A more livable life now: rehabilitation research looks to high-touch.

Dr. George Kraft, MD, MS, and Alvord Professor of MS Research in the department of Rehabilitation Medicine at the University of Washington in Seattle, is on a mission. The lanky, once-upon-a-time redhead has focused his research career on helping people with MS live a better life now.

Today, treatments and therapies can delay additional damage, but so far they are helpless to fix what has been broken, Dr. Kraft explained. He and his colleagues at the University of Washington MS Rehabilitation Research and Training Center (which goes by the jaw-breaking initials UW MSRRTC) are devoted to changing that picture.

At the 2006 State of the Science Conference in MS Rehabilitation Research in Washington, DC, Dr. Kraft detailed the huge toll of possible MS losses: especially cognitive function, depression, and pain. Medical literature suggests all three are often inadequately treated, he noted. And they often feed each other in a vicious cycle.

"The cumulative effects of these impairments produce serious vocational disability," Dr. Kraft told the conference. "Moreover, because life is not dramatically shortened even as MS progresses, the MS population as a whole could theoretically require almost 9 billion days of personal care."

"Rehabilitation is a proven way to improve function for people with MS," Dr. Kraft frequently repeats. Research will uncover more approaches--and, many hope, provide data showing the dollars-and-cents advantages. Currently on deck at UW MSRRTC are studies on such low-cost interventions as:

* "Motivational interviewing" by telephone. (The interviewing is conducted by nonprofessionals who receive short-term training and modest supervision.) Motivational interviewing has helped people make good choices about using compensatory technology--ranging from canes to computers to vehicle modifications. Now a team of MS rehab specialists--Drs. James Bowen, Kurt Johnson, and Charles Bombardier--are collaborating on a series of studies to see if this low-tech, high-touch therapy will help people stick to exercise programs or increase their job retention.

* Exercise as a way to preserve function and treat depression in MS. Drs. Bombardier and Bowen are studying measures of the protective effects of activity on mood. Their earlier study suggested that aerobic exercise as a treatment for depression in people with MS has a more lasting impact and a lower incidence of side effects than a standard antidepressant medication.

* Cost-effective ways to distribute and teach the use of assistive technology. Dr. Kurt Johnson's project focuses on money and time. "Unaffordable or unused technology does nothing to make life better for people with MS," he pointed out.

* Hypnosis for MS pain. Dr. Mark Jensen's research suggests that hypnotherapy and behavior therapy can be literally life-changing for people with hard-to-treat MS pain.

The UW MSRRTC researchers are also seeking to improve rehab research design by developing "participation" as a standard outcome measure. "The degree of participation in activities indicates how MS can interfere with a person's involvement in what they valued in life," said Dr. Kathy Yorkston, who is taking the lead on this project. Social withdrawal is one of the more devastating effects of MS depression, fatigue, and cognitive problems, she explained. The research challenge lies in developing the verifiable measurements of these symptoms that good science requires.

The 2006 conference ended with calls for more and better trained rehabilitation researchers, more fellowships and mentoring programs, and--importantly--more participation in rehabilitation by people with MS. The Society is now funding a mentor-based rehabilitation research training program. Individuals are urged to consult their health-care professionals and learn more about how rehab might keep them moving ahead with their lives.

For a full report on this conference, with the medical literature references, contact Alyssa DiGiacomo at the MS Rehabilitation Research & Training Center, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195. For more information on the center, visit www.msrrtc.washington.edu.