Introduction

Multiple Sclerosis (MS) Handout

Name of Disorder: Multiple Sclerosis

Clinical Information

Core Characteristics

• Etiology: Genetic
• Pathology: Variable
• Rarity Classification: High
• Typical Onset: Adulthood
• Gender Impact: Mostly Women
• Progressive/Degenerative: Yes
• Seizure Prevalence: No (<10%)
• Population Trend: Stable

Pathophysiology

Considered an autoimmune disease but clearly has a hereditary element to it

AAC Considerations

Additional Clinical Notes

Very interesting geographic gradient in the prevalence here, worth looking into. I may be underestimating the % of AAC use, there are many coflicting sources.

Formal Name: Multiple Sclerosis (MS)

Demographic Information:

• Incidence: Approximately 2.5 per 100,000 people per year
• Prevalence: Estimated at around 1 in 1,000 people in the United States
• Gender: More common in women than men, with a ratio of about 3:1
• Onset Age: Typically between 20 and 50 years old, though it can occur at any age

Coding:

• ICD-11: 8A40
• ICD-10-CM: G35
• OMIM: 126200
• UMLS: C0026769
• MeSH: D009103
• GARD: 7314

Quick Reference

| Quick Facts | Details | |-------------|---------| | Incidence | Approximately 2.5 per 100,000 people per year | | Prevalence | ~1 in 1,000 people (approximately 914,000 in U.S.) | | Gender Distribution | More common in women than men (ratio ~3:1) | | Primary Age of Onset | Typically between 20 and 50 years old | | AT/AAC Requirements | Low to Moderate - Approximately 20-25% will require assistive technology; AAC needs increase with disease progression, particularly in severe cases |

Medical Features and Pathophysiology:

• Etiology:

• Pathology:

• Symptoms:

- Muscle weakness and spasticity - Coordination and balance problems - Tremors - Gait difficulties - Sensory Symptoms: - Numbness or tingling - Pain - Visual disturbances (optic neuritis, double vision) - Cognitive and Emotional Symptoms: - Memory and concentration difficulties - Depression and anxiety - Fatigue - Autonomic Symptoms: - Bladder and bowel dysfunction - Sexual dysfunction

• Diagnosis:

Assistive Suggestions and Requirements:

• Requirement Percentage for Assistive Technology:

• Assistive Technology Suggestions:

- Canes or Walkers: To assist with balance and prevent falls. - Wheelchairs: For individuals with severe mobility impairments. - Communication Aids: - Voice Amplifiers: To assist with dysarthria (speech difficulties). - Speech Generating Devices (SGDs): For individuals with severe speech difficulties. - Home Modifications: - Grab Bars and Handrails: To enhance safety and prevent falls. - Adjustable Beds: To improve comfort and ease of movement. - Feeding Aids: - Adaptive Utensils: For individuals with tremor or reduced hand dexterity.

• Access Modalities:

- Voice-Controlled Systems: Beneficial for those who retain good vocal strength. - Touchscreen Devices: Useful for those with adequate hand dexterity.

Care Management and Therapeutic Techniques:

• Aims:

- To provide supportive care and address complications through a multidisciplinary approach. - To offer education and support to patients and caregivers.

• SLP Suggestions:

- Regular speech and swallowing assessments to monitor changes and adjust therapy plans accordingly. - Techniques to improve speech clarity and address dysarthria. - Swallowing techniques to ensure safe swallowing and reduce the risk of aspiration. - Augmentative and Alternative Communication (AAC): - Introduction of AAC devices early in the disease progression to ensure familiarity and ease of use as the disease progresses.

• Special Educator Suggestions:

- Activities designed to enhance executive function, memory, and attention. - Use of memory aids, such as notebooks or electronic organizers. - Behavioral Strategies: - Structured routines to manage apathy and maintain engagement in activities. - Positive reinforcement to encourage participation and effort in tasks.

• Occupational Therapist Suggestions:

- Training in the use of adaptive equipment for self-care activities (e.g., dressing, grooming). - Techniques to conserve energy and manage fatigue. - Home and Environmental Modifications: - Assessing and modifying the home environment to ensure safety and accessibility. - Recommendations for ergonomic furniture and tools to support independence.

AAC Recommendations

Individuals with MS typically retain literacy and cognitive abilities until late-stage disease. Text-based systems with word prediction accommodate motor difficulties while preserving natural language expression. Symbol-based systems are rarely needed unless significant cognitive decline occurs. AAC should be introduced proactively as dysarthria progresses rather than waiting for complete speech loss.

References

1. Lublin, F. D., & Miller, A. E. (2014). Multiple sclerosis phenotypes: Current and future considerations. Neurology, 83(3), 278-286. 2. Compston, A., & Coles, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502-1517. 3. Hauser, S. L., & Goodin, D. S. (2012). Multiple sclerosis and other demyelinating diseases. In D. L. Longo (Ed.), Harrison's Principles of Internal Medicine (18th ed., pp. 3395-3409). McGraw-Hill. 4. (2019). Progressive multiple sclerosis: latest therapeutic developments and future directions. Therapeutic Advances in Neurological Disorders. https://doi.org/10.1177/1756286419878323 5. (2018). Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis. Neurology. https://doi.org/10.1212/WNL.0000000000005347 6. (2007). Remyelination In Multiple Sclerosis. International review of neurobiology. https://doi.org/10.1016/S0074-7742(07)79026-8 7. (2005). Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD003980.pub2 8. (1971). Visually evoked responses in multiple sclerosis. Journal of Neurology Neurosurgery & Psychiatry. https://doi.org/10.1136/jnnp.34.3.275

Epidemiology and Demographics

Etiology and Pathophysiology

Clinical Features and Stages

Diagnosis

Clinical Recommendations

Care Management

Transition Planning