Tag Archives: multiple sclerosis

New England Disabled Sports: Winter Activities

About New England Disabled Sports
New England DisAbled Sports is a national recognized program which provides year round adaptive sport instruction to adults and children with physical and cognitive disAbilities.

Their programs allow individuals with disabilities to enjoy a boundary-free environment, enjoy outdoor recreation with friends and family, as well as provide access to equipment and instruction that might otherwise be unavailable.

Their Mission:
The Mission of New England Disabled Sports is, through sports, to change lives affected by disabilities. Download New England Disabled Sports brochure

Their Vision:
They envision a world where disabilities are not barriers.

Their Values:

  • They embrace volunteerism
  • They foster community
  • They strive for excellence
  • They listen to and learn from everyone
  • They nurture personal development through high-quality training and instruction
  • They strive for diversity

Winter Activities

Alpine Skiing

Mono skiing
The mono ski is a device used mainly by people with limited use (or absence) of the lower extremities. A mono ski, also known as a sit-ski, consists of a molded seat mounted on a metal frame. A shock absorber beneath the seat eases riding on uneven terrain and helps in turning by maximizing ski-snow contact. Modern mono skis interface with a single, ordinary alpine ski by means of a “ski foot,” a metal or plastic block in the shape of a boot sole that clicks into the ski’s binding. A mono skier use outriggers for stability; an outrigger resembles a forearm crutch with a short ski on the bottom. People new to mono-skiing are often surprised to see how much terrain is skiable in a mono ski; advanced mono skiers can be found not only carving turns on groomed runs but also skiing moguls, terrain parks, race courses, glades and even backcountry terrain—in short, wherever stand-up skiers can go.

Bi-skiing
A bi-ski is a sit ski with a can be skied independently like the mono-ski with hand-held outriggers, or can be skied with the assistance of an instructor using stabilizing outriggers and tethers. The skier moves his or her head, shoulders or hand-held outriggers to turn the bi-ski. The bi-ski has a lift mechanism for getting onto a chairlift. It can also be used to accustom a new sit-skier to the snow before moving to a mono-ski. Bi-skis are used by people with upper and lower limb impairments and with poor balance. People with these impairments might bi-ski:

  • Cerebral palsy
  • Multiple sclerosis
  • Muscular dystrophy
  • Amputees
  • Spinal cord injury
  • Severe epilepsy
  • Spinal bifida
  • Severe balance impairment

Outriggers are metal elbow crutches with the tip section of a ski pivoted on the bottom of the crutch. Some outriggers have adjustable brakes attached to the back edge of the ski to give some speed control. Outriggers are used to aid balance and/or to give support. Outriggers are used by mono-skiers, bi-skiers and standing skiers needing aid with balance.

3-Track & 4-Track skiing
3 track skiing is defined as skiing on one ski with outriggers to maintain balance. The student is able to stand on one ski and maintain dynamic balance with the assistance of outriggers (poles). 4 track skiing is very similar to 3 track but the skier has 2 feet on skies, rather than one.

Visually Impaired
Alpine (downhill) skiing is one of the rare opportunities available that allows the blind individual to move freely at speed through time and space. It provides the opportunity to embrace and commune with the primal force of gravity, thus experiencing the sheer exhilaration of controlled mass in motion, in a physically independent setting.

For those with Visual Impairment, a sighted Guide is needed. For lesser impairment the guide may simply need to ski a short distance in front of the skier to show the way. Skiers with greater vision loss or who are totally blind will generally ski using a headset arrangement to give audible instruction.

Snowboarding
Snowboarding has become very popular with New England DisAbled Sports students. People with cognitive or physical disAbilities are able to participate and experience the thrills of riding the mountain. The number of snowboarding lessons increases each year as the sport grows in popularity within our community. New England DisAbled Sports offers ski and snowboard lessons daily throughout the winter season.

Snowshoeing
Come explore the snow trails and fresh air of the mountains covered in snow while snowshoeing. Enjoy a winter hike in the woods from the more stable base of snowshoes. Take in peaceful scenery while working to improve your physical fitness level, balance and spatial awareness. You’ll love it!

Winter Biathlon
A seemingly unlikely combination of events – one is an aerobic activity (skiing or running) which requires strength, speed and endurance; the other is a passive activity (shooting) which requires concentration and a steady hand (difficult after you’ve been skiing, running or walking all out!).

Early Signs and Symptoms of Multiple Sclerosis

Multiple Sclerosis early signs, symptoms can be in such a mild form as not to be initially detectable.

MS early symptoms and signs appear at the onset of the disease, usually between the ages of 20 and 40. MS early symptoms and signs vary in duration and severity from one individual to the other and at different times in the same individual.

The most recurrent are:

  • walking difficulties
  • the sensation of having a weak or numb limb
  • cold or tingling feet
  • facial pain (Neuralgia)
  • blurred vision

Less common MS early symptoms include:

  • lack of coordination
  • cognitive difficulties
  • slurred speech
  • sudden onset of paralysis

As the disease progresses other symptoms can appear.

MS Pain
MS pain is the type of pain that affects the central nervous system and pain syndromes are common amongst MS patients. Almost 50% of MS patients suffer s from chronic pain. There are several types of MS pain. The main types are:

  • Neuralgia, which is a stabbing pain in the face; it is usually treated with anticonvulsants.
  • Dysesthesias, which is a burning, aching body pain; it is usually treated with anticonvulsants and sometimes with antidepressants which act on the nervous central system.
  • Lhermitte sign, which is a brief, electric shock like sensation that runs down the spine and is caused by bending the neck forward or backward. It is controlled by means of a soft collar.
  • A chronic sensation of ‘pins and needles’, which is treated similarly to acute Dysesthesias.
  • Muscle spasm and cramps, which are treated with anti-inflammatory drugs.
  • Back and skeleton pains, which are treated with heat, massage and physical therapy.

Neuromuscular Disorders

Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs. Your nerve cells, also called neurons, send the messages that control these muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.

Examples of neuromuscular disorders include

Many neuromuscular diseases are genetic, which means they run in families or there is a mutation in your genes. Sometimes, an immune system disorder can cause them. Most of them have no cure. The goal of treatment is to improve symptoms, increase mobility and lengthen life.

New England DisAbled Sports: Winter Activities

New Englands Disabled Sports- Winter Activities

About New England DisAbled Sports
New England DisAbled Sports is a national recognized program which provides year round adaptive sport instruction to adults and children with physical and cognitive disAbilities.

Their programs allow individuals with disAbilities to enjoy a boundary-free environment, enjoy outdoor recreation with friends and family, as well as provide access to equipment and instruction that might otherwise be unavailable.

Their Mission:
The Mission of New England DisAbled Sports is, through sports, to change lives affected by disAbilities. Download New England DisAbled Sports brochure

Their Vision:
They envision a world where disAbilities are not barriers.

Their Values:

  • They embrace volunteerism
  • They foster community
  • They strive for excellence
  • They listen to and learn from everyone
  • They nurture personal development through high-quality training and instruction
  • They strive for diversity

Winter Activities

Alpine Skiing

Mono skiing
The mono ski is a device used mainly by people with limited use (or absence) of the lower extremities. A mono ski, also known as a sit-ski, consists of a molded seat mounted on a metal frame. A shock absorber beneath the seat eases riding on uneven terrain and helps in turning by maximizing ski-snow contact. Modern mono skis interface with a single, ordinary alpine ski by means of a “ski foot,” a metal or plastic block in the shape of a boot sole that clicks into the ski’s binding. A mono skier use outriggers for stability; an outrigger resembles a forearm crutch with a short ski on the bottom. People new to mono-skiing are often surprised to see how much terrain is skiable in a mono ski; advanced mono skiers can be found not only carving turns on groomed runs but also skiing moguls, terrain parks, race courses, glades and even backcountry terrain—in short, wherever stand-up skiers can go.

Bi-skiing
A bi-ski is a sit ski with a can be skied independently like the mono-ski with hand-held outriggers, or can be skied with the assistance of an instructor using stabilizing outriggers and tethers. The skier moves his or her head, shoulders or hand-held outriggers to turn the bi-ski. The bi-ski has a lift mechanism for getting onto a chairlift. It can also be used to accustom a new sit-skier to the snow before moving to a mono-ski. Bi-skis are used by people with upper and lower limb impairments and with poor balance. People with these impairments might bi-ski:

  • Cerebral palsy
  • Multiple sclerosis
  • Muscular dystrophy
  • Amputees
  • Spinal cord injury
  • Severe epilepsy
  • Spinal bifida
  • Severe balance impairment

Outriggers are metal elbow crutches with the tip section of a ski pivoted on the bottom of the crutch. Some outriggers have adjustable brakes attached to the back edge of the ski to give some speed control. Outriggers are used to aid balance and/or to give support. Outriggers are used by mono-skiers, bi-skiers and standing skiers needing aid with balance.

3-Track & 4-Track skiing
3 track skiing is defined as skiing on one ski with outriggers to maintain balance. The student is able to stand on one ski and maintain dynamic balance with the assistance of outriggers (poles). 4 track skiing is very similar to 3 track but the skier has 2 feet on skies, rather than one.

Visually Impaired
Alpine (downhill) skiing is one of the rare opportunities available that allows the blind individual to move freely at speed through time and space. It provides the opportunity to embrace and commune with the primal force of gravity, thus experiencing the sheer exhilaration of controlled mass in motion, in a physically independent setting.

For those with Visual Impairment, a sighted Guide is needed. For lesser impairment the guide may simply need to ski a short distance in front of the skier to show the way. Skiers with greater vision loss or who are totally blind will generally ski using a headset arrangement to give audible instruction.

Snowboarding
Snowboarding has become very popular with New England DisAbled Sports students. People with cognitive or physical disAbilities are able to participate and experience the thrills of riding the mountain. The number of snowboarding lessons increases each year as the sport grows in popularity within our community. New England DisAbled Sports offers ski and snowboard lessons daily throughout the winter season.

Snowshoeing
Come explore the snow trails and fresh air of the mountains covered in snow while snowshoeing. Enjoy a winter hike in the woods from the more stable base of snowshoes. Take in peaceful scenery while working to improve your physical fitness level, balance and spatial awareness. You’ll love it!

Winter Biathlon
A seemingly unlikely combination of events – one is an aerobic activity (skiing or running) which requires strength, speed and endurance; the other is a passive activity (shooting) which requires concentration and a steady hand (difficult after you’ve been skiing, running or walking all out!).

 

Enabled By Design

Enabled by Design is a social business run on a not-for-profit basis for the benefit of its community.

It’s all about people-powered products and services:
Enabled by Design is a social business and community of people who are passionate about design for all. They believe that a good design can support people to live as independently as possible, by helping to make day-to-day tasks a little bit easier and in turn more manageable.

Enabled by Design’s work focuses on doing the following:

  • They provide their community with a space to share and talk about independent living products and services that are already available on the market, and to look at how they could be improved.
  • They are interested in exploring how people can “hack” or modify things to make them more accessible and easier to use.
  • They are working to develop relationships with designers, so that their community can help to improve the designs of the future with the aim of mainstreaming accessibility.

Enabled by Design was inspired by co-founder Denise Stephens’ experiences following her diagnosis of multiple sclerosis (MS) in 2003. Having suffered a series of disabling relapses and hospital admissions, Denise was assessed by an occupational therapist (OT) and given a range of assistive equipment to help her to be as independent as possible. Although this equipment made a huge difference to her life, she became frustrated as her home started to look more and more like a hospital. But Denise had an idea…

In April 2008, Enabled by Design was chosen to take part in the first ever Social Innovation Camp. A weekend long competition, Social Innovation Camp brings together people with ideas of how to solve specific social issues, with web developers, designers and those with business expertise to develop online solutions to real world challenges. At the end of the weekend after a Dragons’ Den-style pitching competition, Enabled by Design was awarded first prize as the ‘project with most potential’.

Since then Enabled by Design has been chosen to be part of the independent living stream of the Innovation Exchange’s Next Practice Programme, as well as a Level 1 and Level 2 Better Net UnLtd (Foundation for Social Entrepreneurs) award winner.

Denise and her co-founder, Dominic Campbell (also founder of government consultancy and social innovation incubator FutureGov), continue to work hard to spread the word about Enabled by Design and its goals, building a diverse community of people with an active interest in accessibility and design that supports independent living.

Multiple Sclerosis

Multiple Sclerosis
Multiple Sclerosis can affect individuals in varying ways including tingling, numbness, slurred speech, blurred or double vision, muscle weakness, poor coordination, unusual fatigue, muscle cramps, bowel and bladder problems and paralysis. Due to these symptoms, special equipment or accommodations may need to be made to aid a person in safely maintaining their mobility independence for as long as possible.

Physical Considerations: The following are considerations for selecting a vehicle:

Driving a sedan: The Individual must be able to do the following:

  • Open and close the Door
  • Transfer in and out of the vehicle
  • A wheelchair/scooter must be able to be stored and retrieved. Special equipment is available to aid with storage.

Driving a Van: Options may include a mini-van with a lowered floor and a ramp or a full size van with a lift. Specialized modifications allow a person to transfer to the driver’s seat or drive from a wheelchair. Technology may be able to compensate for the loss of strength or range of motion such as:

  • Reduced effort steering and/or brake systems to compensate for reduced strength.
  • Mechanical hand controls allow for operation of the gas and brake using upper extremities.
  • Servo brake/ accelerator systems compensate for reduced strength/range of motion of arms.
  • If spasticity is difficult to manage, it may lead to an inability to drive.

Visual Changes:

  • May be severe enough that driving is precluded or night driving is prohibited.
  • If double vision is intermittent and can be monitored independently, then driving may be limited to avoid driving during an exacerbation.
  • Sunglasses may help with glare sensitivity.
  • Compensate for loss of peripheral vision with special mirrors and head turning.
  • Learn order of traffic signals to aid with color vision impairment.

Cognitive Issues:

  • Need to regulate emotions and avoid driving when upset, angry or overly emotional.
  • May be limited to familiar routes if some loss of memory or problem solving but still enough judgment to drive.

Decreased Energy:

  • Energy conservation is vital.
  • May require assistance with wheelchair loading to save energy for driving.
  • Air conditioning aids with managing warm climates.

Medications:

  • Seek the physician’s input regarding side effects which may impair driving.
  • Monitor when medications are taken. Don’t drive when sleepy or just before or after medicating

If you or those that drive with you notice any of the above warning signs and need a driving evaluation, give us a call at 508-697-6006 and we can, help you with with knowledge about medical conditions, and help with a comprehensive evaluation and determine your ability to drive.

  • Visual Perception
  • Functional Ability
  • Reaction Time
  • Behind-the-wheel evaluation

 

Multiple Sclerosis Awareness

Multiple Sclerosis Awareness Week is March 3-9, 2014.
Multiple sclerosis destroys connections. So it’s only fitting that connections would be its greatest enemy. As individuals who care about someone affected by MS, the connections we create can become more powerful than the connections MS destroys.
Share your connections here

MS is a Disease of the Immune System

MS is a disease that involves an immune system attack against the central nervous system (brain, spinal cord, and optic nerves). The disease is thought to be triggered in a genetically susceptible individual by a combination of one or more environmental factors. Although MS is thought by some scientists to be an autoimmune disease, others disagree strongly because the specific target of the immune attack in MS has not yet been identified. For this reason, MS is referred to as an immune-mediated disease.

As part of the immune attack on the central nervous system, myelin (the fatty substance that surrounds and protects the nerve fibers in the central nervous system) is damaged, as well as the nerve fibers themselves. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

Most people with MS learn to cope with the disease and continue to lead satisfying, productive lives.

The Four Courses of MS
People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.

  • Relapsing-Remitting MS
    People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
  • Primary-Progressive MS
    This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
  • Secondary-Progressive MS
    Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.
  • Progressive-Relapsing MS
    In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

Why a Toyota should be your next wheelchair van if you live in New England

Toyota offers some of the best options on the market when it comes to wheelchair accessible vans.  Each van offers comfort, reliability, and reasonable pricing for its conversion.   Choosing a new wheelchair van isn’t always as easy as choosing a traditional car.  There isn’t a particular one-size-fits-all van that covers every need or preference. As you make your choice, keep in mind a few practical reasons to choose an accessible Toyota.

why a toyota should be your next wheelchair van if you live in new england

why a toyota should be your next wheelchair van if you live in new england

Variety

Toyota’s wheelchair accessible minivan is a modified version of the Toyota Sienna and is the most popular Toyota vehicle that is converted for accessibility.  Overall, it’s an easy vehicle for the major wheelchair accessible vehicle manufacturers to convert. Toyota currently produces five different models of the Sienna that are available for modification:

  • Sienna L- the L model is the most basic model of Sienna.  It includes all the standard features and will often be the lowest priced model.
  • Sienna LE- the LE is still a fairly basic model but includes a rear-view camera and enhanced climate controls.
  • Sienna SE- Sienna SE is a mid-level option that offers enhanced navigation displays, rear-view cameras, and cross-traffic controls for ease and maneuverability.
  • Sienna XLE- Sienna XLE is outfitted with leather-trimmed driver and front passenger seats.  It also features a blind spot monitor and a power lift gate with jam guard.
  • Sienna Limited- The Sienna Limited is the final and most luxurious model of Sienna.  The Limited features many of the standard and upgraded features of the other models while offering more extras like a JBL sound system, driver and passenger leather- trimmed seats, and a dual moon roof.

Any one of these models of the Sienna can be easily modified to accommodate your specific needs.  Budgetary constraints and your individual situation will play a major part in which model you decide to purchase.  Once you’ve made that decision, VMi New England Bridgewater, MA Mobility Center will help you find a Toyota wheelchair van that combines Toyota’s infamous quality with comfort and accessibility.

Adaptability

Toyota’s wheelchair accessible vans don’t start out being adapted for accessibility.  These vans start as traditional vehicles without any modifications before being converted to accommodate individuals with disabilities.  Toyota relies on certified wheelchair conversion manufacturers, such as VMI, to fit the vehicles with lowered floors, kneeling systems, ramps, and more.

why a toyota should be your next wheelchair van if you live in new england

why a toyota should be your next wheelchair van Bridgewater, MA Mobility Center

After the initial conversion is made the vehicle is sent to our Bridgewater, MA Mobility center where we can make even more adaptations to your vehicles. Mobility seating, hand controls, and pedal extensions are all available and fit beautifully inside the modified Toyota Sienna. There are even products that allow users to control the vehicle by pressing a few key buttons or by simply flipping a switch on the vehicle.

2013 Toyota Sienna VMI Summit Silver VMi New England

2013 Toyota Sienna XLE VMI Summit Silver VMi New England

Though the middle row of seats is removed to accommodate a wheelchair, there are still plenty of options to satisfy your needs. Both front seats can be removed to allow the wheelchair user to ride up front and there is a full bench seat in the back for children or guests. There is also a large trunk to accommodate groceries or additional supplies.

Safety locks and straps are installed into the floor of the van to keep wheelchair passengers in place and prevent any excess movement during transit.  The lowered floors help to compensate for a wheelchair passenger’s added height.  There are countless additional features and add-ons, so it is clear that the Toyota Sienna’s adaptability and flexibility are two key factors that make it a good choice for an accessible vehicle.

2013 Toyota Sienna VMI Summit Silver VMi New England Mobility Center

2013 Toyota Sienna VMI Summit Silver VMi New England Mobility Center

Style

When it comes to the Sienna, you’ll be hard pressed to find a vehicle as stylish. This Toyota is available in a rainbow of colors from a vibrant cherry red to a subtle sage green. Its sleek exterior is curvier and more modern than that of some types of minivans.

The interior is stunning, and the more customizations you make, the more personal and warm the vehicle feels. Its spaciousness accommodates passengers for a ride to the store or a road trip to Disney World with the same comfort and style you’d get from a luxury vehicle. If you’re looking for an accessible vehicle that is practical and attractive, be sure to consider the Toyota Sienna for its superior style.

 

Why Choose a Toyota?

A Toyota Sienna with a VMI Northstar 360 is one of best wheelchair accessible vans on the market. The variety of options means there’s really one for everyone. It’s able to be adapted with ease and features many options to suit all your needs. And, to top it all off, it’s a beautiful vehicle that will provide its purchaser’s with a long life and a lot of fun. It has, without a doubt, cemented its place as a top-rated accessible van that will retain its value and perform under the most rigorous conditions.  If the Toyota Sienna fits what you’re looking for in an accessible van, then come take it for a spin! Contact VMi New England today to schedule a test drive by filling out our online contact form or by giving us a call at 508-697-6006.

Cognitive Impairment in Multiple Sclerosis

Cognitive Impairment in Multiple Sclerosis

A Forgotten Disability Remembered

Unknown

By Kristen Rahn, Ph.D., Barbara Slusher, M.B.A., Ph.D., and Adam Kaplin, M.D., Ph.D.

Editor’s note: Physicians first noted the presence of cognitive impairment in patients with multiple sclerosis (MS) more than 160 years ago, yet it took clinicians until 2001 to codify a standard test to measure cognitive function. We now know that cognitive impairment occurs in up to 65 percent of people with MS and usually lessens their ability to remember previously learned information. So far, trials of drugs formulated to treat cognitive impairment have failed, but the authors remain optimistic that new approaches to diagnosis and drug development could lead to effective therapies in the future.

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) in which the immune system, normally charged with fighting off invading organisms, attacks the body’s myelin sheaths, the protective insulation that envelops neurons and facilitates high-speed neuronal communication. Without myelin to assist and protect neurons, the brain and spinal cord signals that permit us to interact with our environment malfunction. Neurons in the brain can be compared to the electrical wires of a house. Both are wrapped in protective insulation—neurons in myelin and electrical wires in rubber—to protect the integrity of their structures. In a way similar to how lights flicker when there is erratic signaling or fail to turn on when their wires rust and break, MS patients often experience weakness, loss of coordination, and neuropathic pain due to erratic neural signaling. They may also experience paralysis when their neurons and myelin sheaths are damaged beyond repair.

Depending on the extent and location of damage in the CNS, patients with MS may experience a wide variety of symptoms. The most commonly reported symptoms at the time of diagnosis are blurred vision, tingling and/or numbness, and loss of coordination. As the disease progresses, usually with a series of acute immune attacks and a late-stage steady march of function loss, patients with MS commonly experience fatigue, spasticity, difficulty walking, and cognitive impairment. Before 1993 there were no approved treatments of MS. Today, eight of the nine FDA-approved disease-modifying treatments are designed to reduce the frequency of clinical exacerbations in MS, and one is approved to improve walking ability. None, however, target the cognitive impairment often seen in people who have MS.

Cognitive Impairment in MS: An Overview

Although Jean-Martin Charcot is credited with providing a comprehensive description of MS, reports of both MS and comorbid cognitive impairment precede Charcot’s 1868 lectures. Dr. Friedrich von Frerichs first cited MS-related cognitive impairment in 1849, 25 years after the disease’s initial clinical description. Despite multiple early accounts of MS as a disease affecting cognition, reports on the incidence of cognitive impairment in patients with MS were mixed over the following century. While some late 19th and early 20th century physicians recognized deterioration of cognitive faculties in more than half of their MS patients, others reported that only two percent of their patients with MS experienced blunted intellectual function. Discrepancies in these figures are probably due to the fact that the majority of neurologists did not ask patients with MS about their cognitive function, and those neurologists who did inquire had inconsistent means of measuring cognitive function.

The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery—a seven-test, 90-minute assessment of word fluency, visuospatial ability, learning, memory, processing, and executive function (cognitive skills required to unite learning and memory with behavior)—was not established until 2001. The recent development of improved diagnostic tests for cognitive function has allowed researchers to reach a general consensus: Cognitive impairment is a debilitating and widespread comorbidity of MS. Today physicians recognize that MS affects more than 600,000 people in the United States and more than 2 million people worldwide, and 40 to 65 percent of these patients experience some degree of cognitive impairment.

Cognitive impairment substantially impacts the lives of patients with MS and their families. Half to three-quarters of people with MS are unemployed within 10 years of diagnosis. Cognitive impairment is the leading predictor of occupational disability, while physical disability, age, sex, and education contribute less than 15 percent to the likelihood of being employed. Patients with impaired cognition participate in social activities less frequently. Cognitive impairment due to MS may also place significant additional strain on the patient’s caregiver, who must help the patient combat intellectual, social, and occupational disabilities.

The Affected Cognitive Processes

Overt dementia in MS is rare. Most cases of cognitive impairment in MS are relatively less severe than those observed in classically dementing neurological disorders, such as Alzheimer’s disease, in which the patient loses memory of previous experiences and is unable to respond properly to environmental stimuli. However, cognitive impairment in MS can be extremely debilitating, with substantial negative impacts on daily living.

While some researchers conclude that patients with MS have trouble initially committing information to memory, the majority find that most patients have some difficulty remembering information learned in the past. In a study of 426 patients with MS, 66 percent of patients had deficits in at least one recall task, while only 14 percent had encoding impairments (difficulties making new memories).6 The encoding difficulties could be due to decreased processing speed or the inability to make sense of incoming information, both of which are very difficult to measure without an extensive battery of neurocognitive tests.

People with MS also frequently experience compromised attention, and performance on tasks requiring sustained attention can reveal deficits in patients with mild to moderate cognitive impairment. Additionally, it might be difficult for a person with MS to remember information required to complete a task if other distractions are present—a considerable impairment in our multitasking society.

Because the amount of CNS damage and the locations of lesions in the brain vary among patients, cognitive impairment is a somewhat heterogeneous comorbidity of MS. However, studying the cognitive facilities most commonly affected in patients with MS can help us gain insight into effective coping strategies and reveal areas of the brain and signaling pathways that might be logical therapeutic targets. This has important implications for managing and compensating for the daily problems that cognitive impairment causes.

Risk Factors for Cognitive Impairment

Although there are no predictors of which patients will suffer MS-related cognitive deficits, disease duration and subtype, race, sex, and cognitive reserve may all play a role.

There are four subtypes of MS, defined by disease progression. Relapsing-remitting MS (RR-MS) is the most common; this subtype is the initial diagnosis of approximately 85 percent of all people with MS. In RR-MS, patients experience flare-ups of disease symptoms for a period of time, followed by a complete recovery or remission. The majority of patients diagnosed with RR-MS develop secondary-progressive MS (SP-MS) within 10 to 20 years. In SP-MS, as in RR-MS, patients experience flare-ups or relapses of disease symptoms, but there is a steady increase in disease severity between the relapses. The second most common subtype diagnosed at initial presentation is primary-progressive MS (PP-MS), in which a patient experiences a steady increase in symptom severity from the time of disease onset. The final and most rare subtype of MS, progressive-relapsing MS (PR-MS), involves intermittent relapses punctuating a steady progression of the disease. While patients with progressive subtypes of MS are more likely to experience cognitive impairment in general, further studies of patients with PP-MS and PR-MS are needed. Earlier onset of MS increases a patient’s chance of developing MS-related cognitive decline.

Although MS disease incidence is highest in populations from the northern United States, northern Europe, Canada, New Zealand, and southern Australia, people from all countries and of all races have been diagnosed with the disease. Race plays a role in disease pathogenesis and severity. For example, Caucasians have delayed symptom onset compared to Latin-American and African-American patients. It is possible that because clinical manifestations are more severe in African-American patients, the cognitive findings may be part of what is overall a more aggressive disease course. Race also affects MS’ impact on cognition: Adult African-American patients with MS develop cognitive deficits earlier in the disease course compared to adult Caucasian patients. This difference is also observed in pediatric MS patients. A 2010 study from the University of Alabama at Birmingham reported that African-American children affected by pediatric-onset MS performed worse on tests of complex attention and language compared to Caucasian children with MS matched by age, disease severity, gender, and socioeconomic status. A better understanding of the race-based differences in disease characteristics could help physicians tailor treatments to ensure optimal responses.

MS occurs in women more frequently than it does in men; ratios of incidence range from 2:1 to 3:1, depending on the geographical region. Despite the elevated frequency in women, studies have shown that disease severity is typically higher and progression more rapid in men compared to women. Additionally, the incidence and severity of cognitive deficits are higher in men.

Intelligence and education history contribute to the formation of cognitive reserve, which affects the brain’s resilience in the presence of injury. Previous studies in Alzheimer’s disease (AD) have shown that individuals with higher cognitive reserve are less likely to develop dementia. As with AD, MS patients with high levels of cognitive reserve are less likely to experience cognitive impairment. A study following patients with MS over a five-year period showed that those with a high cognitive reserve at baseline experienced no loss of cognitive function, while those who started with a low cognitive reserve suffered a significant cognitive decline.

The Roles of Depression and Physical Disability

Inflammation, neuronal degeneration, and lesion formation are likely among the causes of cognitive impairment in people with MS. Gray matter (neuron) loss in the brain, specifically in the cerebral cortex (the thin layer of cells that makes up the outer layer of the brain) and the thalamus (the relay station between the brain and the spinal cord, through which nearly all motor and sensory information travels), correlates with cognitive impairment. However, some patients with extensive brain lesions remain cognitively intact, while others with a low lesion load experience cognitive impairment. Additionally, the patterns of deficits in patients affected by cognitive impairment vary widely. For example, some patients experience relatively subtle cognitive problems, such as word-finding difficulty, while others are so debilitated that they cannot navigate roads in their own neighborhood or remember important phone numbers that used to be familiar to them. While the exact causes of cognitive impairment in MS are unknown, two factors often further impair cognitive performance in patients with the disease: depression and physical disability.

Depression often plagues people with MS-related cognitive impairment. The lifetime prevalence of depression within the general population is approximately 20 percent, while the prevalence in patients with MS is around 50 percent. A host of studies have linked depression in MS to impairments in learning, memory, processing speed, and executive function. The lesion location in an MS patient can affect depressive symptoms, as patients with brain lesions are more likely to experience depression compared to patients with spinal cord lesions. Furthermore, lesions in the temporal lobe elevate a patient’s likelihood of experiencing depression compared to lesions in other areas of the brain. Temporal lobe lesions could be the common thread linking depression and cognitive impairment, as brain structures involved in learning and memory function, such as the amygdala and the hippocampus, are located in the temporal lobes.

Depression is predominantly caused by inflammation in the brain, which is a hallmark of MS. Although researchers do not fully understand the pathogenesis of MS, they think inflammation precedes neuron death and myelin loss. One might hypothesize that depression would arise due to early inflammation, to be followed by degeneration of neurons and lesion development, leading to cognitive impairment.

Physical and cognitive effects of MS can occur separately, but there are relationships between them. About 10 percent of patients suffer from benign MS (that is, their score is two or below on the Expanded Disability Status Scale for at least 10 years of disease duration), in which physical disease symptoms are absent. Approximately 20 percent of patients with clinically benign MS, with a relatively mild disease course and accumulation of little disability over time, have cognitive impairment, while more than half of all MS patients suffer from cognitive impairment.

The relationships among psychological factors, fatigue, physical disability, and cognitive impairment raise some very important questions: Which of these aspects of disease arise first, and how do they interact? Does depression lead to fatigue, lowered motivation, and decreased medication compliance, thus compromising physical ability? Does physical disability or cognitive impairment make a patient more likely to become depressed and fatigued? A better understanding of disease pathogenesis and improved diagnostic tools will help researchers answer these important questions in the future.

Current Treatment Options

Researchers recently evaluated four pharmacological interventions intended to reverse cognitive impairment in patients with MS in large-scale (n > 40), double-blind, placebo-controlled clinical studies. Researchers likely chose the compounds—ginkgo biloba, donepezil, rivastigmine, and memantine—due to anecdotal evidence and clinical success in treating memory impairment in patients with Alzheimer’s disease (AD). Two of these drugs, donepezil and rivastigmine, are designed to increase brain levels of acetylcholine (ACh), a neurotransmitter (or chemical messenger) that facilitates learning and memory processes. The third, memantine, which prevents abnormal activation of signaling pathways between neurons in the brain, has demonstrated success in treating early AD. AD studies using ginkgo biloba, a plant often used in traditional Chinese medicine and reported to affect neurotransmitter signaling and neuroprotection, have shown mixed results; some demonstrate cognitive-enhancing effects, while others show no effect compared to placebo. Unfortunately none of these compounds demonstrated beneficial, reproducible improvements in cognitive function in clinical trials with MS.

Cognitive rehabilitation therapy is a nonpharmacological method of improving a specific cognitive skill through practice and training. The brain is a dynamic organ, and practicing a specific cognitive task strengthens the communication between neurons required for that task. Results from trials focusing on cognitive rehabilitation in MS are mixed. Researchers did find, however, that neurocognitive rehabilitation alleviates fatigue in patients with MS, and this also might help restore cognitive facilities such as attention span and working (short-term) memory.

If a patient has irreversible cognitive deficits, the focus shifts from restoration to compensation. Coping strategies might be both emotion-focused and problem-focused. Emotion-focused strategies, which help a patient regulate the emotional consequences of cognitive deficits, include accepting the deficit and obtaining social support from peers or trained professionals. Problem-focused strategies alleviate some of the stress that cognitive impairment places on the individual through solutions to specific problems, such as using a tape recorder in meetings or lectures to aid in recall. A 2010 study demonstrated that patients with MS are unlikely to use positive coping strategies. Instead, many avoid situations in which their cognitive impairment might be evident or obvious to others. This is particularly true if the patient had deficits in attention and executive functioning, which indicates that educating patients with MS on the benefits of positive coping strategies is an important and unmet need.

In addition, researchers found that physical activity affects cognition in some patients with MS. Reported benefits of yoga in populations of patients with MS include reduced fatigue and improved attention. A 2011 study demonstrated a positive correlation between physical activity and cognitive processing speed in ambulatory patients with MS. While definite conclusions cannot be drawn from these studies, the positive association between physical activity and cognitive function (which also has been demonstrated in healthy and AD populations) suggests that physical activity might be an efficacious nonpharmacological treatment for cognitive impairment in MS.

The Role of Imaging

The search for a marker or specific cause of cognitive impairment in patients with MS has proven unsuccessful, and not knowing the exact mechanism(s) makes it extremely difficult to develop a treatment. The advancement of brain-imaging techniques and the development of more sophisticated experimental disease models have allowed for a more thorough understanding of pathogenesis in MS, but the exact cause or trigger is still unknown. Less than five years ago, researchers identified a cell that significantly contributes to MS development and progression. These T helper 17 immune cells are thought to contribute to CNS inflammation and are located within the brain lesions of people with MS. Despite recent advances, much work is still required to understand the cause of MS, the triggers for disease pathogenesis, and the mechanisms behind loss of myelin and neuronal degeneration.

Before the advent of magnetic resonance imaging (MRI) in the 1980s and computed tomography (CT) scans in the 1970s, only extremely crude brain-imaging techniques (such as plain X-rays) were available. Makeshift temperature tests were commonly used to assist in making an MS diagnosis, as uninsulated neurons conduct poorly at elevated temperatures. Thus, in bygone eras, many patients who presented with symptoms suggestive of MS were told to go home and get into a hot bathtub, and if their condition worsened significantly, then the diagnosis was confirmed as well as possible. Thankfully, diagnostic tools in neurology have improved, and techniques such as MRI can safely and accurately aid in diagnosing MS.

MRI uses a powerful magnet without harmful radiation to view successive sections of the brain and spinal cord with remarkable detail in any desired plane, much as one would slice a loaf of bread or a vegetable. Areas of the brain that appear “bright” or “hyperintense” on MRI images, called T2 hyperintense areas or simply T2 lesions, are thought to correspond to regions of inflammation, swelling, or injury. Dye is injected into the bloodstream of a patient, and leakage of dye into the brain indicates disruption of the protective barrier between the brain and the blood. This disruption occurs in patients with MS due to active inflammation, and immune cells rush into the brain to do battle with what is mistakenly perceived as an adversary.

MRI has become integral to the initial diagnostic workup of patients with MS. However, when it comes to the prediction of clinical status, course, or outcome, MRI has proven to be a surprisingly poor indicator. Perhaps the injury that results in clinical symptoms happens in a more general way throughout the brain, and the number of hyperintense lesions seen on MRI is not directly related to the severity of a patient’s deficits. Alternatively, it is possible that the brain is particularly good at routing neural impulses around regions actively under attack by the immune system. Although MRI highlights sites of inflammation, it does not show the compensatory mechanisms mediated by brain changes in signal routing or electrochemical boosting. Nowhere has the lack of a correlation between MRI findings and disability been more pronounced than in the poor prediction of cognitive impairment. Whatever the cause, the clinical-MRI paradox (the lack of correlation between findings on MRI and the level of clinical disability) has played a role in slowing the development of novel and potent therapies, especially those targeting cognitive preservation or improvement.

Researchers have investigated a number of related neuroimaging techniques in an effort to overcome the limitations of standard MRI in predicting cognitive performance. General measurements of either whole-brain or regional atrophy (brain shrinkage), the final outcome of demyelination and neuronal injury throughout the brain, correlate with cognitive impairment better than MRI imaging does. Two other techniques that indicate tissue damage have been used with some preliminary success in correlating with cognitive impairment in MS: magnetization transfer imaging, which measures how charged aspects of water interact with charges at the molecular level in the brain, and diffusion tensor imaging, which measures how water diffuses through the brain.

We recently had preliminary success, which is not yet published, in correlating the cognitive function of human MS patients with magnetic resonance spectroscopy (MRS). Unlike MRI, which determines the structural integrity of the brain based on the water distribution, MRS measures chemical compounds in specific areas of the brain. Since the brain’s hippocampus has a prominent role in learning and memory functions, we used MRS to investigate the chemistry of this brain region in people with MS. We found very strong positive correlations between cognitive function and levels of N-acetylaspartylglutamate (NAAG), an abundant signaling molecule in the brain. Specifically, higher NAAG levels were correlated with improved cognitive function. Although human studies of this chemical await the development of a drug that safely elevates NAAG levels in humans, we found that elevating the levels of NAAG in an animal model of MS resulted in a two-fold improvement in learning and memory functions compared to untreated animals. There may be hope on the horizon for the development of pharmacological interventions for MS cognitive impairment.

Improving Treatment Development

Today’s method of drug development for cognitive impairment in patients with MS—evaluating drugs that have improved cognition related to other neurodegenerative diseases—does not work. While this approach was the obvious first step, other methodologies must be developed if effective treatments are to be found. A promising new avenue for cognition-enhancing drug development in MS involves the use of the animal model experimental autoimmune encephalomyelitis (EAE). EAE is not a novel model of disease; since 1933, it has helped scientists to learn about the disease process and to test treatments to improve physical symptoms. In 2010, researchers demonstrated that this model of MS, in addition to mimicking the disease with regard to lesion formation and induction of physical disability, also causes cognitive impairment. This was the first study that measured cognitive function in the EAE model, and it provides a valuable new method for the evaluation of novel treatments for MS-related cognitive impairment.

The awareness of cognitive impairment in MS is improving among physicians, researchers, and patients. Although past efforts to develop treatments for cognitive impairment in MS have largely been minimal or ineffective, improved research tools and imaging modalities and the emergence of more studies focusing on this problem are causes for optimism.

Adapting Motor Vehicles for People with disAbilities

newenglandwheelchairvan.com boston strong

Introduction

A Proven Process for Gaining Freedom on the Road

The introduction of new technology continues to broaden opportunities for people with disabilities to drive vehicles with adaptive devices. Taking advantage of these opportunities, however, can be time consuming and, sometimes, frustrating.

The information in this brochure is based on the experience of driver rehabilitation specialists and other professionals who work with individuals who require adaptive devices for their motor vehicles. It is centered around a proven process —evaluating your needs, selecting the right vehicle, choosing a qualified dealer to modify your vehicle, being trained, maintaining your vehicle — that can help you avoid costly mistakes when purchasing and modifying a vehicle with adaptive equipment.

Also included is general information on cost savings, licensing requirements, and organizations to contact for help. Although the brochure focuses on drivers of modified vehicles, each section contains important information for people who drive passengers with disabilities.

 


 

Investigate Cost Saving Opportunities &Licensing Requirements

Cost Saving Opportunities

The costs associated with modifying a vehicle vary greatly. A new vehicle modified with adaptive equipment can cost from $20,000 to $80,000. Therefore, whether you are modifying a vehicle you own or purchasing a new vehicle with adaptive equipment, it pays to investigate public and private opportunities for financial assistance.

There are programs that help pay part or all of the cost of vehicle modification, depending on the cause and nature of the disability. For information, contact your state’s Department of Vocational Rehabilitation or another agency that provides vocational services, and, if appropriate, the Department of Veterans Affairs. You can find phone numbers for these state and federal agencies in a local phone book. Also, consider the following.

  • Many nonprofit associations that advocate for individuals with disabilities have grant programs that help pay for adaptive devices.
  • If you have private health insurance or workers’ compensation, you may be covered for adaptive devices and vehicle modification. Check with your insurance carrier.
  • Many manufacturers have rebate or reimbursement plans for modified vehicles. When you are ready to make a purchase, find out if there is such a dealer in your area.
  • Some states waive the sales tax for adaptive devices if you have a doctor’s prescription for their use.
  • You may be eligible for savings when submitting your federal income tax return. Check with a qualified tax consultant to find out if the cost of your adaptive devices will help you qualify for a medical deduction.

Licensing Requirements

All states require a valid learner’s permit or driver’s license to receive an on–the–road evaluation. You cannot be denied the opportunity to apply for a permit or license because you have a disability. However, you may receive a restricted license, based on your use of adaptive devices.

 


 

Evaluate Your Needs

Driver rehabilitation specialists perform comprehensive evaluations to identify the adaptive equipment most suited to your needs. A complete evaluation includes vision screening and, in general, assesses:

  • Muscle strength, flexibility, and range of motion
  • Coordination and reaction time
  • Judgment and decision making abilities
  • Ability to drive with adaptive equipment

Upon completion of an evaluation, you should receive a report containing specific recommendations on driving requirements or restrictions, and a complete list of recommended vehicle modifications.

Finding a Qualified Evaluator

To find a qualified evaluator in your area, contact a local rehabilitation center or call the Association for Driver Rehabilitation Specialists (ADED). The phone number is in the resource section. The Association maintains a data base of certified driver rehabilitation specialists throughout the country. Your insurance company may pay for the evaluation. Find out if you need a physician’s prescription or other documen-tation to receive benefits.

Being Prepared for an Evaluation

Consult with your physician to make sure you are physically and psychologically prepared to drive. Being evaluated too soon after an injury or other trauma may indicate the need for adaptive equipment you will not need in the future. When going for an evaluation, bring any equipment you normally use, e.g., a walker or neck brace. Tell the evaluator if you are planning to modify your wheelchair or obtain a new one.

Evaluating Passengers with Disabilities

Evaluators also consult on compatibility and transportation safety issues for passengers with disabilities. They assess the type of seating needed and the person’s ability to exit and enter the vehicle. They provide advice on the purchase of modified vehicles and recommend appropriate wheelchair lifts or other equipment for a vehicle you own. If you have a child who requires a special type of safety seat, evaluators make sure the seat fits your child properly. They also make sure you can properly install the seat in your vehicle.

 


 

Select the Right Vehicle

Selecting a vehicle for modification requires collaboration among you, your evaluator, and a qualified vehicle modification dealer. Although the purchase or lease of a vehicle is your responsibility, making sure the vehicle can be properly modified is the responsibility of the vehicle modification dealer. Therefore, take the time to consult with a qualified dealer and your evaluator before making your final purchase. It will save you time and money. Be aware that you will need insurance while your vehicle is being modified, even though it is off the road.

The following questions can help with vehicle selection. They can also help determine if you can modify a vehicle you own.

  • Does the necessary adaptive equipment require a van, or will another passenger vehicle suffice?
  • Can the vehicle accommodate the equipment that needs to be installed?
  • Will there be enough space to accommodate your family or other passengers once the vehicle is modified?
  • Is there adequate parking space at home and at work for the vehicle and for loading/unloading a wheelchair?
  • Is there adequate parking space to maneuver if you use a walker?
  • What additional options are necessary for the safe operation of the vehicle?

If a third party is paying for the vehicle, adaptive devices, or modification costs, find out if there are any limitations or restrictions on what is covered. Always get a written statement on what a funding agency will pay before making your purchase.

 


 

Choose a Qualified Dealer to Modify Your Vehicle

Even a half inch change in the lowering of a van floor can affect a driver’s ability to use equipment or to have an unobstructed view of the road; so, take time to find a qualified dealer to modify your vehicle. Begin with a phone inquiry to find out about credentials, experience, and references. Ask questions about how they operate. Do they work with evaluators? Will they look at your vehicle before you purchase it? Do they require a prescription from a physician or other driver evaluation specialist? How long will it take before they can start work on your vehicle? Do they provide training on how to use the adaptive equipment?

If you are satisfied with the answers you receive, check references; then arrange to visit the dealer’s facility. Additional information to consider is listed below.

  • Are they members of the National Mobility Equipment Dealers Association (NMEDA) or another organization that has vehicle conversion standards?
  • What type of training has the staff received?
  • What type of warranty do they provide on their work?
  • Do they provide ongoing service and maintenance?
  • Do they stock replacement parts?

Once you are comfortable with the dealer’s qualifications, you will want to ask specific questions, such as:

  • How much will the modification cost?
  • Will they accept third party payment?
  • How long will it take to modify the vehicle?
  • Can the equipment be transferred to a new vehicle in the future?
  • Will they need to modify existing safety features to install the adaptive equipment?

While your vehicle is being modified, you will, most likely, need to be available for fittings. This avoids additional waiting time for adjustments once the equipment is fully installed. Without proper fittings you may have problems with the safe operation of the vehicle and have to go back for adjustments.

Some State Agencies specify the dealer you must use if you want reimbursement.

 


 

Obtain Training on the Use of New Equipment

Both new and experienced drivers need training on how to safely use new adaptive equipment. Your equipment dealer and evaluator should provide information and off-road instruction. You will also need to practice driving under the instruction of a qualified driving instructor until you both feel comfortable with your skills. Bring a family member or other significant person who drives to all your training sessions. It’s important to have someone else who can drive your vehicle in case of an emergency.

Some state vocational rehabilitation departments pay for driver training under specified circumstances. At a minimum, their staff can help you locate a qualified instructor. If your evaluator does not provide on-the-road instruction, ask him or her for a recommendation. You can also inquire at your local motor vehicle administration office.

 


 

Maintain Your Vehicle

Regular maintenance is important for keeping your vehicle and adaptive equipment safe and reliable. It may also be mandatory for compliance with the terms of your warranty. Some warranties specify a time period during which adaptive equipment must be inspected. These “check ups” for equipment may differ from those for your vehicle. Make sure you or your modifier submits all warranty cards for all equipment to ensure coverage and so manufacturers can contact you in case of a recall.

For additional copies of this brochure and other important vehicle safety information, you can contact DOT’s web site at www.nhtsa.dot.gov and the DOT Auto Safety Hotline: 888-DASH-2-DOT (888-327-4236).

 


 

Resources

The Association for Driver Rehabilitation Specialists (ADED)
2425 N. Center Street # 369, Hickory, NC 28601
(866) 672-9466
www.driver-ed.org
www.aded.net

National Mobility Equipment Dealers Association (NMEDA)
11211 N. Nebraska Ave., Suite A5, Tampa, FL 33612
(800) 833-0427 
www.nmeda.org

AAA
1000 AAA Drive, Heathrow, FL 32746-5063
(404) 444-7961
www.aaa.com

Department of Veteran Affairs
(800) 827-1000
www.va.gov

State Departments of Vocational Rehabilitation
Listed in telephone book.


The following manufacturers offer rebates or reimbursements on new vehicle modification.

Daimler Chrysler Corporation
(800) 255-9877
(TDD Users: (800) 922-3826)
www.automobility.daimlerchrysler.com

Ford Motor Company
(800) 952-2248
(TDD Users: (800) TDD-0312)
www.ford.com/mobilitymotoring

General Motors Corporation
(800) 323-9935
(TDD Users: (800) TDD-9935)
www.gmmobility.com

Saturn
(800) 553-6000, Prompt 3
(TDD Users: (800) 833-6000)
www.saturn.com

Volkswagen
(800) 822-8987
www.vw.com

Audi
(800) 822-2834
www.audiusa.com

Declare Your Independence on the 4th of July with a Wheelchair-Accessible Vehicle

  • Wheelchair Van VMi New England Boston Strong
  • Learn more about how to pick the right wheelchair-accessible vehicle that meets your needs.
  • Take a look inside the latest minivans, and other accessible vehicles like a pickup truck, motorcycle or snowmobile.
  • Buy new? Buy used? Convert your current vehicle? Here, we provide some factors to consider before making your decision.

Freedom. That’s what it’s all about, isn’t it? A wheelchair shouldn’t be a barrier to getting out and about, whether for work, day-to-day living or pleasure.

“we will always do all we can to deliver the driving freedom most take for granted to someone in a wheelchair, we are going to change the world one person on at a time” , -Jim Sanders 7/4/1988

Finding the right vehicle means analyzing your needs. Do you want to ride in your wheelchair or transfer to the vehicle’s seat? Will you be the driver or the passenger? If your muscle weakness is still progressing, how will your accessibility needs change down the line — and how can you accommodate them now?

What kind of vehicle do you want: car, minivan, van, truck, SUV or motorcycle? New or used? After-market conversion or built for accessibility from the start? Side or rear entry?

A great place to start answering questions is at the website for Vmi New England

The website is a treasure trove of tips for finding the right vehicle.

For an in-depth look into the life of Ralph Braun, founder and CEO of The Braun Corporation, read CEO with SMA Brings Mobility to All . Learn how he turned his scooter and modified van designs into a multimillion-dollar business — all while battling spinal muscular atrophy.

 

 

Braun Wheelchair Van Mobility Center vmienwenglan.com Boston Strong

Of course, in purchasing a vehicle, monetary concerns always come into play. The New England Mobility Center site offers various directions to take in finding government funding and public assistance. You’ll also find tips on buying auto insurance, numerous blogs on accessible-vehicle-related subjects and info on many travel accessories to make life easier on the road.

Because of the tremendous number of variables in the custom fitment for each persons specific needs, it’s not possible to give exact prices for the minivans featured. However, we can provide some figures that will give you a ballpark idea of accessible vehicle pricing.

  • New side-entry converted minivans range from around $48,000 to $75,000.
  • New rear-entry converted minivans with manually operated fold-out ramps start in the low $40,000s.
  • You can find 3-year-old minivans with brand-new conversions starting in the low $30,000s.

For those with severe muscle weakness who want to drive their vehicle themselves, certified driver rehabilitation specialists (CDRS) can evaluate your needs at the Bridgewater, MA Mobility Center, and provide a prescription for adapted driving equipment and driver training.  (For more on this topic, contact us at 508-697-6006).

As you’ll discover, the scope of accessible vehicles is very broad indeed. Here’s a sampler of the myriad options currently available in the world of wheelchair-accessible vehicles and conversion equipment.

MinivansBraunAbility’s Chrysler Entervan features flexible floor plans
For easier boarding, the Entervan has an integrated “kneeling” system; while the door is opening, the rear suspension is lowered, reducing the slope of the ramp. To learn more, call 508-697-6006 .Because wheelchair transportation requirements can change over time, BraunAbility enables buyers to easily configure the floor plan of its Chrysler Entervan. Whether you want to be the driver or the front-seat passenger, removing the appropriate seat is literally a snap: Unlock the seat base and roll the entire seat out of the van.
VMI’s Honda Odyssey Northstar promotes easy entry

 

Wheelchair Van bridgewater, ma newenglandwheelchairvan.com boston

In the side-entry, lowered-floor Honda Odyssey Northstar conversion by VMI, a remote control triggers the PowerKneel System, lowering the vehicle and activating a power ramp that telescopes out from within the interior floor.

The lower ramp offers a gentler angle, and the unrestricted entry means better maneuverability once inside.

VMI also offers the Summit accessible Toyota van conversion featuring a power fold-out, heavy-duty ramp system with an anti-rattle mechanism. It also has the power kneeling feature. To learn more, call 508-697-6006

.2013 Toyota Sienna VMI Summit Silver VMi New England Wheelchair Van Boston

Consider a rear entry, says Jim Sanders
Although rear-entry vehicles don’t allow wheelchair users to park in the driver or front-passenger locations, Jim’s vision has always been to offer as many options possible including optional swiveling driver or front-passenger seat that may facilitate transferring from the wheelchair. (For more on the rear- versus side-entry question, see them at, the Bridgewater, MA Mobility Center.) To learn more, call 508-697-6006 .Believing that entering and exiting the van through the back sometimes avoids  barriers, Our viewpoint and vision has always been to offer as many options as is practical. Rear-entry, lowered-floor modification converts Chrysler, Ford, GM, Honda and Toyota minivans. An automatic remote-control option can even activate the ramp and door. This vision and technology of lowering the vehicle closer to the ground and the ramp to a more comfortable angle for wheelchair access.

 

‘A mobility concept vehicle’ starts out as a accessible ground up conversion; that can even go green
A car or minivan hybrid concept vehicle can be designed custom for you from the ground up with safety and accessibility as its top priority.

mobility concept vehicle mobility center bridgewater, ma boston strong

Rental vehicles New locations are being added, before your next trip or give us a call to learn more at 508-697-6006. It’s may even be possible to rent a Rollx wheelchair-accessible Dodge or Chrysler minivan at selected airports around the country. Someone even told us Thrifty Car Rental, Dollar Rent-a-Car or Payless Car Rental companies were thinking about offer accessible vans at airports like T.F. Green airport 2000 Post Rd, Warwick, RI 02886, Manchester–Boston Regional Airport 1 Airport Rd, Manchester, NH 03103, Logan International Airport 1 Harborside Dr, Boston, MA 02128
Cars and SUV’s Sport an attitude with a flair for the freedom to have different concept vehicles built with optional Motors depending on your needs a Scion xB might even work.If you’re just not the minivan type, consider the freedom of a concept vehicle, Want a custom sporty wheelchair-accessible vehicle? Click the remote: Simultaneously, the driver’s door swings open, the rear driver-side door gull-wings up and the ramp unfolds, ready for you to maneuver your wheelchair into driving position.

 

A similar conversion can be configured on the passenger side. Or if rear entry suits your needs, we offer you the freedom to pick a model that work best for you. Prices range from the low $30,000s for a manual rear-entry model to the low $500,000s for a one off concept vehicle with automatic side-entry. To learn more, call 508-697-6006
.

Hand controls and footless driving solutions
Systems from mechanical to servo actuated can be installed on most cars with automatic transmissions. The accelerator input can mounted within easy reach of the vehicle’s standard steering wheel, with the controls just inches away on either the right or left. Smoothly accelerate the vehicle remotely without use of your feel, designed to make hands only driving safe and easy.Depending on the make and model of your vehicle, installed prices start around $1,200, additionally we offer transportation of the vehicle to and from our mobility center. To learn more, call 508-697-6006
Buying used AMS pre-owned van might even be considered.Resale on them is typically incredibly low and these can be a ok deal if your able to bring it to a qualified mobility center to ensure it is in safe and working condition.

AMS pre-owned van bridgewater, ma newenglandwheelchairvan.com

There’s no getting around the fact that wheelchair vans are expensive; retrofitting new vans with accessibility equipment doesn’t come cheap. One way to cut costs is to buy a used van to avoid the  depreciation that happens when buying new.VMi New England offers many pre-owned vans outfitted with their new conversion equipment which can save buyers as much as $15,000 to $20,000.

Or, if you already have a fairly new Chrysler, Dodge or Volkswagen van, they may be able to convert it for you. Rear-entry conversions start at around $13,000, while side-entry conversions start at around $22,000, not including the price of the vehicle. To learn more, call 508-697-6006.

There are many grey market conversion vans available to you via the internet, ebay and private parties.

Many of these vehicles are being sold by direct marketing companies or individuals who bought them via the internet or ebay only to find out there were many problems with the van, it was unsafe and or wouldn’t work for there needs.

So in turn they are for sale again for what appears to be a great deal.

I wish i had a dollar for every customer who brought a “internet deal”, “used car dealer van”, “ebay wheelchair van deal” into our facility wanting to know what we could do to make it work for them.

Only to hear, i’m very sorry you didn’t visit with us before you purchased this van that your family member or friend in the wheelchair will not fit into the van.

Motorcycles

When it comes to motorcycles Jim Sanders has and will always promote accessible motorcycles and his personal belief that they offer the ultimate freedom when it comes to travel (unless it’s snowing in which case we need to talk about snowmobiles)

If you can operate a manual wheelchair, you may be able to drive a wheelchair-accessible motorcycle, says Sanders. Want a touring bike, a BMW, a KTM or how about a dirt bike. A remote-controlled drop-down ramp at the rear of the vehicle can be up fitted  allowing a rider to pull his or her chair into position, secure it with a push-button docking system, and ride off — no transferring necessary.

 

Bikes featuring a powerful BMW 1170 cc engine, a six-speed, two-button, thumb-operated gear shifter, and a rear-wheel-drive differential can be up fitted . Want a bike with a reverse gear for easier parking and maneuvering? To learn more, call 508-697-6006. If you can operate a manual wheelchair, you maybe able to drive a wheelchair-accessible motorcycle, says Sanders.

A remote-controlled drop-down ramp at the rear of the vehicle allows a rider to pull his or her chair into position, secure it with a push-button docking system, and ride off — no transferring necessary.

SUVs and trucks 

ryno wheelchair pick up truck bridgewater, ma boston, ma  newenglandwheelchairvan.com

A Stow-Away lift puts you inside

Bruno doesn’t sell wheelchair-accessible vehicles, but they do offer products that can be up fit  into vehicles.

Known for their home stair lifts and attachable vehicle lifts for transporting wheelchairs and scooters, they also make an add-on mechanism that may allow you to transfer you from a wheelchair up into the seat of a high-profile SUV or pickup.

 

Ryno no-transfer conversion for pickups 

Being a wheelchair user doesn’t mean you have to give up using a pickup truck. VMi New England has been offering pick up truck conversions for over 10 years allowing either driver-side or passenger-side entry into the cab of a GMC Sierra or Chevy Silverado without ever having to transfer out of the wheelchair.

When activated with the remote control, the door opens from the cab, then the lift platform deploys which rests flat on the ground. The wheelchair user backs onto the platform, which then elevates up and into the cab as the door slides back into the closed position.

To learn more, call 508-697-6006.

 

Logan International Airport
General Edward Lawrence Logan International Airport is located in the East Boston neighborhood of Boston, Massachusetts, US. It covers 2,384 acres, has six runways, and employs an estimated 16,000 people.Wikipedia
Code: BOS
Elevation: 19′ 0″ (5.80 m)
Address: 1 Harborside Dr, Boston, MA 02128
Phone: (800) 235-6426
Manchester–Boston Regional Airport
Manchester–Boston Regional Airport, commonly referred to simply as “Manchester Airport,” is a public airport located three miles south of the central business district of Manchester, New Hampshire on … Wikipedia
Code: MHT
Elevation: 266′ (81 m)
Address: 1 Airport Rd, Manchester, NH 03103
Phone: (603) 624-6539
T. F. Green Airport
T. F. Green Airport, also known as Theodore Francis Green Memorial State Airport, is a public airport located in Warwick, six miles south of Providence, in Kent County, Rhode Island, USA. Wikipedia
Code: PVD
Elevation: 55′ (17 m)
Address: 2000 Post Rd, Warwick, RI 02886
Phone: (888) 268-7222
Hours:

Open all.  –  See all
Conquest
conquest [ˈkɒnkwɛst ˈkɒŋ-]

n

1. the act or an instance of conquering or the state of having been conquered; victory
2. a person, thing, etc., that has been conquered or won
3. the act or art of gaining a person’s compliance, love, etc., by seduction or force of personality
4. a person, whose compliance, love, etc., has been won over by seduction or force of personality

 

 

Diagnosing Multiple Sclerosis – What Makes It So Difficult?

Know the signs and symptoms your doctor will look for in examining you for multiple sclerosis.

Diagnosing Multiple Sclerosis - What Makes It So Difficult?

Besides the fact that no single test can detect the disease, MS symptoms can mimic those of a number of other conditions, and they can change over time. Symptoms can also vary from person to person — and from day to day in the same person.

Here’s what you should know.

Symptoms of Multiple Sclerosis

Some early symptoms of MS are:

  • Numbness or tingling in parts of the body, usually an arm or leg
  • Unexplained weakness, dizziness and fatigue
  • Blurry vision, double vision or blindness

Other symptoms include:

  • Muscle spasms
  • Impairment of the sense of touch and the ability to feel temperature changes and pain
  • Problems with balance and coordination
  • Tremor
  • Slurred speech
  • Bladder and bowel problems
  • Sexual problems
  • Depression
  • Mild difficulties with concentration, attention, memory and poor judgment
  • Moderate to severe pain
  • Heat sensitivity

To diagnose the disease, healthcare providers use a number of tools and tests that often help rule out other possible causes.

Multiple Sclerosis Diagnosis: Tools and Tests

  • Medical history: Doctors ask for details about personal health history and family health history and also question patients carefully about symptoms, their duration and their onset.
  • Physical examination: A physical exam will most likely include tests to determine the health of nerves and muscles. Doctors may look for weakness in specific parts of the body, uncoordinated eye movements, and problems with balance, vision, and speech.
  • Magnetic resonance imaging (MRI): If doctors possibly suspect MS after a physical exam, they will probably order additional diagnostic tests, starting with an MRI. During an MRI, a patient’s body is placed within a magnetic field and scanned by radio waves. This combination creates detailed pictures of the part of the body being examined. In MS, doctors take scans of the brain or spine depending on the symptoms and physical exam. The resulting pictures can show patches, or scars, in the central nervous system where myelin has been destroyed. These areas are referred to as plaques. Since other disorders can cause these patches, an MRI scan can’t provide definitive evidence of multiple sclerosis. But doctors rely primarily on MRIs to see evidence of the disease. MRIs are also important in tracking the progress of the disease, and doctors may order new tests from time to time to monitor a patient’s condition. Researchers also use the test to see if experimental treatmentshave an effect on scarring in the central nervous system.
  • Cerebrospinal fluid collection (CSF collection): If the diagnosis is still not clear, doctors may take a sample of spinal fluid. Patients typically lie on their sides with their knees bent up. The doctor administers a local anesthetic in the lower spine and, using another needle, takes out a sample of the spinal fluid. Doctors examine the sample for abnormalities associated with MS, such as increases in white blood cells and high levels of an antibody called immunoglobulin G.
  • Evoked response tests (ERTs): These electronic tests, sometimes called evoked potential tests, measure the speed of brain connections. The most common ERTs are the visual evoked response test (VER), the brainstem auditory evoked response test (BAER) and the sensory evoked response test (SER). In each, doctors attach wires to a patient’s scalp. Then, depending on the test, they give patients visual, auditory, or sensory stimulation. These stimuli are a checkerboard pattern patients see on a monitor, a series of clicks they hear through earphones, or short electrical impulses they feel on an arm or leg. The tests measure the speed of visual, hearing, and sensory pathways and can detect damaged areas in the brain.

Multiple sclerosis study reveals how killer T cells learn to recognize nerve fiber insulators

Misguided killer T cells may be the missing link in sustained tissue damage in the brains and spines of people with multiple sclerosis, findings from the University of Washington reveal.  Cytoxic T cells, also known as CD8+ T cells, are white blood cells that normally are in the body’s arsenal to fight disease.

killer-T-cell2

Multiple sclerosis is characterized by inflamed lesions that damage the insulation surrounding nerve fibers and destroy the axons, electrical impulse conductors that look like long, branching projections.  Affected nerves fail to transmit signals effectively.

Intriguingly, the UW study, published this week in Nature Immunology, also raises the possibility that misdirected killer T cells might at other times act protectively and not add to lesion formation.  Instead they might retaliate against the cells that tried to make them mistake the wrappings around nerve endings as dangerous.

UW Immunology chair Joan Goverman studies the cellular mechanisms behind autoimmune disorders of the central nervous system.

Scientists Qingyong Ji and Luca Castelli performed the research with Joan Goverman, UW professor and chair of immunology.  Goverman is noted for her work on the cells involved in autoimmune disorders of the central nervous system and on laboratory models of multiple sclerosis.

Multiple sclerosis generally first appears between ages 20 to 40.  It is believed to stem from corruption of the body’s normal defense against pathogens, so that it now attacks itself.  For reasons not yet known, the immune system, which wards off cancer and infection, is provoked to vandalize the myelin sheath around nerve cells. The myelin sheath resembles the coating on an electrical wire.  When it frays, nerve impulses are impaired.

Depending on which nerves are harmed, vision problems, an inability to walk, or other debilitating symptoms may arise.  Sometimes the lesions heal partially or temporarily, leading to a see-saw of remissions and flare ups.  In other cases, nerve damage is unrelenting.

The myelin sheaths on nerve cell projections are fashioned by support cells called oligodendrocytes.  Newborn’s brains contain just a few sections with myelinated nerve cells. An adult’s brains cells are not fully myelinated until age 25 to 30.

For T cells to recognize proteins from a pathogen, a myelin sheath or any source, other cells must break the desired proteins into small pieces, called peptides, and then present the peptides in a specific molecular package to the T cells.  Scientists had previously determined which cells present pieces of a myelin protein to a type of T cell involved in the pathology of multiple sclerosis called a CD4+ T cell.  Before the current study, no cells had yet been found that present myelin protein to CD8+ T cells.

Scientists strongly suspect that CD8+ T cells, whose job is to kill other cells, play an important role in the myelin-damage of multiple sclerosis.  In experimental autoimmune encephalitis, which is an animal model of  multiple sclerosis in humans, CD4+T cells have a significant part in the inflammatory response.  However, scientists observed that, in acute and chronic multiple sclerosis lesions, CD8+T cells actually outnumber CD4+ T cells and their numbers correlate with the extent of damage to nerve cell projections.  Other studies suggest the opposite: that CD8+T cells may tone down the myelin attack.

The differing observations pointed to a conflicting role for CD8 + T cells in exacerbating or ameliorating episodes of multiple sclerosis. Still, how CD8+T cells actually contributed to regulating the autoimmune response in the central nervous system, for better or worse, was poorly understood.

TIP dendritic cells, stained to show their physical features.

Goverman and her team showed for the first time that naive CD8+ T cells were activated and turned into myelin-recognizing cells by special cells called Tip-dendritic cells. These cells are derived from a type of inflammatory white blood cell that accumulates in the brain and the spinal cord during experimental autoimmune encephalitis originally mediated by CD4+ T cells. The membrane folds and protrusions of mature dendritic cells often look like branched tentacles or cupped petals well-suited to probing the surroundings.

The researchers proposed that the Tip dendritic cells can not only engulf myelin debris or dead oligodendrocytes and then present myelin peptides to CD4 + T cells, they also have the unusual ability to load a myelin peptide onto a specific type of molecule that also presents it to CD8+ T cells.  In this way, the Tip dendritic cells can spread the immune response from CD4+ T cells to CD8+ T cells. This presentation enables CD8+ T cells to recognize myelin protein segments from oligodendrocytes, the cells that form the myelin sheath.  The phenomenon establishes a second-wave of autoimmune reactivity in which the CD8+ T cells respond to the presence of oligodendrocytes by splitting them open and spilling their contents.

“Our findings are consistent,” the researchers said, “with the critical role of dendritic cells in promoting inflammation in autoimmune diseases of the central nervous system.”  They mentioned that mature dendritic cells might possibly wait in the blood vessels of normal brain tissue to activate T-cells that have infiltrated the blood/brain barrier.

The oligodendrocytes, under the inflammatory situation of experimental autoimmune encephalitis, also present peptides that elicit an immune response from CD8+T cells. Under healthy conditions, oligodendrocytes wouldn’t do this.

The researchers proposed that myelin-specific CD8+T cells might play a role in the ongoing destruction of nerve-cell endings in “slow burning” multiple sclerosis lesions. A drop in inflammation accompanied by an increased degeneration of axons (electrical impulse-conducting structures) coincides with multiple sclerosis leaving the relapsing-remitting stage of disease and entering a more progressive state.

Medical scientists are studying the roles of a variety of immune cells in multiple sclerosis in the hopes of discovering pathways that could be therapeutic targets to prevent or control the disease, or to find ways to harness the body’s own protective mechanisms.  This could lead to highly specific treatments that might avoid the unpleasant or dangerous side effects of generalized immunosuppressants like corticosteroids or methotrexate.

The study was funding by grants AI072737 and AI073748 from the National Institutes of Health. The authors declared no competing financial interests.

Early Signs and Symptoms of Multiple Sclerosis

Early Signs and Symptoms of Multiple Sclerosis

Early Signs and Symptoms of Multiple Sclerosis
Multiple Sclerosis early signs, symptoms can be in such a mild form as not to be initially detectable.
MS early symptoms and signs appear at the onset of the disease, usually between the ages of 20 and 40. MS early symptoms and signs vary in duration and severity from one individual to the other and at different times in the same individual.
The most recurrent are:
  • walking difficulties
  • the sensation of having a weak or numb limb
  • cold or tingling feet
  • facial pain (Neuralgia)
  • blurred vision
Less common MS early symptoms include:
  • lack of coordination
  • cognitive difficulties
  • slurred speech
  • sudden onset of paralysis
As the disease progresses other symptoms can appear.
MS pain
MS pain is the type of pain that affects the central nervous system and pain syndromes are common amongst MS patients. Almost 50% of MS patients suffer s from chronic pain. There are several types of MS pain. The main types are:
  • Neuralgia, which is a stabbing pain in the face; it is usually treated with anticonvulsants.
  • Dysesthesias, which is a burning, aching body pain; it is usually treated with anticonvulsants and sometimes with antidepressants which act on the nervous central system.
  • Lhermitte sign, which is a brief, electric shock like sensation that runs down the spine and is caused by bending the neck forward or backward. It is controlled by means of a soft collar.
  • A chronic sensation of ‘pins and needles’, which is treated similarly to acute Dysesthesias.
  • Muscle spasm and cramps, which are treated with anti-inflammatory drugs.
  • Back and skeleton pains, which are treated with heat, massage and physical therapy.

Shrinkage of Brain Region May Signal Onset of Multiple Sclerosis

Atrophy of a key brain area may become a new biomarker to predict the onset of multiple sclerosis, researchers say. If so, that would add to established criteria such as the presence of brain lesions to diagnose the progressive, incurable disorder.

 Shrinkage of Brain Region May Signal Onset of Multiple Sclerosis

Using special MRI images, scientists from three continents found that the thalamus — which acts as a “relay center” for nervous-system signals — had atrophied in nearly 43 percent of patients who had suffered an initial neurological episode that often comes before a multiple sclerosis (MS) diagnosis.

“The telling appearance of lesions, which is a hallmark of the disease, is only part of the pathology,” said study author Dr. Robert Zivadinov, director of the Buffalo Neuroimaging Analysis Center at the University of Buffalo, in New York. “Our finding is more related to [initiating] clinical trials, to using thalamic volume as a new biomarker for testing and treatment, and to increasing awareness among investigators that this disease is more than just about lesions.”

The study was published online April 23 in the journalRadiology.

Believed to be an autoimmune disorder, MS results in lesions on the brain and spinal cord that disrupt nerve signals to various parts of the body. Symptoms, which can come and go, include numbness, tingling, vision disturbances, problems walking, dizziness, and bowel and bladder problems.

More than 2 million people live with MS worldwide, according to the Multiple Sclerosis Foundation.

For the new research, Zivadinov and his team used contrast-enhanced MRI images to evaluate more than 200 patients who had suffered an initial, short-term neurological episode known as clinically isolated syndrome. About 85 percent people who have one of these episodes will go on to be diagnosed with MS within two years, and the diagnosis also relies on a second attack and the detection of new or enlarging lesions using MRI.

The study performed follow-up scans on patients at six months, one year and two years. It found that decreases in the size of the thalamus were independently associated with the development of clinically definite MS, along with an increased volume in another part of the brain known as the lateral ventricles.

The findings suggest shrinkage of the thalamus could become a biomarker for MS because it’s detectable at a very early stage, Zivadinov said.

“What’s triggering this and how it’s connected with the thalamus should be explored,” he said, “but … that this research is indicating that the thalamus is profoundly affected so early on leads us to focus more on those regions of the brain.”

Dr. Gary Birnbaum, director of the MS Treatment and Research Center at the Minneapolis Clinic of Neurology, said he thinks the study highlights the concept that MS is a combination of inflammatory and degenerative processes.

But Birnbaum, who was not involved with the study, said measuring the size of the thalamus on special MRI scans is more complex than what is possible with traditional scans. He said this new finding needs to be confirmed before being useful in clinical MS diagnoses.

Setting new standards in multiple sclerosis care and research

setting new standards in multiple sclerosis care and research

Setting new standards in multiple sclerosis care and research

In the run up to the 2012 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting in Lyon, France, two important new multiple sclerosis (MS) initiatives are making progress. The International Collaborative on Progressive MS published its agenda of research priorities in late August, while the European MS Platform (EMSP) is due to roll out the next stage of MS Nurse Professional (MS Nurse PRO), a programme to standardise training for MS nurses across Europe, in Barcelona, Spain, at the end of September. Despite taking very different approaches, these initiatives have the potential to benefit many of the estimated 2·5 million people worldwide who have MS.
About 10—15% of people with MS present with primary progressive disease and 80% of the rest develop secondary progressive MS within 20 years. But, despite relative success in the development of treatments for relapsing-remitting MS, the options for people with progressive MS remain limited and a breakthrough is desperately needed. The International Collaborative on Progressive MS, a group of researchers and representatives of MS patient societies from Europe and North America, has the ultimate goal of expediting the development of disease-modifying and symptomatic treatments. In its research agenda, the Collaborative outlines five priority areas for research: experimental models, identification and validation of therapeutic targets, strategies for proof-of-concept clinical trials, clinical outcome measures, and symptom management and rehabilitation. Working groups are now looking at how to overcome the barriers to progress in these areas, and a call to the wider MS research community to collaborate on ongoing and new projects to address these challenges is planned for 2013.
Meanwhile, MS Nurse PRO is being developed to improve care for people in Europe with MS of all types. Specialist MS nurses can be an important point of contact for patients from diagnosis onwards, and they can enable neurologists to devote more time to the patients who need it most and to research. However, in 2010, the MS-Nurse Empowering Education (MS-NEED) survey led by the EMSP identified substantial variability across Europe in the roles and training of MS nurses and in the quality and availability of nursing care. To address these disparities and provide formal recognition for MS nurses, the EMSP has developed MS Nurse PRO with input from the European Rehabilitation in MS (RIMS) network and the International Organization of Multiple Sclerosis Nurses (IOMSN), which already provides international training for MS nurses. MS Nurse PRO will be based on five core modules: epidemiology and pathophysiology, clinical presentation, diagnosis and assessment, management of MS, and patient care and support. Despite the desire for standardisation, the training will accommodate national differences in the availability of drugs and the needs of employers of MS nurses, which can include charities, health-care providers, and pharmaceutical companies. The scheme has already run a pilot in Malta, and the Spanish launch with be the first test in a language other than English; MS Nurse PRO should also be available in German, Italian, and Czech by the end of 2012 and rolled out to other European countries from 2013 onwards.
Collaboration between organisations in different countries will be crucial for both projects. Large multicentre studies will be needed to overcome at least some of the barriers identified by the International Collaborative on Progressive MS, and any eventual recommendations, such as for outcome measures and trial design, will need to be recognised and implemented internationally if they are to lead to further progress. The MS Nurse PRO curriculum is accredited by the UK Royal College of Nursing, but similar endorsement in other countries will be needed if the programme is to become a standard qualification across Europe. The results from Malta and Spain, a planned consensus paper, and a written declaration in the European Parliament calling for recognition in member states should raise awareness. Funding will also be needed to sustain MS Nurse PRO beyond the development phase, which is being supported by a pharmaceutical company. For the International Collaborative on Progressive MS, member societies and government, corporate, and private organisations have been identified as potential sources of financial support.
More information should be available on both initiatives at ECTRIMS: from the Multiple Sclerosis International Federation, one of the societies behind the International Collaborative on Progressive MS, and from the EMSP. With enough funding and collaborative will, these initiatives could be important opportunities to improve the lives of thousands of people, and we look forward to following their progress.

mobility concept vehicles for wheelchair drivers

“To get something you never had, you have to do something you’ve never done.” ~Unknown

dodge wheelchair driver and passenger concept vehicles
Were going to change the world one person at a time
Join the revolution
Do you want a 4×4 wheelchair vehicle you can drive?
We have built 4×4 accessible vehicles going all the way back to the 80’s
Want a 4×4 SUV you can drive your wheelchair from?
Want a Ford Explorer SUV that is a wheelchair accessible vehicle?
We can and will build you a concept vehicle you can drive from a wheelchair.
 'Courage is fear holding on a minute longer.'    - -George S. Patton
‘Courage is fear holding on a minute longer.’    – -George S. Patton

One definition of resilience is “the ability to cope with shocks and keep functioning in a satisfying way”. Resilience is about the self organizing capacity of systems. This means the ability to bounce back after disaster, or the ability to transform if a bad stage has happened. Both of these forms of resilience seem relevant to explore in our times, especially in relation to Assistive Driving Technology for Wheelchair Drivers.

Vmi New England and Automotive Innovations as a company is aware of this challenge and has been working on cutting edge wheelchair driving technology since the 80’s

automotive mobility concept vehicle systems
Vmi New England and Automotive Innovations is leading in its study of ever evolving automotive wheelchair driving systems.

wheelchair driver and passenger concept vehicles

Ford wheelchair driver and passenger concept vehicles

The way we see it, everyone has a fundamental need to have there own personal transportation, to access anything they need like, clean water, food, fibres and many other goods and services.

For future human development it is essential to understand the contribution each person can make to human livelihoods, health, security and culture if given the chance.

wheelchair driver and passenger concept vehicles

wheelchair driver and passenger concept vehicles

Resilience thinking is part of the solution, as it thrives at building flexibility and adaptive capacity. People and nature are interdependent. That means, we have to look for collaboration within society to find resilient solutions.

Interdependence between people and nature.

IMG_0094

Exploring the missing links in our imagination
Solutions to find new possibilities in the Assistive Driving Technology require creativity.

Creativity is the answer to missing links in our imagination, at least according to Jim Sanders. They have found a unique way to explore the relationship between current automotive designs, people and technology.
A safe operating vehicle for people in wheelchairs
“In the face of ever evolving change in transportation needs, we need to work together to find safe mobility solutions for humanity. The key is in creative mobility solutions that connect nature with people. Flexible and adaptive strategies will bring us further. By stretching our imagination, we will start to explore the unknown. And by always looking for new combinations of technology, and common sense, we will find the new solutions.” Jim Sanders 2013

Sometimes even the smallest shift in thinking or doing can create the biggest changes in someones lifecan you save trust for a rainy day?necessity is the mother of invention

IMG_1598

driven by the freedom of the choice  to explore the worlds future possibilities

 VMi New England Mobility Center and Automotive Innovations is one of America’s best providers of wheelchair vans, vehicle modifications, and adaptive equipment including hand controls, wheelchair and scooter lifts, ramps, raised doors, lowered floors and specialized gas, brake and steering controls. With hundreds of accessible vehicles available to be custom built for your specific needs, from the industries best manufacturers such as VMI, Eldorado and Braun, at our New England mobility center.   Founded in 1984 and offering the best equipped mobility facility in New England with a unparalleled commitment to offering a broad selection of specialized vehicles and services to meet the needs of every customer. Our facility is also Quality Assurance Program (QAP) certified (first in Massachusetts) through the National Mobility Equipment Dealers Association (NMEDA), resulting in Automotive Innovations being held to the highest standards in the vehicle modification industry.   We have a strong and committed Veteran sales staff with many decades of experience satisfying our customers’ needs. Feel free to browse our inventory online, visit our huge indoor showroom where every day is a ability expo, request more information about vehicles, set up a test drive or inquire about financing!   Feel free to call upon our friendly Mobility Consultants with any questions you may have about options on wheelchair vans or any of our other products. 508-697-6006We look forward to exceeding your expectations for decades to come!
concept |ˈkänˌsept|nounan abstract idea; a general notion: structuralism is a difficult concept | the concept of justice.• a plan or intention; a conception: the center has kept firmly to its original concept.• an idea or invention to help sell or publicize a commodity: a new concept in corporate hospitality.• Philosophy an idea or mental picture of a group or class of objects formed by combining all their aspects.• [ as modifier ] (of a car or other vehicle) produced as an experimental model to test the viability of new design features.ORIGIN mid 16th cent. (in the sense ‘thought, frame of mind, imagination’): from Latinconceptum ‘something conceived,’ from concept-‘conceived,’ from concipere (see conceive) .
exceed |ikˈsēd|verb [ with obj. ]be greater in number or size than (a quantity, number, or other measurable thing): production costs have exceeded $60,000.• go beyond what is allowed or stipulated by (a set limit, esp. of one’s authority): the Tribunal’s decision clearly exceeds its powers under the statute.• be better than; surpass: catalog sales have exceeded expectations.mobilitynoun1 elderly people may become socially isolated as a result ofrestricted mobility: ability to move, movability,moveableness, motility, vigour, strength, potency.2 the gleeful mobility of Billy’s face: expressiveness,eloquence, animation.3 the mobility of the product: transportability,portability, manoeuvrability.4 an increasing mobility in the workforce: adaptability,flexibility, versatility, adjustability.
freedom |ˈfrēdəm|nounthe power or right to act, speak, or think as one wants without hindrance or restraint: we do have some freedom of choice | he talks of revoking some of the freedoms.• absence of subjection to foreign domination or despotic government: he was a champion of Irish freedom.• the state of not being imprisoned or enslaved: the shark thrashed its way to freedom.• the state of being physically unrestricted and able to move easily: the shorts have a side split for freedom of movement.• (freedom from) the state of not being subject to or affected by (a particular undesirable thing):government policies to achieve freedom from want.• the power of self-determination attributed to the will; the quality of being independent of fate or necessity.• unrestricted use of something: the dog is happy having the freedom of the house when we are out.• archaic familiarity or openness in speech or behavior.

Multiple sclerosis: Causes, incidence, and risk factors

Multiple sclerosis

national multiple sclerosis society massachusetts

MS; Demyelinating disease
Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

Causes, incidence, and risk factors

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.
MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.
The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.
You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Symptoms

Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions).
Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.
It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.
Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.
Muscle symptoms:
  • Loss of balance
  • Muscle spasms
  • Numbness or abnormal sensation in any area
  • Problems moving arms or legs
  • Problems walking
  • Problems with coordination and making small movements
  • Tremor in one or more arms or legs
  • Weakness in one or more arms or legs
Bowel and bladder symptoms:
Eye symptoms:
Numbness, tingling, or pain
Other brain and nerve symptoms:
  • Decreased attention span, poor judgment, and memory loss
  • Difficulty reasoning and solving problems
  • Depression or feelings of sadness
  • Dizziness and balance problems
  • Hearing loss
Sexual symptoms:
Speech and swallowing symptoms:
  • Slurred or difficult-to-understand speech
  • Trouble chewing and swallowing
Fatigue is a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.

Signs and tests

Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.
People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.
The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.
A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:
  • Abnormal nerve reflexes
  • Decreased ability to move a part of the body
  • Decreased or abnormal sensation
  • Other loss of nervous system functions
An eye examination may show:
  • Abnormal pupil responses
  • Changes in the visual fields or eye movements
  • Decreased visual acuity
  • Problems with the inside parts of the eye
  • Rapid eye movements triggered when the eye moves
Tests to diagnose multiple sclerosis include:

Treatment

There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.
Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:
Steroids may be used to decrease the severity of attacks.
Medications to control symptoms may include:
  • Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
  • Cholinergic medications to reduce urinary problems
  • Antidepressants for mood or behavior symptoms
  • Amantadine for fatigue
For more information see:
The following may also be helpful for people with MS:
  • Physical therapy, speech therapy, occupational therapy, and support groups
  • Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
  • A planned exercise program early in the course of the disorder
  • A healthy lifestyle, with good nutrition and enough rest and relaxation
  • Avoiding fatigue, stress, temperature extremes, and illness
  • Changes in what you eat or drink if there are swallowing problems
  • Making changes around the home to prevent falls
  • Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)
For more information about living with MS, see: Multiple sclerosis – at home
Household changes to ensure safety and ease in moving around the home are often needed.

Support Groups

For additional information, see multiple sclerosis resources.

Expectations (prognosis)

The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.
The following typically have the best outlook:
  • Females
  • People who were young (less than 30 years) when the disease started
  • People with infrequent attacks
  • People with a relapsing-remitting pattern
  • People who have limited disease on imaging studies
The amount of disability and discomfort depends on:
  • How often you have attacks
  • How severe they are
  • The part of the central nervous system that is affected by each attack
Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.
Those with a support system are often able to remain in their home.

Complications

Calling your health care provider

Call your health care provider if:
  • You develop any symptoms of MS
  • Symptoms get worse, even with treatment
  • The condition deteriorates to the point where home care is no longer possible

References

  1. Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 436.
  2. Carroll WM. Oral therapy for multiple sclerosis–sea change or incremental step? N Engl J Med. 2010 Feb 4;362(5):456-8. Epub 2010 Jan 20. [PubMed]
  3. Goodin DS, Cohen BA, O’Connor P, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: the use of natalizumab (Tysabri) for the treatment of multiple sclerosis (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008:71(10):766-73. [PubMed]
  4. Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004192. [PubMed]
  5. Kappos L, Freedman MS, Polman CH, et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet. 2007:370(9585):389-97. [PubMed]
  6. Miller DH, Leary SM. Primary-progressive multiple sclerosis. Lancet Neurol. 2007;6:903-912. [PubMed]
  7. Marriott JJ, Miyasaki JM, Gronseth G, O’Connor PW; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 May 4;74(18):1463-70. [PMC free article] [PubMed]

Multiple Sclerosis

Multiple Sclerosis can affect individuals in varying ways including tingling, numbness, slurred speech, blurred or double vision, muscle weakness, poor coordination, unusual fatigue, muscle cramps, bowel and bladder problems and paralysis. Due to these symptoms, special equipment or accommodations may need to be made to aid a person in safely maintaining their mobility independence for as long as possible.

Physical Considerations: The following are considerations for selecting a vehicle: 

Driving a sedan: The Individual must be able to do the following:

  • Open and close the Door
  • Transfer in and out of the vehicle
  • A wheelchair/scooter must be able to be stored and retrieved. Special equipment is available to aid with storage.

Driving a Van: Options may include a mini-van with a lowered floor and a ramp or a full size van with a lift. Specialized modifications allow a person to transfer to the driver’s seat or drive from a wheelchair. Technology may be able to compensate for the loss of strength or range of motion such as:

  • Reduced effort steering and/or brake systems to compensate for reduced strength.
  • Mechanical hand controls allow for operation of the gas and brake using upper extremities.
  • Servo brake/ accelerator systems compensate for reduced strength/range of motion of arms.
  • If spasticity is difficult to manage, it may lead to an inability to drive. 

Visual Changes: 

  • May be severe enough that driving is precluded or night driving is prohibited.
  • If double vision is intermittent and can be monitored independently, then driving may be limited to avoid driving during an exacerbation.
  • Sunglasses may help with glare sensitivity.
  • Compensate for loss of peripheral vision with special mirrors and head turning.
  • Learn order of traffic signals to aid with color vision impairment.

Cognitive Issues:

  • Need to regulate emotions and avoid driving when upset, angry or overly emotional.
  • May be limited to familiar routes if some loss of memory or problem solving but still enough judgment to drive.

Decreased Energy:

  • Energy conservation is vital.
  • May require assistance with wheelchair loading to save energy for driving.
  • Air conditioning aids with managing warm climates.

Medications:

  • Seek the physician’s input regarding side effects which may impair driving.
  • Monitor when medications are taken. Don’t drive when sleepy or just before or after medicating

If you or those that drive with you notice any of the above warning signs and need a driving evaluation, give us a call at 508-697-6006 and we can, help you with with knowledge about medical conditions, and help with a comprehensive evaluation and determine your ability to drive.

  • Visual Perception
  • Functional Ability
  • Reaction Time
  • Behind-the-wheel evaluation