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    Overall Neuropathy Limitations Scale (ONLS)

    Quantifies severity of peripheral neuropathy.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Specifically validated in peripheral neuropathies, particularly immune-mediated types (GBS, CIDP and paraprotein-associated demyelinating neuropathies). 
    • Non-neuropathic conditions that affect function (e.g. arthritis) should be considered and not scored. 
    • Not validated for use in children, and should be applied to adult patients only.

    • Used to quantify functional disability relating to peripheral neuropathy, particularly to assess progression over time or response to treatment.
    • The ONLS is essentially a modified ODSS (Overall Disability Sum Score), which was derived from a tool at Guy’s Hospital for assessing patients with multiple sclerosis. 
    • Involves primarily assessment of function, with grades 0-5 in the arms and 0-7 in the legs (higher numbers indicate worse function), and a total score of 0-12 allowing broad assessment of a patient’s disability (the original ODSS graded lower limb function as zero if walking was not affected, whereas the ONLS reduces the ceiling effect by requiring the additional tasks of running and climbing stairs to be unaffected).
    • May not be as responsive to changing symptoms in neuropathies without a significant motor component (e.g. DADS-M).
    • Best used when combined with direct questions of the patient and direct observation of function.
    • The ONLS allows semi-objective measurement of function, which is useful to detect changes with therapy, and relatively earlier changes may be detected than on the standard five-point Medical Research Council scale used in routine examination of muscle power. 
    Arms grade score
    No
    Yes
    Legs grade score
    No
    Yes
    No
    Yes
    No
    Yes
    Without aid
    With one stick or crutches or holding to someone’s arm
    With two sticks or crutches or one stick or crutch holding onto someone's arm or frame
    With a wheelchair
    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Richard A.C. Hughes

    About the Creator

    Richard A.C. Hughes, MD, is an emeritus professor of neurology at King’s College London and a visiting professor of neurology at University College London. He was awarded the Fellowship of the Academy of Medical Sciences in 2000 and the Medal of the Association of British Neurologists in 2006. Dr. Hughes’s primary research is focused on the pathogenesis and treatment of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, and systematic reviews of treatment for neuromuscular disease.

    To view Dr. Richard A.C. Hughes's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Antony Winkel, MBBS, FRACP
    About the Creator
    Dr. Richard A.C. Hughes
    Are you Dr. Richard A.C. Hughes?
    Content Contributors
    • Antony Winkel, MBBS, FRACP