To whom it may concern:

The World Health Organization defines impairment as any loss or abnormality of physiological, physical, anatomical structure or function. They go on to comment that when an impairment inhibits one from maintaining personal independence in self care and other activities, the result is a disability.

In (your name) case her Multiple Sclerosis (MS) induced spasticity and weakness fit these parameters. In the case of any physical impairment, rehabilitation may be expedited with a comprehensive and customized therapeutic program. In the case of physical impairments that are secondary to a neurological disease the rehabilitation program becomes a vehicle through which physical function may be maintained or quite possibly improved. In the past, rehabilitation often required one on one nursing or personal assistance. Now with the advent of new technology, computerized medical equipment can allow physically impaired persons to take on more responsibility and care for themselves.

Multiple Sclerosis is a disease that involves the demyelination of the central nervous system. Symptoms may include but are not limited to sensory deficits, fatigue, spasticity, paresis, ataxia, pain and visual impairments. Individuals with Multiple Sclerosis may experience a myriad of these symptoms and may also have neurogenic bowel and bladder problems. The result may be a picture of limitations that range from cessation of strenuous recreational or vocational activities to the need for maximal assistance to complete simple daily tasks such as brushing ones teeth (due to the loss of mobility). People with MS whom are ambulatory often require that use of assistive devices such as braces, crutches or walkers. Often as the disease progresses, the level of assistance necessary for general mobility such as moving in bed, transfers and ambulation increases correspondingly.

When I first treated (your name) at the (name of the clinic), she was independent in all transfers and self care. She used a walker for ambulation due to leg spasticity. At that time, our relationship goals were set to help her decrease or maintain her level of spasticity while gently strengthening the muscles that remained under her volitional control. This program consisted of stretching to improve range of motion, icing and other tone inhibiting techniques as well as a customized strengthening program. Over the course of time the disease progressed and her functional capacity decreased. The use of braces and her walker were not enough to support her anymore and she was at an increased risk for falls. Eventually, the use of her wheelchair became a necessity to cover all distances, as she was unable to ambulate. Transfers became more energy consuming, even with the use of a sliding board. Moving in bed became exhausting, as she had to use her upper body and arms solely to move her often spastic “dead weight” lower body. She needed more and more assistance to complete her Home Exercise Program and her spasms and paresis became increasingly cumbersome.

Today, (your name) is dependent upon someone else to change her position in bed, sit up or lie down, transfer from one surface to another. Her upper extremities have since become involved and present with ataxia, sensory deficits and paresis. She is unable to propel a manual wheelchair. Our rehabilitation goals are focused on maintaining her flexibility, controlling her muscle spasticity through stretching, reflex inhibiting positions such as standing, and select strengthening in an effort to maintain control over certain muscle groups that she can still move volitionally.

Immobilization due to inability to move can have devastating effects on the body, as well as the spirit. For instance, the digestive system generally becomes less efficient which can lead to constipation or worse such as impacted bowels or inflammatory bowel syndrome (which can require hospitalization). The function of the respiratory system may become impaired simply due to the fact that a person does not fully contract the diaphragm or intercostal muscles while immobilized. Cough power may be diminished as well as the respiratory capacity in general. This sets up the system for potential infection or pneumonia. Along this vein, the level of cardiovascular requirements as well as circulatory function also drops or stagnates. In general the result will often be seen as cold extremities, increased swelling with poor resolve and overall fatigue. The musculoskeletal system is subject to joint and muscle contractures, which can lead to postural mal alignment and resultant pain or difficulty with basic assisted activities of daily living. Muscular atrophy and osteoporosis are also potential risks of immobility.

Researchers have shown that activities such as passive standing may prevent or even improve the effects of prolonged immobilization. Standing facilitates erect posturing for more efficient pulmonary, toileting and functioning. This may assist in the prevention of potential pulmonary illness such as pneumonia. Cardiovascularly, while standing there is greater potential for improved circulation as many of the joint angles have opened up allowing ease of flow.

Digestively, the upright position allows gravity to assist in the downward flow necessary to evacuate the colon and the bladder. In so far as the musculoskeletal system, it has long been held that weight bearing is an effective method of managing lower extremity spasticity through prolonged stretching. With regard to maintaining bone mass, researchers have found that the longitudinal forces through the long bone produced by standing actually prevent osteoporosis.

Not all of (your name) body is immobile, however, most of it is. (Your name) had volitional control but with mild ataxia of her two upper extremities and her head and neck. She has little to no control below the level of her shoulder blades. She is subject to muscle spasms in her trunk and legs particularly while attempting such activities as rolling over in bed. It is my feeling that in addition to her previously prescribed Home Exercise Program that (your name) would highly benefit from the activity of standing as provided by the LifeStand Compact power wheelchair/stander. On the next page, please find a list of components of the LifeStand, and their medical justification.

Sincerely,

Your PT