Orthopedic Impairment—Multiple Sclerosis (MS)
Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines orthopedic impairment as follows:
“…a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).”
[34 Code of Federal Regulations §300.8(c)(8)]
Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.
MS is thought to be an autoimmune disease. The body's own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system. The nerve fibers themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur. (National MS Society, 2012)
In the United States today, there are approximately 400,000 people with MS - with 200 more people diagnosed every week. Worldwide, MS is thought to affect more than 2.1 million people. Although MS occurs most commonly in adults, it is also diagnosed in children and adolescents. Estimates suggest 8,000-10,000 children in the United States have MS, and another 10,000-15,000 have experienced at least one symptom suggestive of MS. Diagnosis in children is more challenging than in adults due to the frequency of other childhood disorders with similar symptoms and characteristics. Most symptoms of MS seen in children are similar to those seen in adults. There are, however, symptoms experienced by children that are not typical in adults, such as seizures and mental status changes (lethargy). Increasing evidence suggests a slower disease course in children with MS, but significant disability can accumulate at an earlier age compared to individuals with adult onset MS. (National MS Society, 2012)
While the cause of MS is still not known, scientists believe that a combination of several factors may be involved. Studies are ongoing in the areas of immunology, epidemiology, and genetics in an effort to answer this important question. There are four major theories about the causes of MS focusing around the following areas: immunologic, environmental, infectious, and genetic. (National MS Society, 2012)
Although there is still no cure for MS, effective strategies are available to modify the disease course, treat exacerbations, manage symptoms, improve function and safety, and provide emotional support. (National MS Society, 2012)
Over the course of the disease, some symptoms will come and go, while others may be more lasting. Some of the most common symptoms are:
Some of the less common symptoms include:
Relapsing-Remitting MS: experience clearly defined attacks of worsening neurologic function. These attacks - which are called relapses, flare-ups, or exacerbations - are followed by partial or complete recovery periods, during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
Primary-Progressive MS: characterized by slowly worsening neurologic function from the beginning - with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
Secondary-Progressive MS: following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flair-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.
Progressive-Relapsing MS: in this relatively rare case of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions. (National MS Society, 2012)
Modifying the Disease Course: There are medications approved by the FDA to reduce disease activity and disease progression for many individuals with relapsing forms of MS, including those with secondary progressive disease who continue to have relapses.
Treating Exacerbation: An exacerbation of MS is caused by inflammation in the central nervous system (CNS) that causes damage to the myelin and slows or blocks the transmission of nerve impulses. To be a true exacerbation, the attack must last at least 24 hours and be separated from a previous exacerbation by at least 30 days. However, most exacerbations last from a few days to several weeks or even months. Exacerbations can be mild or severe enough to interfere with a person's ability to function at home and at work. Severe exacerbations are most commonly treated with high-dose corticosteroids to reduce the inflammation.
Managing Symptoms: Symptoms of MS are highly variable from person to person and from time to time in the same individual. While symptoms can range from mild to sever, most can be successfully managed with strategies that include medication, self-care techniques, rehabilitation, and the use of assistive devices.
Promoting Function through Rehabilitation: Rehabilitation programs focus on function and are designed to improve or maintain the ability to perform effectively and safely at home and at work. Rehabilitation may include: physical therapy, occupational therapy, speech therapy, cognitive rehabilitation, and vocational rehabilitation. (National MS Society, 2012)
A physician may diagnose MS in some patients soon after the onset of illness. In others, however, doctors may not be able to readily identify the cause of the symptoms, leading to years of uncertainty and multiple diagnoses punctuated by baffling symptoms that mysteriously wax and wane. The vast majority of patients are mildly affected, but in the worse cases, MS can render a person unable to write, speak, or walk. MS is a disease with a natural tendency to remit spontaneously, for which there is no universally effective treatment. (NINDS, 2012)
Multiple sclerosis can sometimes lead to difficulties with concentration, memory, emotional expression and self-control. It is often hard to tell which emotional or behavioral symptoms are directly caused by MS and which are a response to loss, or to difficulties in coming to terms with the disease and its implications. Symptoms of depression, for instance, can be the result of a variety of physical, psychological and social factors. Treatment must take account of all these aspects, and include psychological assessment, cognitive rehabilitation, counseling and family therapy.
733 Third Avenue, Third Floor
New York, NY 10017
The mission of the National Multiple Sclerosis Society is to end the devastating effects of MS. Founded in 1946, the National Multiple Sclerosis Society supports more MS research, offers more services for people with MS, provides more professional education programs, and furthers more MS advocacy efforts than any other MS organization in the world. We do this through the extensive research we support to find the cause, cure and improved treatments of the disease; the comprehensive services we provide to people with MS and their families; the professional education programs we offer to assist health care providers better serve their MS patients; and through our advocacy efforts on state and federal levels to encourage public policies supportive of the needs of people with multiple sclerosis. This is why we at the National Multiple Sclerosis Society are here.
The mission of the MS Awareness Foundation is to provide information and service to achieve a more rewarding and buoyant life experience for those with Multiple Sclerosis, a long term, nonfatal neurological disease with no known cure. Our goal is to promote self-awareness and educate the public at large about the health and lifestyle challenges facing those affected with the disease.
The primary focus is the directly affected and their immediate circles of family, friends, business and professional contacts. For those who have this disease, we provide factual information on how diagnoses are obtained, emotional reactions, rationalization, acceptance, available treatments and coping techniques in a positive, upbeat manner. For everyone, our factual information is intended to dispel myths, hearsay and ignorance.
706 Haddonfield Road
Cherry Hill, NJ 08002
The Multiple Sclerosis Association of America (MSAA) is a national nonprofit organization dedicated to enriching the quality of life for individuals with multiple sclerosis. MSAA provides ongoing support and direct services to these individuals with MS and the people close to them. MSAA also serves to promote greater understanding of the needs and challenges of those who face physical obstacles.
6520 North Andrews Avenue
Fort Lauderdale, Florida 33309-2130
As a predominantly service-based, non-profit organization, our primary mission is to ensure the best quality of life for those coping with MS by providing comprehensive support and educational programs. We strive to help make A Brighter Tomorrow by supporting research into its cause and cure as well as investigations of various medical and complementary treatment options. The scope of our services goes beyond that of a clearinghouse of pamphlets. Our priority is to serve with empathy, resourcefulness, and responsibility. We are here to listen, assist, and empower.
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