July 06, 2015
If you overhear a research meeting at the Swedish MS Center, it may come up that the rehabilitation studies are not sub-listed under, "disease modifying therapy trials." That is when I usually pipe up and say, "Rehabilitation is disease modifying in MS!" In fact, it is one the of proven disease modifiers in progressive MS. Below is a summary of the recent article from the Italian MS group that reviewed improvements in brain plasticity from motor and cognitive rehabilitation in patients with MS. The Italian researchers do an excellent job in quantifying outcome measures from rehabilitation interventions using imaging.
May 22, 2015
Many multiple sclerosis (MS) patients take supplements for their health. The natural substances that have the most evidence based medicine for health in MS are ensuring adequate levels of Vitamin D, B-12, Omega 3 fatty acids, and Calcium.
February 21, 2015
There is increasing evidence that impairment of the sensory system in multiple sclerosis contributes to balance and gait disorders. The majority of the disruption of sensation comes from spinal cord lesions. MS spinal lesions have a propensity to affect the posterior portion of the spinal cord. This involves the Posterior column-medial lemniscus pathway (PCML) (also known as the dorsal column-medial lemniscus pathway) that conveys localized sensations of fine touch, vibration, two-point discrimination, and proprioception (position sense) from the skin and joints. It transmits information from the body to the postcentral gyrus of the cerebral cortex (brain). A recent research article, “Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial”, highlights that rehabilitation targeted to this issue may help:
November 25, 2014
The great wisdom traditions teach us that internal reflection is a useful means to grow. Reflecting upon that. I thought that we could spend some time reviewing a technique of external reflection in rehabilitation known as mirror therapy. This was first described in 1995 by Ramachandran and his team who studied phantom limb pain. Many concepts in multiple sclerosis (MS) rehabilitation come from stroke and pain rehabilitation fields. There is evidence in these fields that supports the use of mirror therapy to help rehabilitation of the weaker side. It also helps reduce neuropathic pain in patients who have phantom limb ( arm or leg) pain after an amputation. There is very limited published research on the use of mirror therapy in MS. We think that adding this type of therapy in the care of MS patients might be beneficial to reduce pain and weakness, and perhaps reduce "learned disuse" of the limb. A brief summary of how to perform M...
August 21, 2014
Seattle's summer is not over yet and temperatures have been on the rise. Many individuals with Multiple Sclerosis experience a worsening of symptoms when the weather is hot or humid. The heat can temporarily induce symptoms; however, it does not cause more disease activity. Should one become overheated, simple steps can be taken to lower your body temperature. The following can assist in easing the effects of heat:
March 29, 2014
Up to 80 percent of people with multiple sclerosis (MS) have problems with walking. The combination of weakness of the muscles of the legs, spasticity, and core weakness contributes to this. Often, it will present with problems lifting the foot, referred to as foot drop. This is due to weakness of the muscles that lift the foot (dorsiflexors) and spasticity or over power of the muscles that push the foot down (plantar flexors). Traditional ankle foot orthosis have advantages over functional electrical stimulation (FES) braces in that they help with ankle stability and reduce spasticity. Advantages of FES braces include some evidence that there may be stimulation of the cortical neurons above the stimulation area, they are less cumbersome, and more discrete to wear. A recent study looked at ..
November 15, 2013
I am delighted to write the blog over the Progressive MS session that was given at ECTRIMS 2013. Much emphasis has been given to the need for more research in the fields of progressive MS. The majority of MS patients fit into this broad category: primary progressive MS, secondary progressive MS, and progressive relapsing forms of the disease. During a session devoted to progressive MS, leaders in the field discussed several initiatives underway to address the challenges presented by these forms of the disease. Rehabilitation is a mainstay and key to improving the lives of patients with progressive MS. Many patients describe their progression in terms of mobility decline, which is a major target of improvement in rehabilitation programs. The first session was devoted to confusion surrounding the definition of “progression in MS.” We use ...
August 29, 2013
I am pleased to write some of my thoughts after attending the International Conference on Rehabilitation Robotics (ICORR) in June. This bi-annual meeting brings together biomedical, design, and mechanical engineers as well as providers that work in the field of rehabilitation robotics. Robotic devices are part of the future of neuro-rehabiltation for multiple sclerosis (MS) patients. ICORR displayed designs and prototypes of upper extremity devices and lower extremity gait orthosis devices that hold promise for MS patients. Using these devices in clinical rehabilitation practice would improve patients’ ability to perform the frequent, repetitive movements that we know are essential for the brain to adapt to change, re-grow myelin and build connections between neurons (
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July 31, 2013
This post is jointly written with Alika Ziker, Swedish Neuroscience Institute research intern. Botulinum toxin type-A (Botox) is a naturally occurring toxic substance best known for its use in cosmetics. It is taken from certain bacteria and works by preventing the target muscle from contracting. Over the last 15 years, several studies have emerged supporting the idea that Botox is also an effective and safe therapy for people who suffer from a loss of muscle control, lower back pain and even migraines. Because multiple sclerosis (MS) is a disease that attacks the central nervous system, many MS patients suffer from those same conditions, as well as weakness and spasticity. Depending on the individual, the affected muscles may be ....
May 06, 2013
Cognitive dysfunction is common in patients with multiple sclerosis (MS) and can be present from initial diagnosis through late stages of the disease. The most common issues are problems with: Attention Information processing (thinking) Learning and memory Recent papers have looked into which rehabilitative strategies would most help these issues. A new study published in the journal Neurorehabilitation & Neural Repair shows how one specific intervention could improve or restore impaired attention functions in people with relapsing-remitting multiple sclerosis (RRMS) who experienced major attention deficits....
April 21, 2013
“It takes a village to raise a child” but as a new or expectant parent or “village member,” preparing for a new baby can be daunting. From siblings, to grandparents, to aunts, uncles, cousins, and family friends, all of these people feel the ripple effect of having a baby. However, unlike parents, this larger social network may not have had the chance, motivation, or tailored resources to prepare for this change. So how can new or expectant parents help prepare non-parents for the birth of a child? Though the answer depends on the person’s age and their relationship to baby, here are some general tips to prepare your “village.” Involve friends and family in preparing for the baby: Depending on your comfort level and your audience,...
April 11, 2013
Mobility issues secondary to strength, balance, and walking problems affect up to 80 percent of people with multiple sclerosis (MS). Providers and therapists use a variety of scales and tools to measure the extent of these issues such as: The Berg Balance Scale (BBS) is a measure of balance that uses a 14-item scale and is scored based upon the results 0-56. The 6-minute walk (6MW) is a measure of walking endurance. Handheld Dynamometry (HHD) is a way to quantify manual muscle strength testing. There is a lot of emerging research about “MS biomarkers,” which are values that look for ways to predict how patients will do in the future. The above tests are “physical biomarkers” of patient performance that may be able to be used as measures of disease state and change over time. Often patients and clinicians are left...
November 14, 2012
Before they learn to crawl or walk, about 10,000 babies every year in the United States will develop a condition that will change how they will do just that. Cerebral palsy (CP) is a neurological condition caused by a brain injury before birth, during delivery or before a child’s second birthday. An estimated 800,000 Americans live with CP. The most common symptom in CP is spasticity, an increase in muscle tension that impairs proper movement. Abnormal postures or movements, weakness or loss of muscle control and rigidity are also part of the constellation of CP signs and symptoms. While physical therapy remains the cornerstone for treatment, new medications and therapies for CP are being developed to help improve and manage symptoms. Currently,
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