What FS Score will get the patient with tetraparesis (BMRC grade 4 in all limbs), but still unrestricted?A mild tetraparesis with BMRC grade 4 in all muscle groups meets the criteria for an FS Score of 3 (BMRC grade 4 in more than two muscle groups). It sounds somewhat unlikely that the patient is still "unrestricted", but this does not affect the FS Score in this case, anyhow.
In determining the score for the pyramidal system, what constitutes a "muscle group?" Is it the all the muscles that serve to bend a single joint in one direction, is it the muscles on both sides of the body that do the same thing, is it all the extensor (or all of the flexor) muscles in one particular extremity, or is it something else? A muscle group is defined as all mucles that serve to bend a single joint in one direction, e.g. the knee flexors (M. biceps femoris, M. semitendinosus, M. semimembranosus, M. sartorius and M. gastrocnemius).
During assessment of Pyramidal FS patient reported heavy leg while going/ running upstairs. That was remarkable for this patient because he could not run upstairs as fast as before after his children while playing. Assessment of BMRC was 5 in all muscle groups. What pyramidal FS score could I give for this patient?Your patient complained of reduced motor performance. If there is no other good explanation (arthrosis? knee pain? etc.) you must asssume that this is due to MS and score a 2 in the pyramidal FS score (according to motor fatigability or reduced performens in strenuous motor tasks) and and 1 in the Overall motor performance subscore.
The patient states that she occasionally has left arm heaviness that occurs about once every few months. THe heavyness goes away on its own and the patient is able to work through it. It lasts about one day. However on motor testing Dr. KHoury finds that the patient is 5/5 strength in all 4 extremities and in all muscles tested. Should the score be a 0 for pyramidal functions or a 2 based on the minimal disablity she reports?If such weakness does not persist and is neither detectable in the neurological examination nor reported by patient as present on the day of the visit, it won't count for the FS and EDSS. So in your specific case where there is no deficit in limb strength and no reported persisted reduction in strenuous motor tasks, the Pyramidal FS would be 0 (or 1 if there would be any reflex abnormalities etc.).
During assessment of Pyramidal FS patient reported heavy leg while going/ running upstairs. That was remarkable for patient because he could not run upstairs as fast as before after his children while playing. Assessment of BMRC was 5 in all muscle groups. What pyramidal FS score I could give for this patient?In this case you should rate the patient's overall motor performance as abnormal (1) due to reduced performance in strenous motor tasks without reduction in limb strength on confrontional testing. This results in a pyramidal FS score of 2.
Does the oscilation of lower extremities contribute to pyramidal FSS?If you mean with "oscilation of lower extremities" intermittent fluctuation of muscle strength, please use the result of the examination of scheduled visit, if motor-fatigability is reported it contributes to the Pyramidal-FS at least with a score of 2.
When testing reflexes the video does upper extremities but doesn't Testing reflexes and knowing the correct position for testing belongs
tell you which one is for which area i.e: Biceps, triceps, &
brachioradialis; knee and ankle. what does the < and > sign mean?
to the basic of a general neurological examination and so far all
neurologist are familiar with these techniques. "< and >" : you may add
one of these signs to point out that there is a difference between left
and right concerning the intensity of the tested reflexes.
Where is it outlined or discussed for the Pyramidal scores normal The neurostatus scoring booklet will give you a detailed description of
finding versus abnormal findings?
obligatory and recommended tests for the pyramidal system. In addition
you will find detailed examples of examination results (including a
comparison of different scores) on the training DVD-ROM (Neurostatus
The definition for a Pyramidal FS score of 2 includes fatigability in motor tasks. What are some examples of fatigability in motor tasks?Examples include:A patient is now able to jog a considerably shorter distance or for considerably shorter time than previously. Considerably is defined as a reduction by more than 30-50%, not secondary to other non-MS reasons.A patient has difficulty with his morning walk, which he has done everyday for the past year without problems.A patient's tennis game is worsening and cannot keep up with his/her peers.A patient previously exercised three times a week at the gym without problems. Now when the patient exercises he/she is completely exhausted for the rest of the day.