“Bed
patient”, “nonambulatory” or “bedridden” are words not only associated with but
that define the more advanced stages of Multiple Sclerosis.
Back in
the 1950’s, Dr. John F Kurtzke developed the Disability Status Scale for people
with Multiple Sclerosis. Scores range from 0 = normal neurological exam to 10 =
death due to MS.
Using
the terminology of the Expanded Disability Status Scale (EDSS) revised by
Kurtzke in 1983, we can see how much “bed” essentially dominates scores …
8.0 “Essentially
restricted to bed or chair or perambulated in wheelchair…
8.5 “Essentially
restricted to bed much of day…”
9.0 “Helpless
bed patient …
9.5 “Totally
helpless bed patient …”
10.0 “Death
due to MS …”
OK that
was health care jargon circa 1983 but what about today?
The most
current distinctions I could find were in The Health and Safety Code of the State
of California amended in 2010 to address nonambulatory vs bedridden.
The
specific difference has to do with ability to reposition in bed:
“residents/clients
who need assistance in transferring to and from bed (but who do not need
assistance in turning or repositioning in bed), shall be considered
nonambulatory … Bedridden means persons who do need assistance to turn or
reposition in bed”.
Patti
cannot transfer unassisted to and from bed nor turn or reposition in bed.
Additionally challenged to effectively swallow/eat … on paper she might appear
to almost top the charts. Yet with the teamwork, technology and attention of
24/7 care facility era, Patti is far from a “helpless bed patient”.
I cannot
help but wonder how much the availability, level, and commitment to care and
support plays a role in the most advanced stages of MS?
‘Helpless’
denotes a patient’s physical abilities or lack thereof from progression of MS.
God help
us all if Kurtzke ever tried to quantify the caring choices of family and
friends of those with MS.
related entry
MS Caregiving - reframe your idea of normal
Caregivingly Yours, Patrick Leer