How to care for Multiple Sclerosis Patients?

How to care for Multiple Sclerosis Patients?

Multiple Sclerosis Patients

Multiple sclerosis is a serious health condition and a number of persons suffer from this disease. Before you learn how to care for a patient suffering from Multiple Sclerosis, you must first know how this disease affects your body.

Do you know how it affects the body? 

Multiple Sclerosis affects both the brain and spinal cord. Sclerosis means the hardening of tiny tissues, and Multiple is added to it because it affects both the brain and spinal cord. 

In MS, the immune system attacks the protective covering (myelin sheath) of nerve fiber and causes communication between the brain and the rest of the body. This disease can sometimes cause permanent damage to nerves.

The cause of Multiple sclerosis is still unknown, but according to many studies and research, genetics and environmental factors are responsible.

People with Multiple Sclerosis often feel numbness and weakness in limbs. Many people are unable to walk independently. The gait is also disturbed in such patients. The blurring of vision and slurred speech is also common in patients with multiple sclerosis.

Treatment Options

There is no cure for multiple sclerosis. Treatment is mainly focused on speeding the recovery from attack and slowing the progression of the disease.

Primary treatment options include

Medications

Medications do not cure the disease permanently. However, they reduce the symptoms of disease and prevent the relapse of illness.

  • Corticosteroids are used for the treatment of attacks of disease. It reduces nerve inflammation.
  • Interferon-beta medications are used to reduce the frequency of attacks.
  • Muscle relaxants are used to reduce the stiffness and spasm in the legs.
  • Medications like amantadine help to reduce the fatigue caused by Multiple sclerosis.

Physical Therapy

Physical therapy has a significant role in modifying the symptoms of the disease:

  1. The Physical Therapist teaches you stretching and strengthening exercises.
  2. The Physical Therapist helps you to stay active.
  3. The Physical Therapist teaches you how to use assistive devices like a cane, walkers, etc. so that you can walk on the ground freely.

Care for Multiple sclerosis

Here are some tips that can make it easier to deal with patients with Multiple sclerosis

  • Balanced diet
  • Exercise
  • Avoid heat
  • Psychosocial therapy

Balanced Diet

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As we all know, a balanced diet is crucial to living a healthy life. Everyone can get benefit from a nutritious diet, especially the patient with multiple sclerosis. There are no particular guidelines mentioned about eating. 

According to many types of research, eating a low-fat and vitamin-rich diet can benefit people with multiple sclerosis. Eating a healthy diet can help to maximize your energy levels and support your bowel and bladder movement. 

A better diet can help you avoid high cholesterol, high blood sugar, and abdominal fat, which can cause cardiovascular diseases.

Vitamin D also has potential benefits for Multiple sclerosis patients. For example, it can help reduce pain around joints which is a common symptom of multiple sclerosis.

Do you know? Using alcohol can worsens the condition of the patient with Multiple sclerosis. Patients with multiple sclerosis should also limit the use of alcohol as much as possible. The use of alcohol can intensify the symptoms of Multiple sclerosis, such as lack of coordination and walking difficulties.

Exercises

Mind-Body Connection

Exercises can offer many benefits to the patient with Multiple sclerosis. These benefits can range from mental to physical. Regular physical activity helps you to stay active and fit. Exercises can help you improve muscle strength, tone, balance, and coordination if you suffer from mild to moderate multiple sclerosis.

Do you know? 

Walking for 20-30 minutes can improve your gait and balance. Other activities like yoga, pilates can also improve the condition of the patient. The intensity and duration of exercise should depend upon the patient’s condition because, in multiple sclerosis patients, you feel great one day but tired the next day.

Some exercises that can help Multiple sclerosis patient and prevent relapse are here.

  • Working out in pools can be a great activity in treating multiple sclerosis patients. Swimming and walking in pools are effective for joint pain. Water belts and other equipment can be used depending upon the condition of the patient.
  • Strength training like wall squats can e performed to increase the strength of leg muscles, which helps improve the patient’s gait.
  • Wall push-ups can be performed to improve the strength of arms. This can be performed in a sitting or standing position.
  • Balance training is important for multiple sclerosis patients. Marching in place can be the best exercise for these patients as you are challenging your body by shifting weight from one side to the other.

Avoid Heat

When you have Multiple sclerosis, only a slight temperature rise can worsen your symptoms. As you know, multiple sclerosis can damage your protective sheath around nerve cells and slows down the signal. The heat can slow these signals even more.

People with MS should avoid

  • Taking hot baths
  • Going out in hot weather
  • Taking heavy meals

People who have multiple sclerosis should wear cooling collars when exercising. They should wear clothes made of cotton and linen that allow air to move freely, which helps to stay cool. Drink plenty of water.

Psychosocial therapy

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People suffering from long-term illnesses are often stressed out. Mental health is vital no matter what you are going through. Multiple sclerosis is also included in diseases that cannot be cured completely. The patients are often depressed because they are unable to perform the daily tasks. Stress can trigger and can cause relapse.

The patient should learn techniques to reduce stress. They should understand that everything is not under your control.

Many techniques can help you calm things down. Close your eyes and try breathing exercises, take few deep breaths, and loosen your tense body. Let go of your tensions, rotate your head in a smooth circular motion, roll your shoulder, and relax completely.

It will help if you stay connected to your friends and family. Socializing can decrease many of your tensions and worries. Friends and family can support you in your hard time. As much you stay active and happy, your chances of relapse decrease.

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Multiple Sclerosis – What to Eat & What to Avoid

Multiple Sclerosis – What to Eat & What to Avoid

We all know that managing multiple sclerosis is not an easy task. Everything from medications, performing exercises, and maintaining positive mental health becomes essential. However, while balancing physical activities, we often overlook the most important thing—our diet. 

Diet has a vital role in treating multiple sclerosis, which is why you must know what you should eat and what needs to be avoided. To understand the importance of diet in multiple sclerosis, you should first understand what happens in your body if you have multiple sclerosis.

What happens in Multiple Sclerosis?

Our body’s immune system is designed to fight the harmful organisms that attack our bodies, such as viruses, bacteria, etc. However, in Multiple Sclerosis, the body’s immune system mistakenly attacks its own body, especially the widely distributed nerves in your body.

This attack by your body’s immune system damages the covering of the nerves, i.e., Myelin, and the function of these nerves is disrupted.

These nerves are responsible for many functions such as movement, vision, balance, etc., and when the nerve gets damaged, its function is affected. As the name (Multiple Sclerosis) indicates, this damage occurs at multiple sites in your body; hence different symptoms are seen, such as muscle weakness, loss of balance, visual problems, etc.

The connection between Diet and Multiple Sclerosis

As mentioned above, multiple sclerosis occurs when your body’s immune system mistakenly attacks the outer covering of your nerves, i.eMyelin, a diet that affects your immune system, also affects the progression of this disease.

  • Some diets support and protect your nerves (or nervous system), and they can help minimize the relapsing episodes.
  • Some vitamin deficiencies can weaken your nervous system, and they can indirectly worsen your symptoms.
  • A healthy diet improves the overall well-being, and hence the ability to fight several diseases together with multiple sclerosis is increased.
  • Some bacteria are naturally present in your gut, and they play a beneficial role in your body in several ways. Both healthy and unhealthy diets have effects on these bacteria.

As diet is closely linked with multiple sclerosis episodes and symptoms, one must be very careful in choosing his/her diet if one has multiple sclerosis.

Foods you should eat.

Now, when you understand the importance of diet in multiple sclerosis, let’s have a look at the foods you should eat.

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Probiotics and Prebiotics

As mentioned earlier, there are some beneficial bacteria present in your gut. These bacteria are responsible for breaking up food and nutrients, and they also help in the digestion process.

Probiotics are foods that contain these beneficial bacteria. Eating these foods increases the number of these beneficial bacteria in your body. These foods include

  • Yogurt
  • Kefir
  • Sauerkraut
  • Fermented tea

A diet that promotes the growth of such beneficial bacteria in your gut is known as the probiotic diet. This type of diet mainly contains fiber. These foods include:

  • Garlic
  • Leeks
  • Onions
  • Asparagus
  • Artichokes

Fiber

The fiber in your diet helps nourish your gut bacteria, manages your blood cholesterol levels, and reduces the risks of obesity. Recommended foods for fiber are as follows.

  • Vegetables
  • Legumes (e.g. Lentils)
  • Nuts
  • Seeds
  • Brown Rice
  • Whole grains

Vitamin D

Vitamin D is essential for improving bone health in multiple sclerosis patients. Vitamin D can be achieved by appropriate exposure to sunlight, but certain foods can also help gain it.

  • Fortified Dairy Products
  • Yogurt
  • Orange Juice
  • Egg Yolks

Vitamin B

Vitamin B or biotin has a vital role in minimizing the episodes of relapsing multiple sclerosis, and one can gain it by following foods.

  • Eggs
  • Yeast
  • Sunflower seeds
  • Almonds
  • Spinach
  • Whole-wheat bread

Others

Other important components of a beneficial diet for multiple sclerosis patients include fruits, vegetables, herbs, polyunsaturated fatty acids, antioxidants, etc.

Foods you should avoid

Just like some foods protect and support your nervous system, some foods have a terrible effect on your already compromised nervous system in multiple sclerosis patients.

Besides this, some foods are not suitable for your muscles and bone health, and as they are already weakened in multiple sclerosis, you should avoid these foods.

Let’s have a look at the foods you need to avoid if you have multiple sclerosis.

Saturated Fats

Unlike polyunsaturated fatty acids (PUFA’s), foods containing saturated fats are not suitable for health, especially for those already fighting neurological diseases such as multiple sclerosis. Foods with a high amount of saturated fats are as follows.

  • Butter
  • Cheese
  • Palm and coconut oil
  • Red meat, etc.

Sodium

A high amount of sodium in the body can result in elevated blood pressure (hypertension), and hypertension can increase heart disease and stroke risks.

A study done in 2015 showed that people with multiple sclerosis who have high sodium levels in their bodies are more prone to experience relapsing symptoms of this disease. [1]

Foods containing high levels of sodium are as follows.

  • Salted or canned meat
  • Fish
  • Chicken
  • Sausages
  • Canned entrees
  • Beets

Sugary Foods

Just like a high amount of salt is not suitable for your body, foods containing a high amount of sugar also negatively affect your well-being.

A high amount of sugar or glucose in your body can affect the nerves in your body (neuropathy) and decrease their function. As nerves are already damaged in multiple sclerosis, a high amount of sugar in the body can be damaging to your health.

Foods containing a high amount of sugar are as follows.

  • Ketchup
  • Yogurt
  • Chocolate
  • Cola
  • Fruit Juice
  • BBQ sauce

Fried Foods

Foods fried in a high amount of oil can also be damaging to the health of multiple sclerosis patients. In addition, when a person has a neurological disease and their body is busy fighting that condition, chances of getting affected by other diseases are also increased.

Oily and fried foods increase the amount of bad cholesterol in the body. This increased cholesterol can result in several heart diseases. It can also result in stroke if the blood supply of your brain is interrupted or blocked.

Most commonly used fried foods include fish, fries, chicken strips, and cheese sticks, but a person can deep fry any food.

Final Words

If you have multiple sclerosis, you should eat foods beneficial for your nervous and musculoskeletal (muscles and bones) system and avoid foods that can increase the risks of other diseases.

REFERENCES

1. Riccio, P. and R. Rossano, Nutrition facts in multiple sclerosis. ASN neuro, 2015. 7(1): p. 1759091414568185.

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Dr. Stephen Kanter’s experience with NewGait

Dr. Stephen Kanter’s experience with NewGait

Dr. Stephen Kanter , Chronic Pain Talk

Dr. Stephen Kanter has a vast resumé and is an avid NewGait Fitter at the International Multiple Sclerosis Management Practice where he is the Director of Rehab Services. In the interview, Dr. Kanter reflects on his "Dream" for the NewGait.

Chronic Pain Talk - Video Interview

Watch the video version here. Dr. Kanter discusses his “Dream” for the NewGait. Moderated by Benga Adeeko and Cathy Ruprecht.

BENGA: Thank you everyone for joining. Today We have Cathy Ruprecht, one of our NewGait clinicians, as well as Dr. Stephen Kanter. Dr. Stephen Kanter is a licensed physical therapist and athletic trainer in New York and New Jersey. Dr. Kanter works primarily with patients with balance, gait, and endurance impairments. He earned his Master's of Science and doctorate in physical therapy at Rutgers University. He is the Director of Rehabilitation Services at the International Multiple Sclerosis Management Practice in New York City. He is a nationally recognized expert in rehabilitation for people with MS and has worked to develop the AthCare MS Rehabilitation Professionals Network to promote education and clinical collaboration to improve the care provided to people with MS and their families. In 2015, Dr. Kanter was inducted into the National MS Society Healthcare Professionals Volunteer Hall of Fame. Dr. Kanter is a professor at Seton Hall University where he teaches Biomedical Ethics, Human Anatomy and Sports Pharmacology. Thank you Dr. Kanter, That's quite a resume you've got, thank you for joining us.

DR. KANTER: The short answer is that my father had multiple sclerosis. Neuro rehabilitation was not something that I thought I had enough skills to do. When I came out of physical therapy school, I had a stronger sense and background in sports health care, and became a certified athletic trainer working in professional sports. I really worked that route. After working in professional sports, and thinking about where I wanted my career to go, I had a couple of opportunities in home care in New York City. In that home care experience, I started to work with many people with neuro based disorders, including multiple sclerosis. During that time, developed the skill set that I did not feel like I originally had. In 2008, I interviewed for the job at the International Multiple Sclerosis Management Practice to take over the leadership of the department and develop it to what it is now. Cathy, your patient population was primarily neuro? Geriatric? Both?

CATHY: Primarily folks with chronic pain. A lot of them have gait abnormalities, but we work on some confidence engagement, and we work on changing up some parameters of gait and the most amazing thing is that they’ll tell me, “My pain is gone.”

DR. KANTER: Why do you think that is?

CATHY: Well, if you know anybody that wants to do research, I would like to know why that is. I have some ideas, based on my pain-neuroscience background, in that there’s something about the device that creates a postural realignment, it depresses the scapula. I think it helps to change the breathing from that secondary musculature. I think it helps to create some step with confidence. A lot of people walk with a very narrow gait pattern and they seem unbalanced, with a very lateral trunk sway. A lot of times my people with chronic and persistent pain have had some sort of unresolved orthopedic or neurological issue. So someone that has no plantar flexion, you know, never has any sort of toe off. You’ve got to bring that leg through somehow and swing but there’s something about getting that assistance and suddenly, the nervous system says, “Well, hey, thanks for figuring that out.” Now, I don’t have to use, my quadratus, or my back extensors, or whatever compensatory movement pattern I was trying to do to achieve that movement. They find pain relief with that. It’s just been amazing.

DR. KANTER: That this is a key tool that you’re using is very insightful. We’ll definitely take that into consideration in our program. We are about to open up a big Wellness Center which will incorporate, not just the NewGait, but a lot of state of the art products that can help people with MS walk better and improve their balance. I’ve been on the road to improving the lives of people with multiple sclerosis, and bounce dysfunction ever since.

DR. KANTER: When I started working with people with multiple sclerosis, I started to identify a series of common mobility limitations. Foot drop is a very common one that most physical therapist’s and movement professionals are aware of. Neuro physical therapist’s have a little bit more insight to work with orthotist to manage foot drop, but using an AFO, I quickly found was not very useful. In thinking out of the box, we start to work with different products on the market. During that time, foot drop wasn’t always the primary issue that patients needed to manage because it could be managed through an orthotic or a brace, but the hip drop or the hip weakness really became an element of impairment that we couldn’t really solve. Strengthening it couldn’t help it, and the hip flexion assist orthosis was a product that was developed, as well as a couple other products that became potentially useful for hip flexion weakness and hip drop. None of them really worked as well as I would have wanted it to, or there was a price limitation so patients weren’t willing to try it outside of my clinic. My goal is always to provide something to a patient in the clinic that they can take home and use in their home program and in their day to day life if possible. A patient introduced me to the NewGait. When I saw the NewGait, it clicked right away that it would make sense for people for walking. Also the other major impairment, which is actually stairs or curbs, and ever since then, I’ve been using it with patients on a regular basis.

“When I saw the NewGait, it clicked right away that it would make sense for people for walking… Ever since then, I’ve been using it with patients on a regular basis.”

DR. KANTER: Once they get into NewGait and realize that their hip is engaging better through the energy that’s created by the device and realize that they’re able to move better. And then the conversation gets into where we go from there in regard to balance and gait training, and create some prognosis, which is within reason.

Dr. KANTER: We have a couple of patients who are on the road to getting it. I would be surprised if they didn’t. Previously, I think I’ve had three people who either purchased it or expressed interest in purchasing it. Of those three patients, I know at least two of them have used it beyond just myself. Either in other facilities somewhere, or they have it on their own.

DR. KANTER: I’ve probably tried it on approximately 30 patients in the past year. The big holdup is obviously the past several months of having fewer patients because the clinical services sort of went down. When we started speaking, I went back and looked, and seemed to be about 30 patients myself, my colleague, tried in on five to eight patients. And then our occupational therapist has started to look into how she would integrate it into certain balance and standing activities for her ADL training.

DR. KANTER: I could definitely feel the forces that are being created, which is what my mind focuses on. How to create potential energy from end stance, to toe-off, to initial swing, even if there’s a compensation. I’m not worried as much about the compensation if they can clear the foot, but to see that this can be more efficient, and obviously create a change in how the patient feels with that swing phase, which is really a limiting factor with gait, as you know.

DR. KANTER: The most rewarding were a couple of patients that I trialed it with. They took a step up on a curb in a simulation, that they hadn’t been able to do in a very long time. It was much easier and they got a sense that they can do it without overly compensating, without overly circumducting, and without using their hands. The next step with it, at the MS clinic, is to work on a whole staircase with patients and to be a little more aggressive in their stair training. For patients who need to negotiate that in their house or work, this is the modality of choice for me. When you consider neuroplastic changes, there is a bunch of evidence out there, where, if you’re going to have a muscle do something, it needs to do it in the specific way you want it to. Unfortunately, too many patients are doing sitting exercises, or laying on their back. They say, “I work on this muscle all the time, and I feel stronger, but why cant I do it standing.” When they work with the NewGait, they’re getting the benefit of more reps, rather than harder reps. Patients with MS, many times, are willing to work hard, but they obviously want to see results. You don’t need to fatigue out by over-exerting, when it’s unnecessary. With the NewGait, providing what is equivalent to an active assist at times, will, to me, create more contraction of the hip flexors, and obviously other muscles as well. But the hip flexors I focus on because it really is one of those areas of rehab in MS that we’ve had a lot of difficulty with.

“They took a step up on a curb in a simulation, that they hadn’t been able to do in a very long time. It was much easier and they got a sense that they can do it without overly compensating, without overly circumducting, and without using their hands.”

DR. KANTER: If they see me, they can use it each week or every other week. We’ve had a couple of patients who have done that. The majority right now, come and use it for their first trial, maybe come for a second trial, with the intention that they’ll get it on their own and integrate it into their home program. Or they will find a local PT who either will get it, or has it, or something similar. My dream is that many PT’s out there, would have the NewGait, so that we can do the trial and then say, “Go to a therapist who can utilize the NewGait to perform their exercises with.” Ultimately, I do believe getting it for a home based program is really what would make the biggest difference. It’s not an expensive product in the big picture of rehabilitation modalities. Like I have said, there are other hip flexion products out there, some are reasonably priced, and some are not. The NewGait has variability that the others actually don’t. Technological based FPS products for people with MS to help them walk are thousands of dollars. A neural based approach would be to incorporate this device and supplement it with a musculoskeletal and strengthening program. But if they only do the strengthening program, and don’t do the neural based program, then they miss out. I hope if anything that patients therapists gain from this conversation, is to get a neuro based closed-chain, standing program, and if they have hip flexion weakness, then incorporate this device. My role at the IMSMP is to try to gain a network of therapists who are willing to accept referrals for patients with MS. After I see them and develop a plan of care, I’m looking to pass them on because I can’t see them locally. The network was created for people who are in wellness and rehab, medicine, nursing, or social work, who want to get referrals from myself and our practice, to work collaboratively. I’m still looking for any physical therapists, occupational therapists, and wellness professionals who are looking for people to get referrals from people with MS. Let me know and we’ll speak and hopefully get you on the network list. They can contact me directly, email is probably easiest at skanter2@imsmp.org. If you go to the International Multiple Sclerosis Management Practice site, you’ll be able to call the number there. We’ve had good stuff so I’m looking forward to getting the word out there.

“My dream is that many PT’s out there, would have the NewGait… Ultimately, I believe getting it for a home based program is really what would make the biggest difference. It’s not an expensive product in the big picture of rehabilitation modalities.”

Dr. Stephen Kanter has a vast resumé and is an avid NewGait Fitter at the International Multiple Sclerosis Management Practice where he is the Director of Rehab Services. In the interview, Dr. Kanter reflects on his “Dream” for the NewGait.