontinence

4

In need of almost constant catheterization

5

Loss of bladder control

6

Loss of bowel and bladder control

O

Normal

1

Scotoma with acuity better than 20/30

2

Worse eye=20/30-20/59

3

Worse eye=20/60-20/99

4

Worse eye=20/100-20/200 OR #3 + better eye worse than or=to 20/60

5

Worse eye less than 20/200 OR #4 + better eye worse than or=to 20/60

6

#5 + better eye worse than or=to 20/60

O

Normal

1

Mood alteration only (does not affect EDSS score)

2

Mild decrease in mentation

3

Moderate decrease in mentation

4

Marked decrease in mentation

5

Dementia – severe or incompetent

O

Normal

1

Mild-minor problems with coordinated tasks

2

Moderate-unable to write clearly

3

Severe-unable to feed self

O

Normal

1

Mild-minor problems with coordinated tasks

2

Moderate-unable to write clearly

3

Severe-unable to feed self

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