Tag Archives: multiple sclerosis

Setting new standards in multiple sclerosis care and research

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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

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“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.

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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

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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

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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

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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