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Background: Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. Methods: An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results: Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Conclusions: Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.

Intention tremor is related to lesions in the cerebellum or connected pathways. Intention tremor amplitude decreased after peripheral arm cooling in patients with multiple sclerosis (MS), likely caused by a reduction of muscle spindle afferent inflow, while amplitude increased when muscle spindles were artificially stimulated by tendon vibration. This study investigated the contribution of peripheral reflexes to the generation of MS intention tremor. Tendon reflexes of biceps, triceps, and brachioradialis, muscles were measured, using an electromechanical triggered reflex hammer. MS patients with (n = 17) and without (n = 17) upper limb intention and 18 healthy controls were tested. Latency of brachioradialis, biceps, and triceps tendon reflexes was greater in MS patients with tremor than in healthy controls and MS patients without tremor (except for the triceps reflex). Peak and peak-to-peak amplitude were not different between groups. It is concluded that tendon reflexes were delayed but not enlarged in MS patients with tremor.

Objective: To investigate the long-term dosage evolution and complication rate of intrathecal baclofen use in multiple sclerosis and spinal cord injury patients, based on a large population with a long follow-up. Design: Retrospective data analysis Setting: Academic hospital Subjects: Patients with multiple sclerosis ( n = 81) or spinal cord injury ( n = 49) having an intrathecal baclofen pump implanted at the University Hospitals Leuven between 1988 and 2009. Intervention: Medical records review of included patients in August 2010. Main measures: Complications linked to intrathecal baclofen therapy. Daily baclofen dosage after 3 and 6 months, and yearly thereafter. Data on dosage evolution were analysed using a mixed-effect linear model. Results: In 130 patients with a mean follow-up of 63 months, comprising 797 pump years, 104 complications were recorded. This corresponds to a complication rate of 0.011 per month, equally divided among both groups. Seventy-eight of these complications were catheter related. The mean dosage of baclofen stabilizes two years after implantation at 323 µg/day in the multiple sclerosis population. In spinal cord injury patients the daily dose only stabilizes after five years at a significantly higher dosage (504 µg/day). No significant increase in dosage is seen in the long term. Conclusions: In multiple sclerosis and spinal cord injury patients, intrathecal baclofen therapy has a complication rate of 1% per month. Complications are mainly due to catheter-related problems (74%). The intrathecal baclofen dosage stabilizes in the long term, indicating that long-term tolerance, defined as progressive diminution of the susceptibility to the effects of a drug, is not present.