Friday, October 23, 2009

HOME SAFETY - by Susan Dorne, OT
One of the biggest concerns I have as a health care professional is the safety of people. It’s amazing how many barriers are around us, many of which we are not aware of. For people without deficits, they can usually maneuver around obstacles with little or no harm or even thought for that matter. However, when you have MS and your vision, mobility, balance, strength, endurance, and sensation may be affected, consequences are often inevitable. It never ceases to amaze me when people reply “I Know But…” when I try to address potential safety risks and make recommendations.
To begin with, get rid of throw and area rugs as they are a significant safety hazard and one of the biggest causes of falls. It is best to use skid resistant rugs and mats to avoid the rug from sliding or folding over. Flooring can be tricky. Tiles can be slippery while rugs can make mobility difficult. Challenges with rugs can occur when you have weakness in the legs or feet, fatigue, limited endurance and use of different mobility aides (such as a cane, rolling walker and a
wheelchair when you have to push yourself). Choose flooring that best suits your needs and don’t be discouraged if you have to change it later on. No matter what, you always want to be aware of the surface you are walking on in and outside the home.
Rooms should be clutter free. Arrange furniture so that it is easy to move around safely and take into consideration any walking devices or wheelchairs/scooters used. Move cords so they are not in the way and make sure there is easy access to good lighting at all times. Use night lights for areas you go to regularly especially the bedroom, bathroom and hallways.
Couches, chairs and beds should be at a proper height to get into and out of easily. These surfaces should be at height equal to the back of your knees (use cushions or pillows to raise the surface), chairs with arm rests are easier to use, and avoid wheels whenever possible. Beds can be against the wall to serve as a protective barrier if there is a risk of falling off the bed during sleep. A side rail can be used for the open side if need be. If you use a wheelchair, you will need 4 ½ feet on one side of the bed for access.
A common place for falls is the bathroom. Grab bars are used to maintain balance in tubs, showers and by commodes/toilets. They come in various shapes, sizes, and colors and I strongly suggest having them installed by a licensed and insured company or individual. Towel racks and soap dishes are
not intended to be used as a supportive device as they are slippery
and can easily break from the wall. There are also portable grab bars (attached by rubber suction) to use for stability in other places and rooms, if you’re renting, or to take when traveling.
Shower chairs and tub benches are used to help with limitations in standing, mobility, and fatigue. If a tub bench is required, you will need to remove shower doors and install a shower curtain. Whenever a shower curtain is used, make sure the shower rod is bolted or screwed into the wall and the clips attaching the curtain to the rod are sturdy. A hand held shower hose provides easier showering. Non-skid mats and strips are used inside tubs and showers as well as outside for drying off.
Sensory deficits are important to be aware of and to take proper precautions. Set your water heater thermostat to 110 degrees or lower to help prevent scalding. It is best to test water temperature by touch and if you are experiencing numbness, I encourage you to purchase a water thermometer.
In addition, proper care must be taken while cooking. Be aware as handles get hot, food splatters, oven racks and sides get extremely hot as well as all baking and cookware. Eliminate or minimize use of sharp objects (this is important for visual deficits and hand weakness as well). Some examples include: purchase pre cut foods to minimize using knives; use electric razors, and use blunt scissors instead of sharp ones (if you must use them at all).
Another issue I want to emphasize is the importance of using an assistive device if you are advised to use one. Walls, furniture and counter tops do not count as assistive devices so stop using them! Do not get a walking aide and use it without proper assessment, sizing and instruction from a therapist.
The information provided are just some examples of how you can have a safe environment at home. An occupational therapist (OT) can do a full home evaluation where suggestions and training will be made based specifically on your needs.
If you’re ever in doubt whether you can or should do something, wait until you have another person is available. It’s important to always ask assistance whenever possible regardless of the situation and don’t be afraid or embarrassed to do so.
Link to article:http://bit.ly/22fuYh
Gentle Touch May Aid Multiple Sclerosis Patients

While gripping, lifting or manipulating an object such as drinking from a cup or placing a book on a shelf is usually easy for most, it can be challenging for those with neurological diseases such as multiple sclerosis or Parkinson's, or for people who had a stroke. For them, the tight gripping can cause fatigue, making everyday tasks difficult.
A team of University of Illinois at Chicago physical therapists report this month in the journal
Neurorehabilitation and Neural Repair that persons with multiple sclerosis use excessive force when they are lifting objects.
In an earlier finding reported in the journal Clinical Neurophysiology, they reported that regaining control and coordination may be as easy as applying a gentle touch to the affected hand from a finger of the opposite hand.
"We studied how this light touch application changes the way people apply force to an object they want to grip," said Alexander Aruin, professor of physical therapy.
The study compared eight adults with multiple sclerosis to eight without the disease, gender-matched and of comparable age. "In each case, the grip force required to lift an object decreased," said Aruin.
He found similar results in an earlier study he did of people with arm weakness caused by a stroke.
Why the simple light finger touch application works so well is not fully understood, but Aruin offers a hypothesis.
"It could be due to auxiliary sensory information from the contra-lateral arm," he said. "When we use our second hand and touch the wrist of the target hand, available information to the central nervous system about the hand-object interaction may increase. Without the touch, the information needed to manipulate an object comes only through vision and sensory input from just the target arm and hand."
Aruin and his colleagues tested subjects griping and lifting a variety of objects that they moved in several different ways, directions and velocities. The gentle finger touch always helped to reduce grip force, making the task easier.
The UIC researcher said he and his colleagues plan to test the approach on those with other
neurological and muscular diseases to examine the effects.
"We look forward to developing training and rehabilitation procedures on how to use this," said Aruin.
"We know that MS patients are prone to fatigue and muscle weakness. This finding may enable them to perform daily activities more independently to improve their quality of life."
The papers' lead author was Veena Iyengar, a former master's student of Aruin's now at Advocate Lutheran General Hospital in Park Ridge, Ill. Other authors were Marcio Santos, a former UIC postdoctoral fellow now at Santa Catarina State University in Brazil, and Michael Ko, a neurologist with Loyola University Chicago's medical center.
The research was supported by a grant from the National Multiple Sclerosis Society.
Source: University of Illinois at Chicago
Article URL: http://www.medicalnewstoday.com/articles/167426.php

Multiple Sclerosis: Controlling Muscle Spasms

Many people with MS experience spasticity, or muscle stiffness and spasms. It usually affects the muscles of the legs and arms, and may interfere with the ability to move those muscles freely.

Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It can feel like a muscle tightening or it can cause severe pain. Spasticity can also produce feelings of pain or tightness in and around joints and can cause low back pain. The intensity may vary depending on your position, posture, and state of relaxation.

What Causes Spasticity?

Spasticity is the result of an imbalance in the electrical signals coming from the brain and spinal cord, often caused by damage to these areas from by MS. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions of the muscle, and increased muscle tension.

What Triggers Spasticity?

Spasticity may be aggravated by extremes of temperature, humidity, or infections. It can even be triggered by tight clothing.

How Is Spasticity Diagnosed?

To diagnose spasticity your doctor will first evaluate your medical history, including what medications you have taken and whether there is a history of neurological or muscular disorders in your family. To confirm the diagnosis, several tests can be performed to evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.

How Is Spasticity Treated?

Spasticity can be treated using physical therapy, medications, surgery or any combination of these treatments. Your doctors will consider the severity of your condition, your overall health, and the following factors when prescribing an appropriate treatment plan:

  • Is the spasticity affecting function or independence?
  • Is the spasticity painful?
  • What treatment options have already been tried, and how did they work?
  • What are the costs of the possible treatments?
  • What are the limitations and side effects of the treatment?
  • Will the benefits outweigh the risks?

How Does Physical and Occupational Therapy Help Spasticity?

A basic physical therapy stretching program is the first step in treating spasticity. A daily regimen of stretching can lengthen muscles to help decrease spasticity.

An occupational therapist may prescribe splinting, casting, and bracing techniques to maintain range of motion and flexibility.

If physical and occupational therapy do not adequately control the spasticity, medications may be added to the treatment plan.

What Medications Are Used to Treat Spasticity?

Common medications used to treat spasticity include the muscle relaxants baclofen and Zanaflex.

Another drug that might be used to treat spasticity is Valium, which is often helpful when taken at night to relieve spasms that interfere with sleep.

If medications taken orally are not effective, a pump can be surgically implanted to deliver the medication (such as the baclofen pump). Botulinum toxin (or Botox) can also be injected locally into the affected area to relax the muscles.
What Types of Surgery Are Available?
When other treatments fail, rhizotomy and tendon release are two surgical procedures used to treat spasticity.
Rhizotomy involves surgically cutting away part of the spinal nerve. It is performed to relieve pain or decrease muscle tension.
Tendon release, also called a tenotomy, may be performed to help reduce the frequency or magnitude of the spasticity,
depending on the age of the patient. The surgery involves cutting severely contracted tendons away from the muscles to which
they're attached.
Tendon release may need to be repeated.
These surgeries are usually only done in extreme cases that do not respond to other treatments.
Article Link:
http://www.webmd.com/multiple-sclerosis/guide/controlling-muscle-spasms

Thursday, October 15, 2009

(WBFO) - UB Neurologists are ready to investigate the possible underlying cause of Multiple Sclerosis.
(2009-10-15)
(Listen to the audio report featuring Dr. Robert Zivandinov)

Click the audio player AT THIS LINK to hear Eileen Buckley's full story now or use your podcasting software to download it to your computer or iPod.

An Italian researcher has uncovered a new clue in the search for the cause of MS. It is the discovery of a narrowing of the primary veins outside of the skull. It restricts normal blood flow to the brain resulting in a vascular condition found in MS patients. Now UB is ready to dig into this research. Dr. Robert Zivadinov is an associate professor of Neurology.

A study is already underway in Buffalo. Dr. Murali Ramanathan, associate professor of Pharmaceutical Sciences at UB, says they want to replicate the findings from Italy.

© Copyright 2009, WBFO

Multiple Sclerosis: Understanding the Differences in MS

In some ways, each person with multiple sclerosis lives with a different illness. Although nerve damage is always involved, the pattern is unique for each individual who has MS.

Although individual experiences with MS vary widely, physicians and researchers have identified several major types of MS. The categories are important. That’s because they help predict disease severity -- and response to treatment.

Primary progressive multiple sclerosis

In primary progressive MS, symptoms continually worsen from the time of diagnosis. There are no well-defined attacks. And there is little or no recovery. Between 10% and 15% of people with multiple sclerosis have primary progressive MS.

Several aspects of primary progressive MS distinguish it from other types of MS:

  • People with primary progressive MS are usually older at the time of diagnosis -- an average age of 40.
  • Roughly equal numbers of men and women develop primary progressive MS. In other types of MS, women outnumber men three to one.
  • Primary progressive MS usually leads to disability earlier than relapsing-remitting MS (see below).
  • Perhaps the most upsetting difference in primary progressive MS is its poor response to treatment. So far, no treatments have been shown to help, although studies are ongoing.

Relapsing-remitting multiple sclerosis

Most people with multiple sclerosis -- around 90% -- have the relapsing-remitting type. Symptoms first affect most people in their early 20s. After that, there are periodic attacks (relapses), followed by partial or complete recovery (remissions).

The pattern of nerves affected, severity of attacks, degree of recovery, and time between relapses all vary widely from person to person.

Eventually, most people with relapsing-remitting MS will enter a secondary progressive phase of MS.

Secondary progressive multiple sclerosis

After living with relapsing-remitting MS for many years, most people will develop secondary progressive MS. In this type of MS, symptoms begin a steady march, without relapses or remissions. (In this way, secondary progressive MS is like primary progressive MS.) The transition typically occurs between 10 and 20 years after the diagnosis of relapsing-remitting MS.

It’s unclear why the disease makes the transformation from relapsing-remitting to secondary progressive MS. A few things are known about the process:

  • The older a person is at original diagnosis, the shorter the time for the disease to become secondary progressive.
  • People with incomplete recovery from initial relapses generally convert to secondary progressive MS sooner than those who recover completely.
  • The process of ongoing nerve damage changes. After the transformation, there’s less inflammation, and more slow degeneration of nerves.

Secondary progressive MS is challenging to treat -- and to live with. Treatments are moderately effective at best. Progression occurs at a different rate in each person and generally leads to some disability.

Progressive relapsing multiple sclerosis

Progressive relapsing multiple sclerosis is the least common form of multiple sclerosis. Relapses or attacks occur periodically. However, symptoms continue and are progressive in between relapses.

Progressive relapsing MS is rare enough that little is known about it. Probably around 5% of people with multiple sclerosis have this form. Progressive relapsing MS seems to be similar to primary progressive MS in many ways.

What causes MS?

No one knows what causes multiple sclerosis. Tantalizing clues have sparked research in many areas, but no definite answers. Some theories have included:

  • Geography. People in the northern U.S. develop MS more often than those in the warmer south. Research into vitamin D and sunlight as protective factors is ongoing.
  • Smoking. Tobacco may increase the risk slightly. But it’s not the whole story.
  • Genetics. Genes do play a role. If an identical twin has MS, the other twin has a 20% to 40% chance of developing it as well. Siblings have a 3% to 5% chance if a brother or sister is affected.
  • Vaccines. Extensive research has essentially ruled out vaccines as a cause of MS.

Multiple sclerosis is probably an autoimmune disease. Like lupus or rheumatoid arthritis, the body creates antibodies against itself, causing damage. In MS, the damage occurs in the lining, or myelin, of nerves.

How is multiple sclerosis diagnosed?

Multiple sclerosis is generally diagnosed after a person has experienced troublesome symptoms related to nerve damage. Vision loss, weakness, and loss of sensation are common complaints.

The most common tests used to diagnose MS are scans of the brain and spinal cord with magnetic resonance imaging (MRI) and lumbar puncture or spinal tap.

Unfortunately, the time between the first appearance of symptoms and diagnosis of MS can be prolonged. Studies show that because symptoms are often low-grade or vague, doctors may miss the diagnosis.

Even when symptoms are definitely consistent with MS, the diagnosis still can’t be made right away. This is because, by definition, multiple sclerosis is a long-term illness. After the first symptoms, there’s an often frightening and frustrating period of waiting until more symptoms occur and the diagnosis becomes clear.