By Cheryl Lloyd, RN, BSN, CCM

"The team on the rehab unit is one of the best I've ever experienced. They are professionals who really care," said Sid, a patient who recovered from a recent worsening of symptoms, or exacerbation, of multiple sclerosis at Northern Nevada Medical Center's rehabilitation unit.

Sid is among the approximately 400,000 people nationwide affected by this central nervous system disease that has no cure. Multiple sclerosis (MS) is a disease that is difficult to diagnose and unpredictable in its course. However, with many different therapies available, the number of attacks can be reduced and permanent disability can be delayed.

What is multiple sclerosis?
Multiple sclerosis affects the myelin sheath that surrounds nerve fibers that aid the transmission of electrical impulses. In MS, the myelin is progressively destroyed, causing changes in nerve conduction and leading to signs and symptoms such as fatigue, depression, tingling, numbness and even pain. Slurred speech, weakness, loss of balance, visual changes, memory loss and difficulty concentrating also are signs. MS affects women more than twice as often as men and rarely occurs in adolescence.

In 2004, an Expert Opinion Paper was published for physicians by the Professional Resource Center of the National MS Society. Its primary points were: "The Medical Advisory Board of the National MS Society recommends that people with MS be referred for assessment by rehabilitation professionals when there is an abrupt or gradual worsening in functional limitations or increase in impairment that has a significant impact on mobility, safety, independence and/or quality of life. It also is recommended that assessment for rehabilitation services be considered early in the disease when behavioral and lifestyle changes may be easier to implement."

Bruce Witmer, MD

Sid manages his chronic disease with a positive attitude and a rehabilitative approach. Rehabilitation stresses improvement of function, so patients with MS, even at mild stages, can benefit from maintenance or preventive rehabilitation. Patients with milder early stages of MS may only need a home evaluation by a multidisciplinary team of healthcare providers:

• A physical therapist can assist with gait training and mobility and prescribe an exercise program in collaboration with the physician to maximize endurance and strength.
• An occupational therapist can recommend assistive devices to aid in dressing and bathing activities.
• A registered nurse can assist with bowel and bladder management and medication teaching.
• At home, family caregivers can be taught how to care for a patient with MS safely and effectively.

Patients who require 24-hour nursing care may need an inpatient rehab stay to improve function and allow for greater independence.

Medications and therapies for MS
Several drug therapies are used to treat MS. Steroids commonly are used for exacerbations. Immunomodulator drugs, known as interferons, such as Avonex^® and Betaseron^® also are used. Drugs can help with bladder dysfunction and muscle spasticity commonly seen in MS. Chemotherapy also is a way of controlling rapidly progressing or exacerbating MS.

Bruce Witmer, MD, medical director of Northern Nevada Rehabilitation, believes that rehabilitation patients benefit from specialized care. "Northern Nevada Medical Center offers rehabilitation patients not only continuity of care, but exceptional care," he said. "Patients enjoy the privacy of their rooms and the services of an acute care hospital."

Sid's inpatient plan of care focused on managing his diabetes, blood pressure and severe weakness as a result of his MS. Before he was discharged, he was thrilled to be able to walk with his front-wheeled walker almost all the way around the unit without stopping. He has returned home with a trained caregiver, and he attributes his success to NNMC's supportive environment and great staff.

Cheryl Lloyd, RN, BSN, CCM

Cheryl Lloyd, RN, BSN, CCM, is Director of Northern Nevada Rehabilitation, located on the fourth floor of the hospital. For more information, please call 356-4004. Additional MS resources include:

• The National Multiple Sclerosis Society, at 1-800-FIGHT-MS (1-800-344-4867) or www.nationalmssociety.org.
• The Multiple Sclerosis Association of America at www.msaa.com
• Consortium of Multiple Sclerosis Centers at www.mscare.org