EDSS Alternative in an iPad, that can accurately gauge walking, balance, manual dexterity, visual acuity, and a measure of cognition in people with MS

Stuart SchlossmanAlternative therapies and devices for Multiple Sclerosis (MS)

July 21, 2014
A study demonstrates that an iPad app can accurately gauge walking, balance, manual dexterity, visual acuity, and a measure of cognition in people with MS

MITCH LESLIE
Doctors, researchers, and patients could all benefit from an easier way to quantify MS disability. Now, scientists report that they were able to conduct performance tests on MS patients using an iPad and an app they designed (Rudick et al., 2014). The system, which the team described in the Journal of Visualized Experiments, might increase the number of doctors who can apply such measurements and could eventually allow patients to test themselves at home.
The iPad is positioned at the sacral level for walking and balance testing. From Rudick <em>et al</em>., 2014.

The iPad is positioned at the sacral level for walking and balance testing. From Rudick et al., 2014.

“I think this is a really exciting and elegant step forward,” said Jeffrey Gelfand, M.D., an assistant professor of neurology at the University of California, San Francisco, who wasn’t involved in the study. “This is the beginning of the next phase of bringing performance testing into the MS clinic.”

Although researchers have proposed several methods to quantify MS disability, for more than 30 years the standard has been the Expanded Disability Status Scale, or EDSS (Kurtzke, 1983). The scale runs from 0 to 10 and is based on an evaluation by a neurologist or other expert. For patients at the lower end of the scale, scores depend on whether certain functional systems, such as the bladder or the visual system, are impaired. For patients with more severe disabilities, ratings depend on factors such as how far they can walk without help and whether they are bedridden.
The EDSS has figured in thousands of studies and almost all clinical trials of MS treatments. “It’s been critical for getting 10 drugs to patients,” said Richard Rudick, M.D., former director of the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic in Ohio and now a vice president for development sciences at Biogen Idec in Cambridge, Massachusetts.
But the EDSS has taken its lumps over the years. “It’s the measure we most love to hate,” said Rudick, who was lead author of the iPad study. One complaint is that the scale is not linear. So if a patient’s score increases from 1 to 2, that doesn’t represent the same amount of physical decline as an increase from 6 to 7—a problem that limits the statistical analyses researchers can perform on EDSS data (Goldman et al., 2010). Critics have also knocked the EDSS for leaning heavily on walking ability. “We all acknowledge that there are flaws and we should be able to do better to measure disability for MS,” Gelfand said.
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