Imagine this scenario: Anna Fields, a young mother of a five-year-old, experiences intermittent bouts of arm numbness for more than a year. Believing she is sleeping “wrong” or just overexerting herself, she ignores this condition until it becomes more prominent with numbness down the entire side of her body. When receiving a diagnosis of multiple sclerosis (MS), she is shocked because of her young age and lack of family history of the disease. While Fields is not a real patient, the depicted situation occurs fairly often.
Contrary to a common misconception, MS is not caused by genetics or poor health. While an exact cause is unknown, the disease is associated with an immune system malfunction that can affect anyone. Although it can occur at any age, it is most prevalent among women in their 20s and 30s and those living in the northern hemisphere.
“MS is a progressive disease,” explains Carmen Angles, MD, Clinical Director of the Medical Rehabilitation and Comprehensive Treatment Unit at MossRehab. “It affects women more than men, especially early in their lives when they are just starting careers or a family.”
What is MS?
MS is a disease that affects the brain, spinal cord and other nerves, causing physical and cognitive changes. The disease has several categories, the most common characterized by episodes when symptoms worsen, or new ones appear after periods of stability. “Individuals in this stage have periods where they regain strength, mobility, and overall function,” notes Dr. Angles. “While disease-modifying treatments can slow disease progression, a person can steadily decline in function without periods of remission.”
People with MS may first experience blurry vision and numbness in the arms or legs. Other signs include balance and walking problems, speech and swallowing difficulties, stiffness, fatigue, numbness, and weakness. Symptoms may appear and then disappear for months or years. Signs may be so subtle that it may take a while before someone is diagnosed with MS.
“Often, people don’t know they have MS until symptoms significantly reveal themselves,” explains Dr. Angles. “It isn’t until someone falls because of weakness or experiences numbness from the waist down that they seek medical care.”
MossRehab Team Approach to MS
MossRehab provides inpatient and outpatient services for individuals with MS. Patients are typically referred by a neurologist or family physician after an acute attack and may return as an outpatient when experiencing new deficits after a recovery period. Taking a team approach, MossRehab clinicians support patients from assessment through treatment and rehabilitation.
“Patient treatment requires a team of specialized clinicians who are knowledgeable in providing specific care for persons with MS,” remarks Dr. Angles. One team for a patient may include a physiatrist experienced in MS, MS-certified therapists, a neurologist, a urologist, and other specialists.
“Some MossRehab therapists are so dedicated that they have designed devices like a controlled-release splint for patients with spastic hands.”
Because MS is not curable, many treatments focus on controlling or managing symptoms. The goal is to start medical care as soon and aggressively as possible to slow the disease progression and spread the time between relapses.
“Treatment is based on the disease severity and symptoms of MS,” says Dr. Angles. “We may use intravenous steroids to control inflammation, nerve block injections to help with pain, or botulinum toxin injections to relieve muscle spasms.” In addition to medical interventions, different rehabilitation therapies are available to treat MS symptoms. For example, an occupational therapist can help with activities of daily living, a speech therapist can concentrate on swallowing problems or speech, a hand therapist can work on motor control for the upper extremities, a massage therapist can relax muscle spasms and increase the range of motion while a physical therapist can help improve walking and posture.
Comprehensive Care with High-tech Resources
Specialized laboratories, state-of-the-art robotics, and innovative treatment approaches support MossRehab in its treatment of people with MS. Clinicians can assess movement problems and evaluate optic nerves in the Sheerr Gait and Motion Analysis Lab, and analyze arm muscle function and dexterity in the Motor Control Analysis Lab. MossRehab’s Electrodiagnostic Center allows physiatrists to diagnose nerve injuries, while patients learn to adapt to visual changes with Moss’s specialized Low Vision Rehabilitation.
MossRehab also has more than 25 therapeutic robots that clinicians use during inpatient and outpatient rehabilitation. Some assist in arm and hand rehabilitation while others help patients with MS regain strength and movement coordination for improved gait and balance.
“MossRehab offers world-class treatment technologies in patient care,” notes Dr. Angeles. “When a patient comes to MossRehab, we evaluate them, develop a highly personalized plan of care, and treat the whole sphere of the patient living with MS.”
MossRehab also sponsors programs and support groups at its facilities for people living with MS and their families to share experiences and learn how to handle the different symptoms and stages of the disease. To help individuals choose the right wheelchair and safely use it, MossRehab offers a Wheelchair Evaluation and Training Clinic. Yoga sessions are also offered to help people better manage the symptoms of MS at its Elkins Park and Doylestown locations. Classes are adapted for individuals using a wheelchair.
Advances in Treatments
Dr. Angles notes several medical advancements in MS treatments. Medications, such as Copaxone, are available in pill form so patients do not have to inject them. Disease-modifying medications also are in development including a new injectable infusion drug that promises to slow relapses. New MRI machines are taking more precise imaging than those of just five years ago to help assess the impact of the disease on the nervous system. Clinicians also are taking a more aggressive approach and not waiting until symptoms indicate the need for a specific treatment.
“If someone has mild symptoms, we start with the disease-modifying drugs as early as possible,” says Dr. Angles. “We are trying to find new ways of not only stopping progression but having the earliest diagnosis of the disease. I think we're more aware of catching it early, especially as diagnostics tools become more sophisticated.”
Preventative Measures and Alternative Treatments
What can someone do to prevent MS? While there is no specific known regime, diet and exercise are important to maintain health and avoid diseases. Dr. Angles recommends keeping vitamin D levels on target as a deficiency can contribute to poor health. Magnesium and biotin also are friendly to the nervous system.
Patients with MS looking for alternative or supplemental methods to treat the disease can embrace an anti-inflammatory diet and active lifestyle that includes exercise to build strong muscles and bones. Yoga and Tai Chi are excellent for balance and flexibility.
“It is also important for individuals to take notice of symptoms and report them to their physician so assessment and treatment can start early,” says Dr. Angles.
Check out the MossRehab Multiple Sclerosis Program