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coordination and/or cause weakness, poor difficulty with walking, which is also cal ed balance, numbness, or spasticity (abnormal ambulation. The term “gait” refers more increase in muscle tone). Visual or cognitive specifically to the manner or pattern of problems can also interfere with walking. walking (for example “unsteady gait”). studies suggest that half the people with sometimes leading to social isolation.
“Gait problems in ms are al over the map,” observes sue Kushner, a physical therapist Gait problems in ms are caused by a variety at slippery rock university in Pennsylvania, of factors. ms frequently causes fatigue, with long experience in multiple sclerosis. “This makes walking problems difficult to address.” Difficult, but not impossible.
if you are having difficulty walking or keeping Your healthcare provider wil probably refer your balance, if fatigue turns your legs to you to a physical therapist (Pt) for this jel y, don’t despair — speak up. many walking problems can be significantly improved with mechanics of your gait, a Pt may ask you physical therapy, exercise, the right assistive to walk across a room or down a hal way in device, or medication, including the newly- order to observe coordination, positioning below]. You are not “giving in” when you seek be asked to provide your medical history. treatment. untreated walking problems can You may also be asked to perform tests that lead to emotional distress, injuries, added measure muscle strength, fatigue levels, fatigue, and suspicion by other people that range of motion, spasticity, and balance. your abnormal gait stems from alcohol or some Pts use video cameras to record their observations. computerized devices such as talking with your primary healthcare provider also be used to quantify gait and balance. about getting an accurate assessment of your The good news is that gait evaluation is gait pattern is an important step toward maintaining and enhancing your mobility.
Ampyra™ampyra™ (dalfampridine, formerly called fampridine sR) was approved by the U.s. food and Drug administration (fDa) in January 2010 to improve walking in people with Ms. this oral medication contains a sustained-release formula of 4-aminopyridine, which blocks tiny pores (or potassium channels) on the surface of nerve fibers. blocking potassium channels may improve the conduction of nerve signals in nerve fibers whose insulating myelin coating has been damaged by Ms. in the clinical trials of ampyra, a significantly greater proportion of people on treatment had a consistent improvement in walking speed compared to those who took placebo. and those who experienced increased walking speed also demonstrated improvement in leg strength. ampyra can be used by people with all forms of Ms, along with whatever disease-modifying therapy they are taking. this medication should not be used by anyone with a history of seizures or moderate to severe renal disease. for additional information, contact the ampyra support line at 1-888-881-1918.
once the factors involved in your particular two new devices — the WalkAide and Ness l300 — are now available to assist in the Pt and your healthcare provider wil work sending low-level electrical impulses to the peroneal (sometimes called fibular) nerve, which signals leg muscles to lift the foot. reimbursement for Pt. review your coverage Although many users find these devices easier to avoid nasty surprises. Your physician and to wear and more convenient than AFos, not everyone with ms experiences positive results help you battle for the coverage required to address your problems. or you may need to peroneal nerve must be capable of sending pay physical therapy costs yourself. it is wise a signal and the muscles must be capable of to be frank and upfront with your Pt about receiving it. in ms, a variety of complications cost, payment plans, and the benefits you may prevent this from happening. You should be evaluated by a Pt to determine if the WalkAide or Ness l300 would work for you.
These devices are also a great deal more walking. Damage to neurons (nerve cells) weakness in ms isn’t the same as the couch- nervous system input that normal y guides potato syndrome that can be addressed by the act of walking. The result may be legs strength training.” in fact, the wrong kind of exercise will do nothing to improve walking Foot drop is a specific kind of weakness that and can lead to fatigue and increased weakness.
results from poor nerve conduction to the Dr. Francois Bethoux of the mellen center muscles used to flex the ankle. A person for ms treatment and research in cleveland with foot drop finds it difficult to lift one is a strong advocate of exercise for people or both feet fully while walking, making it with ms. However, he cautions “most ms difficult to manage curbs, stairs, and uneven patients cannot tolerate the levels of exercise surfaces. The right assistive device is often the most effective strategy. A brace cal ed an ankle-foot orthotic (AFo) is often prescribed. increase in ms symptoms. similarly, what is good exercise for one person with ms may not be good for another.” experience shows that even a small amount of exercise helps, as long as it is repeated at least 5 days per people can learn appropriate exercises as wel as ways to compensate for lost strength.
difficult, it can result in falls and injuries. A loss of balance and coordination can produce muscle weakness that interferes with walking a swaying, uneven gait — called ataxia — is not the same thing as ms fatigue, which that is often mistaken for drunkenness.
is a feeling of lack of energy. But ms fatigue “Balance is a complex system,” observes fatigue is so common in ms, an assessment susan e. Bennett, Pt, DPt, Ncs, clinical will include exploration of these problems Associate Professor at the university at Buffalo. “When it doesn’t work effectively, mobility aid to manage fatigue and muscle a comprehensive examination by a physical ination includes evaluation of muscle strength, spasticity or stiffness of the muscles, and walking, not give up on it! using an aid is the specialized balance system consisting of not an all or nothing choice. many people vision, inner ear and sensation in the legs. continue to walk, and to work on improving it is important to identify the underlying their walking, while using an aid. They find problems so the best rehabilitation can be that assistive devices al ow them to get where they want to go without exhausting all their energy reserves, and without being at risk of “Therapeutic strategies that may help balance falling. marie e., of rhode island, who lives deficits include eye muscle exercises, move- with progressive ms, got a fold-up wheelchair ments of the head activating the inner ear, as for outings that involve long distances. using well as “core” strengthening, stretching and it lets her focus on shopping or seeing the strengthening the legs. Aerobic activity, sights instead of concentrating al her energy stretching, and strengthening specific muscles can address some of the “secondary” reasons for balance difficulties,” says Bennett.
“A cane or walker may be prescribed for safe and independent walking. utilizing an assistive device is much safer than reaching for the walls or furniture,” Bennett notes. installing grab bars around the home can As a person moves, the nervous system sends also make transfers easier and daily activities streams of signals to muscle groups to expand safer. Getting rid of clutter and area rugs minimizes the risk of tripping and falling.
interfere with these coordinated events, they shouldn’t. spasticity can cause uneven gait. in addition, muscles in spastic limbs may atrophy from lack of use, and joints loss of feeling or tingling in the legs or may develop contractures (freezing in one feet indicate that the brain is not receiving painful position) if they remain rigid over accurate sensory input. As marie e. describes time. loss of range of motion can make it it, “it’s like i’m wearing thick heavy boots so difficult to perform simple daily activities. solutions may involve using a cane, walker, or canadian crutch (which has an arm cuff The right mix of stretching, exercise and and grab handle). The mobility aid relays medications can control spasticity, improve missing information to the brain by carrying serious complications described above. A device into the hand and arm. Visual cues Pt can recommend individualized and safe may also work. People learn to watch where techniques for stretching and exercising, their feet are falling to compensate for the and appropriate assistive devices. Baclofen and tizanidine are the medications most often used to treat spasticity. other treatments such marie likes the convenience of collapsible as botulinum toxin (Botox) and intrathecal canes, which can be easily stowed in a bag in some patients. controlling spasticity is a long-term effort. Good management cal s for a team approach, with the individual, the physician or nurse, and the Pt al contributing spasticity is abnormal muscle tone or tightness sometimes spasticity actual y helps preserve function. For example, the increased tone spasms. spasticity can be uncomfortable, allows some people who have weak legs to walk or stand more easily. However, Dr. mindy los Amigos National rehabilitation center (rancho), which is part of the los Angeles warns against relying on spasticity too much. Janet l., of Philadelphia, pulled up to a “excessive stress on joints or muscles can neighborhood delicatessen and decided to lead to unnecessary permanent damage,” leave her cane in the car. “it didn’t seem that far to walk,” she thought. As she threaded her way past some outdoor tables, she suddenly lost her balance — and fel across a stranger’s lap. “i was so mortified i wanted to cry,” she recalled. But she had the presence of mind it is embarrassing as well as frightening to fall down in public. People have been known to stop going out at all to avoid the “come here often?” she asked. They both possibility of a fal . But staying put at home started laughing. she pulled herself up and is not much of a solution. in fact it may explained that she sometimes loses her balance Kathy Dieruf, assistant professor in the Physical Therapy Program at the university National ms society. she knows that it’s “The painful consequences of a prior fall or not always easy to keep a sense of humor current fear of fal ing may lead to a devastating in this kind of situation, but for her it’s downward spiral of decreased activity, decreased the best strategy. As she puts it, “ms is not strength and endurance, diminished range of motion, and increased impairment that may actually add to the risk of falling.” to handle the problems.” A former dancer, Janet is keenly aware of the ways in which While it is essential to preserve one’s mobility in and outside their home, this should be done in a safe way. modifications to the environment (e.g., ramps), devices (e.g., “Keep moving! it’s important to be in the cane, walker, scooter), and common sense all can help you enjoy an active life without excessive fatigue or risk of injury from fal ing.
offers product information, resources, and links. Their advice is worth noting: “to select devices most appropriate to your needs, we We human beings are distinguished by our ability to develop technologies that make with professional advice, product evaluations, tasks easier. in a sense, all technology from safety pins to super-sonic jets is “assistive” technology, helping us to accomplish feats Do-it-Yourselfers run the very real risk we couldn’t do otherwise. When physical of using devices incorrectly and causing disability develops, canes, braces, walkers, unnecessary damage to their muscles or joints.
wheelchairs, and scooters assist. They help occupational therapist should assist you in The idea is not appealing initially. to many selecting the correct device to enhance your people, a cane represents “feebleness” — a mobility, in adjusting the device, and in wheelchair or scooter says that ms has “taken training you so you can use it appropriately and safely. sue Kushner encourages her clients to choose devices that are aesthetical y pleasing. And there are attractive choices available. the right assistive technology end up with a very different perspective. They recognize Janet, the former dancer, used the internet that a brace or cane allows them to walk to locate designer cane makers, and she now with confidence; a wheelchair or scooter has a col ection in different colors and styles, provides safety, speed, and saves energy for including a glittery lucite cane that she used more important things. A rehab professional when she was a bridesmaid in a friend’s with ms experience can help people improve their gait and manage fatigue, weakness, professionals look for individual solutions to individual gait problems.
the assistive technology industry offers Full or partial reimbursement for assistive options aplenty — from rolling walkers to technology (or durable medical equipment) weighted 4-pronged canes; from ultra-light may be available through private or public power-assist wheelchairs to fully-powered insurance, community organizations, social multi-level wheelchairs. There are excel ent web service agencies, or your state’s vocational sites with information about such equipment. rehabilitation agency. remember to explore A good starting place is ABleDAtA (able-
veteran’s benefits if you have done military data.com), a federally-funded project that
service. reimbursement programs require a prescription from a physician or a rehabilitation Dr. Aisen, for one, is optimistic that research professional, and a statement that explains being done in other conditions, such as spinal the medical necessity of the purchase. The cord injury and stroke, will eventually prove statement may take some careful preparation.
useful in ms. There is some evidence that intensive, repetitive physical therapy can People with ms often fail to fit into standard improve damaged neural function, perhaps disability categories because gait problems by stimulating the brain to create new neural various forms of aerobic exercise and weight strength and the ability to walk. According to Barbara Giesser, mD, clinical Director n clearly communicate these requirements to your physician or therapist, as reimbursement will depend on supporting material from your Geffen school of medicine, “The research is helping us identify what types of exercise n contact your National Ms society chapter work best to address ms symptoms, as well for assistance if your healthcare provider is as how frequent and intense the exercise “it is important to have a strong advocate tailored to the needs of each individual.” to explain why a device is justified,” says Dr. innovations in assistive technology are also expected to continue at a brisk pace — in part to keep up with aging baby-boomers. lighter, more flexible mobility aids with sporty styling and cheerful colors are already available. “sick” is out and “active” is in for people who compensate for disabilities with At present, people with walking limitations related to ms remain mobile and independent through physical therapy, exercise, medication, and assistive technology. New ways to prevent permanent losses and to improve the tech- nology that compensates for losses are in The society publishes many other pamphlets and articles about various aspects of ms. Visit nationalMSsociety.org/brochures
Ampyra: A New Medication to Improve to download them, or call your chapter at Walking featuring Patricia K. coyle, mD.
nationalMSsociety.org/ampyra
nationalMSsociety.org/dalfampridine
n stretching with a helper for People with Ms ampyra is a trademark of acorda therapeutics. botox is a registered trademark of allergan, inc.
* the National Multiple sclerosis society is proud to be a source of information about multiple sclerosis. Our comments are based on professional advice, published experience and expert opinion, but do not represent individual therapeutic recommendation or prescription. for specific information and advice, consult your personal physician.
2010 National Multiple sclerosis society

Source: http://www.msdoit.com/files/11512.3.17_brochure_Gait.pdf

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Persistent Idiopathic Facial Pain (Previously “Atypical Facial Pain”) Definition Persistent idiopathic facial pain (PIFP), previously termed “atypical facial pain,” is a persistent facial pain that does not have the characteristics of cranial neuralgias and cannot be better attributed to a different disorder. Epidemiology The prevalence of PIFP is far less frequent than that o

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Overview of Presentation: What’s it al  Goals- Differentiate between programs Eligibility Rules Coverage  Basic Rights and Responsibilities Keeping Eligibility  Appealing Adverse Decisions 1965 Federal matching dollars for state dollars Entitlement Program- You’re eligible, you apply,  States have authority to administer, increase eligibility to additional gr

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