Advanced Practice Clinicians: are clinical nurse specialists, nurse practitioners, and registered nurses with additional education (certification or master's degree) and expertise in a specialty area or clinical practice.
Physician assistants are specialists that undergo a specific training program to enable them to work with physicians in an area of clinical practice. Together, APNs and physician assistants can be considered advanced practice clinicians and are an integral part of the Mellen Center’s health care team.
Working independently and in collaboration with a doctor, advanced practice clinicians are able to provide a wide variety of services.
APCs who treat people with ADEM provide many health services including:
- Patient and family education about ADEM and related problems
- Ongoing assessment and management of ADEM symptoms
- Counseling on general health maintenance and wellness
- Information about medicines and monitoring side effects
- Education in the management of bowel, bladder, or other personal care issues
- Guidance in determining when change might be needed in the treatment plan
- Administration and monitoring of medicines according to treatment and research protocol
- Coordination of outpatient care with home care services
- Consultation to health team members as well as outside providers
- Speaking at community programs about ADEM and related topics
Atrophy: a shrinkage or reduction in volume. Often used in describing brain or spinal cord shrinkage with disease.
Axon: a nerve fiber that carries information from the nerve cell to other nerve cells or muscle fibers.
Brainstem: the back part of the brain above the base of the skull. Many nerves to the face come from this area.
Central Nervous System: the brain and spinal cord. The central nervous system is different from the peripheral nervous system, which consists of the nerves and muscles outside of the spinal cord.
Cerebrospinal Fluid (CSF): a clear, colorless fluid that circulates in around the brain and spinal cord. The CSF cushions the brain from hitting the inside of the skull and may be important in removing chemicals from the brain.
Demyelination: a process in which the myelin that covers many nerve fibers is stripped off by disease.
Dysfunction: a medical term that describes abnormal function in a tissue or organ, usually based on disease.
Evoked Potentials: tests that check nerve conduction in the brain, spinal cord, and other nerves. They may show slowing in people with MS.
Exacerbation: an episode usually lasting days to weeks, not caused by fever or illness, where there are new or worsened neurological symptoms in patients with MS. Note that exacerbation=attack=relapse=flare; they are all terms for the same thing.
Gadolinium: a dye made of a heavy metal (gadolinium) sometimes used in MRI. It is injected into a vein and helps better define the tissues of the body on MRI.
Inflammation: a process where white blood cells as well as chemical messengers go to an area of the body to stimulate healing or to attack viruses or foreign material in the body.
Lesion: a localized area of abnormality. In MS, it is usually an area in the brain or spinal cord. This is not a specific term but is just a description of a finding usually seen on MRI or sometimes CT scanning.
Lumbar Puncture (LP): also called a spinal tap. An LP is a test where fluid is taken from the central nervous system, usually by placing a needle in the lower back. It tests for abnormalities in the cerebrospinal fluid.
Magnetic Resonance Imaging (MRI): the key way that doctors are able to look at the brain and spinal cord. This test is done in a very powerful magnet that shows the appearance of the inner tissues of the body.
Myelin: the material that is produced by oligodendrocytes in the central nervous system. Myelin wraps around the axons of many nerves. It helps speed nerve activity and insulates electrical conduction in the nerves.
Neurologist: a neurologist is a medical specialist trained to evaluate problems of the nervous system, including the symptoms of ADEM. Neurologists have an in-depth understanding of the central nervous system and how it is affected by disease. Ideally, it is helpful if the neurologist is affiliated with a research facility, or a teaching hospital, particularly when it comes to rare diseases such as ADEM. The neurologists at the Mellen Center specialize in the diagnosis and treatment of multiple sclerosis and related disorders, including ADEM.
- Diagnose ADEM
- Make recommendations for treatment, testing, and symptom management
- Are available to answer your medical questions, sign forms, fill prescriptions, and provide help with disability-related issues
- May initiate courses of care for ADEM including disease modifying therapies, symptom management, and referral to other members of the team for treatment and counseling
A consulting neurologist makes recommendations to your local doctor or neurologist for treatment, testing, and symptom management.
Neuropsychologist: measuring and evaluating the cognitive and emotional state of people with ADEM is often an important part of ADEM care. At the Mellen Center we use neuropsychologists to do a detailed evaluation of cognitive function when it becomes clear that problems in this area are interfering with the patients life or the relationship with family or employers. Such information helps guide out counseling, therapy, and sometimes our medical treatment. It also helps us guide patients and families better in their care decision making.
Neuroradiologist: at the Mellen Center we have integrated neuroradiology into the care fabric of our center. Our neuroradiologists provide us with state of the art imaging, using the latest in MRI technology to allow us the best evaluation of the brain and spinal cord. Our neuroradiologists are at the forefront of their field in terms of research and imaging technology. They are based in the Mellen Center so that there is a constant interplay between the clinicians and the radiologists at the center. Because MRI imaging is so key to the diagnosis and management of ADEM, we believe that having neuroradiologists on site allow us to do the best work we can to care for our patients.
Occupational Therapists: analyze how ADEM affects the way people perform their daily tasks, help them learn new ways to do familiar activities, and prescribe proper seating as needed. Occupational therapists assist individuals in maximizing their level of functional independence. They offer:
- Individualized treatment through appropriate exercise and adaptive equipment, following an accurate assessment of each patient’s current level of functional performance
- Ongoing evaluation and appropriate treatment strategies to optimize the range of motion and muscle strength of patients’ upper extremities (arms and hands) to help them successfully complete activities of daily living such as dressing, eating, toileting, and bathing
Oligoclonal Bands: abnormal bands of proteins seen in certain spinal fluid tests that indicate activity of the immune system in and around the spinal fluid pathways.
Oligodendrocyte: the cell in the central nervous system that makes myelin.
Physical Therapists: are available to assess muscle strength, flexibility, coordination, balance, endurance, walking ability, and mobility. They specialize in:
- Improving function and providing instruction on managing physical disabilities
- Recommending appropriate exercises to maintain flexibility, while preventing and reducing pain
- Providing instruction regarding the use of assistive devices, braces, or other mobility aids to maximize independence
Primary Progressive MS: a form of MS patients do not have attacks but instead have a slowly worsening disease over time.
Progression of MS: In some patients with MS the course is progressive, so that patients gradually worsen over months or years independent of their exacerbations.
Psychologists: are available to help people with ADEM cope with the cognitive, emotional, and interpersonal aspects of the disease. They offer:
- Psychological evaluation of emotional and interpersonal problems
- Individual psychological counseling sessions to reduce emotional distress and improve stress management skills
- Group psychological counseling to develop strategies for coping with the illness and the resulting life changes
- Neuropsychological testing to determine if ADEM is affecting cognitive functions such as attention or memory
Registered Dietitians: provide nutritional counseling through diet management to promote good nutrition while preventing malnutrition. They are available to:
- Assess each patient’s nutritional needs based upon the progression of the disease
- Recommend changes in each patient’s diet to assist in the treatment of ADEM
- Develop individual care plans for each patient to promote a good nutritional status
- If necessary, provide calorie and protein supplements to increase daily caloric and nutrient consumption
- Adapt the consistency of foods and liquids if swallowing becomes difficult
Rehabilitation Specialists: at the Mellen Center rehabilitation specialists work closely with the neurologists and other team members to provide high quality rehabilitation services to people with ADEM and other disorders as well as to other patients with disorders causing spasticity, balance disorders, and leg weakness. The physiatrists evaluate patients for treatment needs, develop plans of care, and monitor their progress. They are involved in treating patients using Baclofen pumps and Botox injections. They are involved in research using new rehabilitative devices to improve movement. They oversee the provision of physical therapy and occupational therapy at the Mellen Center. At the Mellen Center rehabilitation is fully integrated into the care of the patient.
Relapsing-Remitting MS: refers to a form of the MS where patients experience relapses of symptoms and signs (exacerbations), with complete or partial improvement between attacks (remitting).
Secondary Progressive MS: a form of MS in which patients may continue to have attacks, but also show a gradually progressive worsening of their function over time. The worsening is separate from any attacks.
Social Workers: provide personal support to people with ADEM and their families by offering:
- Short-term counseling and referrals for ongoing counseling
- Information about home care assistance services and assistive devices
- Recommendations of community resources, and local and national agencies that offer both information and support for people with ADEM and their families
- Financial resource information such as Social Security disability, supplemental security income, Medicaid, Waiver 4, and PASSPORT financial assistance programs
- Information about quality of life issues including living wills and durable power of attorney for health care
Speech-Language Pathologists: can help people with ADEM maintain as many verbal communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication. The speech-language pathologists are available to:
- Evaluate and treat speech disorders and communication problems
- Assess swallowing problems to provide assistance with eating and drinking
- Recommend appropriate communication technologies to provide treatment that will aid in the success of daily activities
Spinal Cord: the major part of the nervous system that carries information up and down the spine from the brain to the nerves and from the nerves to the brain. It is affected in many people with MS.
Ventricles: are normal fluid-filled spaces in the brain. They contain the cerebrospinal fluid. Many MS lesions touch the surface of the brain where it contacts the ventricles. (A periventricular location is an 'around the ventricle' location.)
Vocational Rehabilitation Specialists: assessing an individual’s needs is the first step in vocational rehabilitation. Information from the assessment helps the patient and the counselor make the best use of vocational services. During the initial interview, a counselor reviews the person’s educational, work, and medical histories and assesses any factors that might affect his or her ability to work. A vocational evaluation also measures the person’s general abilities, and specific needs and interests. After the consultation, the individual might be referred to other services or community resources.
White Matter Lesions: refers to localized changes in the white matter; in MS, these are plaques or lesions. There are other white matter lesions in patients with other disorders.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/31/2011…#14910