MANAGEMENT OF IMPAIRMENT, DISABILITY, AND HANDICAP DUE TO MULTIPLE-SCLEROSIS

In this article, we update management measures for patients with multi ple sclerosis (MS) that can improve or prevent impairment, disability, and handicap and include those factors that a primary-care physician can implement or facilitate, The medical literature since 1989 was rev iewed. Although new drug trials hold promise to decrease impairment fr om MS, well-coordinated interdisciplinary care to minimize disability and handicap most profoundly affect the quality of life for patients w ith MS. MS is usually not severely disabling, and appropriately timed intervention can prevent secondary impairment and reduce disability an d handicap, Pharmacologic, physical, and psychosocial issues-ranging f rom spasticity, pain, weakness, and tremor to neurogenic bowel managem ent and sexuality-are addressed, General wellness measures remain impo rtant, The influence of the Americans With Disabilities Act is discuss ed, and specific adaptive equipment and social resources are outlined, The ultimate goals of management of patients with MS are functional i ndependence and efficient use of medical and community resources: a fo cus on ''ability'' rather than ''disability.'' Although impairment can limit function, wellness and adjustment have no boundaries.