The Neurological Disability Score (NDS)

 

Examination groups: measured separately on the left and right sides:

(1) cranial nerves

(2) muscle weakness

(3) reflexes

(4) sensation

 

Cranial nerves (6):

(1) papilledema

(2) extraocular muscle weakness, Cr III (affects levator palpebrae, inferior and superior rectus, inferior oblique and sphincter pupillae muscles)

(3) extraocular muscle weakness, Cr VI (affects lateral rectus muscle)

(4) face weakness

(5) palate weakness

(6) tongue weakness

 

Muscle weakness (16):

(1) respiratory

(2) shoulder abduction

(3) biceps brachii

(4) brachioradialis

(5) extension at elbow

(6) extension at wrist

(7) flexion at wrist

(8) extension of fingers

(9) flexion of fingers

(10) intrinsic hand

(11) iliopsoas

(12) glutei

(13) quadriceps

(14) hamstrings

(15) dorsiflexors

(16) plantar flexors

 

Reflexes (5):

(1) biceps brachii

(2) triceps brachii

(3) brachioradialis

(4) quadriceps femoris

(5) triceps surae

 

Sensation (8):

(1) index finger (below base of nail): touch pressure

(2) index finger (below base of nail): pricking pain

(3) index finger (below base of nail): vibration

(4) index finger (below base of nail): JP (joint position)

(5) great toe (below base of nail): touch pressure

(6) great toe (below base of nail): pricking pain

(7) great toe (below base of nail): vibration

(8) great toe (below base of nail): JP

Scoring	Points
no deficit	0
mild deficit	1
moderate deficit	2
severe deficit	3
complete absence of function or severest deficit	4

 

cranial nerve subscore

= SUM(points for 6 cranial nerve items from both left and right sides)

 

muscle weakness subscore =

= SUM(points for 16 muscle weakness items from both left and right sides)

 

reflexes subscore =

= SUM(points for 5 reflex items from both left and right sides)

 

sensation subscore =

= SUM(points for 8 sensation items from both left and right sides)

 

total NDS score =

= SUM(all 4 subscores)

= SUM(points for all of the measures bilaterally)

 

Interpretation:

• minimum score: 0

• maximum score, one side: 140

• maximum score, bilateral: 280

• The higher the score, the greater the neurological deficit.

 

Limitations:

• The score is intended to measure deficits and does not allow for hyperactive reflexes or other increased activities.