Review of neurological rehabilitation for Multiple Sclerosis in the British Military

2021 ◽  
pp. bmjmilitary-2021-001852
Author(s):  
Oliver O'Sullivan ◽  
L Allsopp ◽  
J Mitchell ◽  
L Price ◽  
K Tourle ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Armed Forces ◽  
Medical Rehabilitation ◽  
Neurological Rehabilitation ◽  
Patient Support ◽  
Rehabilitation Centre ◽  
Occupational Outcomes ◽  
British Military ◽  
Working Age

Multiple sclerosis (MS) is a progressive neurological disorder, classically presenting in working age adults, including those in the Armed Forces. The Defence Medical Rehabilitation Centre (DMRC) Stanford Hall offers vocationally focused neurorehabilitation services for service personnel (SP) with MS, with the goal to minimise disability, maximise independence and remain able to work.This paper has two aims. First, it briefly provides a clinical update of MS, focusing on pathology, presentation, diagnosis and management. Finally, it will describe the role of DMRC and data from the last decade in the management of MS.Our findings suggest not all SP with MS are being referred to DMRC, and some of those who do have significant delays, potentially impacting on patient support, symptom management and occupational outcomes. It is hoped that this paper will improve awareness and recognition of MS for Armed Forces personnel.

Neurological rehabilitation following heat illness in the UK Armed Forces

2020 ◽  
pp. bmjmilitary-2020-001602
Author(s):  
Daniel Wilkins ◽  
O O'Sullivan ◽  
J Sayer ◽  
L Penny ◽  
D Roiz de Sa ◽  
...  
Keyword(s):  
Armed Forces ◽  
Medical Rehabilitation ◽  
Heat Illness ◽  
Subjective Symptoms ◽  
Neurological Rehabilitation ◽  
Rehabilitation Centre ◽  
Neurological Sequelae ◽  
Service Policy ◽  
The Uk

Heat illness remains a significant threat to health in the UK Armed Forces despite recent improvements in the prevention of cases. A small number of heat illness survivors develop long-term neurological sequelae. Here we briefly review the background literature and present our experience of treating UK Armed Forces patients with neurological consequences of heat illness. In our cohort of patients, we observed significant improvements in subjective symptoms and objective assessments following a period of neurological rehabilitation at the Defence Medical Rehabilitation Centre. We conclude with recommendations for further research and for the incorporation of screening for neurological disability following heat illness into service policy.

scholarly journals Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service

2021 ◽  
pp. e001681
Author(s):  
Oliver O'Sullivan ◽  
R Barker-Davies ◽  
R Chamley ◽  
E Sellon ◽  
D Jenkins ◽  
...  
Keyword(s):  
Occupational Medicine ◽  
Armed Forces ◽  
Acute Illness ◽  
Medical Rehabilitation ◽  
Rehabilitation Centre ◽  
Operational Effectiveness ◽  
Mortality And Morbidity ◽  
Recovery Service ◽  
Significant Mortality

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.

Musculoskeletal injury outcomes: 2-year retrospective service evaluation of a UK defence primary care rehabilitation facility (PCRF)

2020 ◽  
pp. jramc-2019-001229 ◽  
Author(s):  
Peter James Scott
Keyword(s):  
Primary Care ◽  
Performance Indicator ◽  
Armed Forces ◽  
Musculoskeletal Injury ◽  
Medical Rehabilitation ◽  
Patellar Tendinopathy ◽  
Muscle Injuries ◽  
Rehabilitation Centre ◽  
Rehabilitation Facility ◽  
Knee Trauma

IntroductionMusculoskeletal injury represents the leading cause of medical discharge from the UK Armed Forces. This study evaluates effectiveness of care provision within a large primary care rehabilitation facility (PCRF) against directed defence best practice guidelines (BPGs)MethodsAll new patient electronic records from January to July 16 were interrogated to identify demographics, causation, injury pathology, timelines and outcomes.Results393 eligible records (81.9% male) were identified. 17.6% were officers, 32.8% were seniors and 49.6% were juniors. The average age was 35.1 years (mode 30). The average wait to treatment was 8.3 days with 75.6% key performance indicator compliance. 47.3% were repeat injuries. The average care timeline was 117.1 days with 8.7 average treatment sessions needed. 30 remained under care at 2 years. 17.8% accessed hydrotherapy and 44% underwent exercise remedial instructors care. 14.2% of individuals required concurrent DCMH care (15.9% male and 26.8% female). 28.5% required multidisciplinary injury assessment clinic intervention with 74.1% compliance against BPGs. 2.9% used the Defence Medical Rehabilitation Centre. Common pathologies were low back pain (LBP) (n=67), upper limb (UL) soft tissue (n=40) and knee trauma (n=38). LBP had the highest recurrence rates (71.6%). Anterior knee pain took the longest (173.1 days) but had the best outcome on discharge. Ankles and lower limb muscle injuries had the best outcomes. Patella tendinopathy and knee trauma had the poorest outcome on discharge. LBP and patellar tendinopathy had the lowest fully fit rates at 2 years (56.7% and 53.8%, respectively). At 2 years, 58.2% of individuals achieved full fitness (60.7% men and 46.4% women), rising to 64% and 55%, respectively, when including those retained with limitations.ConclusionsThe PCRF was generally compliant with BPGs, achieving good functional outcomes on discharge. Women were disproportionally represented, had higher concurrent DCMH attendance and poorer overall long-term outcomes. Repeat injury rates were significantly high.

The Evolving Role of the Multiple Sclerosis Nurse - Implications of Future Management Directions

2012 ◽  
Vol 7 (1) ◽  
pp. 46 ◽  
Author(s):  
Chrysa Chrysovitsanou ◽  
Del Thomas ◽  
Martin Duddy ◽  
◽  
◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Evidence ◽  
Clinical Trial Data ◽  
Patient Treatment ◽  
Patient Support ◽  
Group Discussions ◽  
Case Examples ◽  
Support Strategies ◽  
Future Management

The role of the multiple sclerosis (MS) nurse is constantly evolving, owing to the introduction of new MS therapies and new patient treatment and support strategies. The second MS nurse symposium, ‘The Evolving Role of the MS Nurse: Implications of Future Management Directions’ took place in Athens between 22–24 September 2011 and was attended by approximately 300 participants from 30 countries. Presentations at the symposium outlined the mechanisms of action and clinical evidence for novel therapies for MS treatment. The importance of making clinical trial data available and understandable to people with MS was addressed, followed by a summary of the latest data on established MS therapies and an update on autoinjectors and their role in improving adherence. Novel patient support strategies were outlined followed by presentations by MS nurses from different countries who discussed their roles and their opportunities to evolve against a background of very different healthcare systems. Group discussions of typical MS case examples emphasised the need for good communications and relationships between patients and MS nurses. The final session focused on communication skills, highlighting ‘tips’ for engaging with people with MS and examining the challenges that different patient expectations and communication media can bring.

scholarly journals Magnetic resonance imaging in the diagnosis of multiple sclerosis cerebral foci

2001 ◽  
Vol XXXIII (3-4) ◽  
pp. 78-83
Author(s):  
M. M. Ibatullin ◽  
T. V. Matveeva ◽  
A. M. Anufriev
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
The United States ◽  
Pathological Feature ◽  
Subsequent Formation ◽  
Working Age ◽  
Autoimmune Processes ◽  
Subcortical Nuclei ◽  
Sclerotic Plaques

The close attention to the problem of multiple sclerosis (MS) is by no means accidental. The widespread prevalence of the disease, the young age of the patients, the low effectiveness of therapy and the high percentage of disability among people of the most working age cause extreme concern [3, 7, 19]. MS is the most common demyelinating disease of the nervous system, which is characterized by a polysymptomatic and recurrent course [1, 4, 5, 59]. According to R. Detd. et al. (1977) and S.M. Poser et al. (1983), MS occurs in 4-10% of cases in different countries, more often in the south of Russia, Israel, the United States, Europe and Latin America. The pathogenesis of the disease is not fully understood, in particular, the role of genetic factors and autoimmune processes in the mechanisms of MS development has not been fully determined [2, 55, 70]. The basis of the disease is the process of demyelination with the formation of disseminated dense sclerotic foci in the white matter of the brain [31, 33]. These foci, resembling gliosis scars, are the result of a local inflammatory process, accompanied by the destruction of the myelin sheaths and axons of nerve cells [28]. The pathological feature of MS is considered to be a violation of the blood-brain barrier. In the acute phase of the disease, the disintegration of oligodendrocytes, which make up the myelin sheath of axons, and the migration of activated immune cells to the focus of antigenic conflict (into microglia and astrocytes) occur. In this case, there is muff-like adhesion of endothelial cells and leukocytes around venules and along the pathways with the subsequent formation of dense sclerotic plaques [8, 16]. In some cases, remyelination occurs, and then re-disintegration with the formation of plaques. In postmortem examination, MS foci are most often detected near the anterior and posterior parts of the lateral ventricles, in the region of the semi-oval center, subcortical nuclei, trunk, cerebellum, in the spinal cord, and also in the optic nerves.

A sense of betrayal

2017 ◽  
Vol 16 (1) ◽  
pp. 6-8 ◽  
Author(s):  
Mo Stewart
Keyword(s):  
Participant Observation ◽  
Armed Forces ◽  
Content Type ◽  
Disabled Veterans ◽  
British Military ◽  
Working Age ◽  
Preventable Harm ◽  
Profound Disability ◽  
The Impact ◽  
Welfare Reforms

Purpose No civilian has any comprehension of life in British military forces, or the impact of the removal of that life when unexpectedly returned to “Civvy Street” following the onset of a permanent illness or profound disability, with the gradual realisation that support in the civilian world means that a disabled veteran is just one of a crowd. The paper aims to discuss this issue. Design/methodology/approach Participant observation. Findings Welfare reforms together with austerity measures introduced by the British government are causing preventable harm to the most vulnerable in society. Research limitations/implications This paper was written by invitation and is limited by word length. Practical implications Older working-age disabled veterans are being abandoned by the state and suffer due to a change in government social policy. Social implications Disregarding the suffering and preventable harm created in society by the ongoing welfare reforms will have consequences that will need to be addressed as a matter of urgency, as the often tragic consequences are eventually alerted to the public. Originality/value A demonstration that the older working-age disabled veterans are being harmed by welfare reforms and the armed forces covenant has been breached.

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