Academic journal article The Journal of Rehabilitation

Demographic, Functional Factors, and Residential Circumstance as Predictors of the Specialized Housing Needs of Americans with Multiple Sclerosis

Academic journal article The Journal of Rehabilitation

Demographic, Functional Factors, and Residential Circumstance as Predictors of the Specialized Housing Needs of Americans with Multiple Sclerosis

Article excerpt

Multiple sclerosis (MS) is one of the most common neurological diseases in the world. It is a degenerative disease of the central nervous system, primarily affecting the brain and the spinal cord (Fraser et al., 2006). MS destroys the fatty tissue called myelin that surrounds white matter tracts (i.e., axons) in multiple locations in the brain and along the spinal cord. The purpose of myelin is to facilitate the axons' conduction of electrical impulses back and forth from the brain to the rest of the body via the spinal cord (Schapiro, 2003). In areas where the myelin is destroyed or compromised, these electrical impulses, which coordinate all mental and physiological processes, are not conveyed effectively. This slowed or blocked conduction of information can have a disruptive influence on virtually every physical, sensory, mental, and emotional process.

Smith and Schapiro (2004) described the demyelination that occurs in MS as similar to the disruption of an impulse or message that would occur if the rubberized coating surrounding a telephone or electrical wire were torn or cut. Such damage interferes with the transmission of information and/or electricity, which is what happens in individuals with MS. For people with MS, the results are often uncoordinated and/or awkward responses to environmental stimuli (Schapiro, 2003). As patches of myelin deteriorate, they are replaced by scar tissue. The resulting lesions, or plaques, further interrupt the conduction of nerve impulses, sometimes creating a progressive and degenerative course of symptoms.

The constellation of physiological symptoms of MS extends over a wide range, including fatigue, mobility problems, spasticity, numbness and tingling in the extremities, tremor, diminished strength and coordination, chronic pain, hypersensitivity to heat, visual impairments, bowel and bladder dysfunction, and sexual dysfunction. Patterns of symptoms have been attributed to the location and size of lesions in the central nervous system and are specific to the individual (Fraser, Kraft, Ehde, & Johnson, 2006). Even within the individual with MS, physiological and other effects may come and go without warning, appear in various combinations, or intensify in a seemingly random pattern (Kalb, 2012).

As if the physiological accompaniments of MS were not debilitating enough, the illness often has a negative impact on one's cognitive abilities, affective responses, and coping skills. Polman and colleagues estimated that as many as 60-65 percent of people diagnosed with MS experience some degree of cognitive impairment that affects their attention, conceptual reasoning, executive functioning, social judgment, and memory--again depending on the location of lesions in the brain (Polman, Thompson, Murray, Bowling, & Noseworthy, 2006). Polman et al. also noted that "psychiatric morbidity is increased in MS, with over 50 percent of patients being symptomatic at some stage" (p. 85). Foremost among the affective disorders experienced by people with MS is depression. Studies repeatedly show that approximately one-half of all people with MS experience at least one major depressive episode during the course of the illness (McReynolds & Koch, 2001). Bipolar disorder is diagnosed in approximately 15% of people with MS (LaRocca, 2004). Euphoria, a persistent feeling of well-being and optimism in spite of negative circumstances, is often exhibited by people with MS in isolation of other symptoms (McReynolds & Koch, 2001). Anxiety disorders and other mental conditions are also common, although they are often treated effectively with anti-anxiety medication.

The National Multiple Sclerosis Society (2013) estimates that 400,000 Americans are currently living with MS, and the disease is the nation's leading cause of neurological disability in early to middle adulthood, requiring 50% of persons with MS to use assistive walking devices within 15 years of diagnosis and 83% within 30 years (Munschauer & Weinstock-Guttman, 2005). …

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