>> Hi, we are part of the Multiple Sclerosis
Rehabilitation Treatment team at the Johns Hopkins
University School of Medicine.
I'm Dr. Abbey Hughes.
I'm an Assistant Professor in the Department
of Physical Medicine and Rehabiliation.
The division for rehabilitation, psychology
and neuropsychology and I'm a Rehabilitation Psychologist.
>> And I'm Dr. Alex Sandoval, Clinical Associate
and MS Rehab Specialist here at Johns Hopkins.
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The Johns Hopkins Multiple Sclerosis Center
is a leading center in the nation
for MS treatments, research and education.
Here we practice a multidisciplinary team based approach
to the overall management of MS.
We have close collaboration among various subspecialties
including neurology, physical medicine, psychology
and rehabilitation therapies.
We know that MS effects each person differently,
therefore we personalize our treatment approach
to each patient depending on his or her specific needs.
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>> The concept of rehabilitation is really important
for patients with MS because in addition to their disease
modifying therapies which is typically managed by
a neurology, rehabilitation focuses on symptom management
and reducing the negative impact
of symptoms on quality of life.
So, with physical medicine, physicians, psychologists and
the rehab therapists, we're able to help patients manage
those symptoms and improve their qualify of life.
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>> The physical medicine and rehab approach to the management
of MS is a multidisciplinary team based approach.
Our team consists of rehab physicians, psychologists
and rehabilitation therapists which includes
physical, occupational and speech therapists.
Now the rehab physician is the one over all in charge
who directs and coordinates the team and he or she can
also provide symptom management by addressing problems
of pain, spasticity, fatigue as well as addressing issues
with problems bowel and bladder.
The physical therapist will provide exercises to help
improve strength, coordination, balance and conditioning.
And they will also train the patient on the use of gate
devices such as canes, crutches, walkers and also braces.
The occupational therapist would provide exercises to help
improve upper extremity function, especially hand function.
They also help retrain the patient on the performance
of his or her activities of daily living.
They will also instruct the patient on the use of
adaptive equipment and devices.
The speech therapist are involved in the treatment of
impairments related to speaking,
swallowing and also cognition.
And we also have the rehab psychologist.
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>> During their first appointment, individuals with MS
can typically expect to meet with their provider, whether
that's the physical medicine physician or the psychologist
or the physical therapist et cetera.
It's usually a clinical interview to start
and we like to get a comprehensive history of background
including things like past medical history, education,
where you worked, other activities
that may be relevant to your rehabilitation.
How you're doing currently.
That includes things like your sleep,
your appetite, your pain.
We really want to get a comprehensive picture
of how things are going currently.
And then there's also usually some assessment that occurs.
Within rehabilitation psychology, we may do some brief
cognitive assessment or some brief screeners, such as
some surveys to fill out, questionnaires about mood,
appetite, pain, those sorts of things.
Sleep is another issue that we typically ask about.
And then, we may recommend patients to continue
with more formal cognitive testing if necessary.
They can sometimes complete that directly after
their appointment with us or they can come back
at another date, particularly if they are feeling fatigued
and we understand that fatigue is one of the most common
symptoms among people with MS so we want
to be sure that we're addressing that.
That's the typical layout for most appointments
when patients come is there's that initial assessment piece
and then there's also treatment.
With rehabilitation psychology, after that first treatment,
we also offer interventions so patients can follow up
with a rehabilitation psychologist to do things like
cognitive behavioral therapy, acceptance
and commitment therapy to address those symptoms,
to treat depression, to treat mood,
to treat pain, to treat sleep disturbance.
All of those things are included
in the intervention which may be
several appointments after that initial session.
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Johns Hopkins has a novel and ground breaking approach
to treating MS through the Precision Medicine Center
for treatment of Multiple Sclerosis.
It's a center for excellence where we tailor treatments
to meet the individual needs of patients.
So precision medicine means personalized care or
individualized care to the patient.
From a neurology perspective and within the neurology
department, that typically means following MRI, DNA and OCT
imaging data over time in addition to lab test
as well so getting some of these physical
markers of disease progression.
And then with rehabilitation, we also follow patients
to determine what kind of symptoms they're experiencing
individually and how we can tailor our interventions
to meet their needs.
So that includes what Dr. Sandoval's already discussed
in terms of the physical rehabilitation needs as well as
rehabilitation psychology interventions.
One of our main goals is again to reduce
the negative impact of disability on
quality of life and to help restore function.
And so that's where are two departments
are very collaborative in that way.
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