Hyatt RegencyI Chicagn
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`Chicagn, Illinnis
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`June 59, 2002
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`Seem-id International
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`Multiple Sclet’nsis l/Veek
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`Multiple Selernsis: A Wnrld View
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`ullipl-e sclemetis is the must cnrnmnn disnrder af-
`fecting timing adults In the prime cut their tlees-
`The new rniliennium brings a fresh peispectil-Ie on MS
`care: a nest.I uisinn cli empnwennent int patients and
`families and punitive appi'naciies th manage the dis-
`ease, its symptnnn. and He psechesncial implicatiens.
`This new Iriew cut M5 care has spanned the nceans and
`has resulted in The tleI-Ielepment et werlclwide net-
`wnrits at health care providers in multiple sclerosis-
`The Cflnflfll‘titlm at Multiple Sclerttsis Centers. RIMS
`{Rehabilitation in Multiple Eclernsis]. LACTRIMS
`{Latin anterican Enntntittee cm Treatment and Re-
`
`search :in Multiple Scleresis]. and lflMSN [internation-
`al flrgaiiisatinn at Multiple Sclefnsis Nursesl has-s- set
`
`glettsl standards in MS care and research and have cel-
`|ahera1ecl In erganire and ce-spnnsnr this meeting.
`
`Multiple Ecleresis: .I'I ‘ti'I-lniitl 1Jiew pliers an interna-
`ttnnal slew L'In cllitJEaI: and Ieseatch issues in multiple
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`scleresis. The eppnrtunity is meet. cnniei and nelwerit
`
`with colleagues irnrn natinns located Ihrnughclut the
`wnrlti malt-t- this annual meeting nne run will: nnt want
`In miss. This is the Scrum! etnnttal lntesnatiniial Multi-
`
`ple Eclernrsis week lthe first taking place in Basel. in
`1999} Featuring an integrated research traclt. nttrnei'nss
`wurltslieps. a slatI
`tntailsr in Spanish ier nut Latin
`American delegates. satellite seinpnsia. and an inter-
`natinnal datahaseiregistries meeting [lCDDllulS].
`
`Centerence i-lighiights:
`Basil: research and clinical trials
`
`Ccdlahnratiee internatidnai approaches in: managing
`multiple sclerosis
`Gender issues in multiple sclerosis
`TEchnelngical ad eances in clinical care and research
`Nets-lurking uppertunities
`Exhibits with the latest in services and pmdurts
`Evening events in Chicago's "Magnificent Mlle'
`
`t...as._1.-....-.I. - ill-itilllntill't-I'I'IIIII'IIII H.1FllllI'Ia'i-
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`l HIHHI
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` '4" I "'1 I
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`II I III "II -\.I IH'I
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`"Li
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`MYLAN INC. EXHIBIT NO. 1028 Page 1
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`MYLAN INC. EXHIBIT NO. 1028 Page 1
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`NONADHERENCE TO IMMUNMODULATION IN MULTIPLE SCLEROSIS
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`Purpose: The primary objective of this study is to outline factors leading to nonadherence or cessation of immunmodulation therapy in a multiple sclerosis clinic pop-
`ulation. The secondary aim is to provide related recommendations to MS patients and nurse educators.
`
`Rationale: Nonadherence has been estimated at greater than 50%. Encouraging adherence to therapy is an integral part of the MS nurse’s role. If only half of all pa-
`tients starting therapy will succeed, we need to learn more about factors relating to unsuccessful therapy attempts.
`
`Methods: A retrospective study of individuals attending a multiple sclerosis out-patient clinic (n = 1,000) will be conducted to identify patients who have received im-
`munmodulating therapy. In addition, patients who have ceased or changed therapy will be identified. Key factors relating to nonadherence will be categorized and
`outlined as they correspond to individual medications. Resulting implications for MS patients and nurse educators will be presented.
`Evelyn Vee McBride, RN, BScN, Kingston General Hospital, Kingston, Ontario, Canada
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`EVALUATION OF A NEW SENSORISED UPPER LIMB TREMOR MEASUREMENT SYSTEM IN MS
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`Developed under the EU programme TREMOR (DE3216) the system consists of linked movement sensors mounted on a lightweight frame. It measures angular di-
`rection, change, velocity and acceleration in 7 degrees of freedom (DOF) at the shoulder, elbow and wrist joints. It is the first system to simultaneously measure
`upper limb kinetic and intention tremor at all three joints and at full range of movement (ROM). Bespoke software allows the collection, storage, retrieval, and
`analysis of recorded signals. A graphic display enables the operator to see whole or part recordings and pinpoint the part of the movement trajectory where tremor
`occurs. Three movement tests were performed encompassing normal functional ROM the “finger to nose test", the “police, stop ” test and the “OK” test. Reliabili-
`ty of the system was tested in 10 control subjects (mean age 45 years). Test-retest values for 10 control subjects showed, modest to good agreement for all move-
`ments and at all linkages. Movements at the wrist showed the poorest agreement. Level of tremor was measured in six MS patients (mean age 47 years, EDSS
`range 6.0 to 7.5). Subjects were clinically assessed using the Fahn tremor rating scale. Mean time taken to accurately perform each test was significantly longer in
`the patient group compared with the control group and longest in those with the greatest tremor (controls 7.6 i 1.95 MS subjects 12.4 i 6.2s). Recorded test time
`and frequency and amplitude of oscillations correlated well with the Fahn score. Whilst elements of the rig and linkage construction need to be improved these
`preliminary studies indicate that the evaluation of tremor at different angular velocities and limb positions is possible with this system. Such information will help
`to develop better therapeutic strategies.
`
`A. Davies Smith, R. Jones, (UK); P. Feys, G. Nuyens, P. Ketelaer (BE); A. Romberg (F); G. Gomes, G. Johnson, J. Cotterill (UK); and S. Scattareggia (IT):
`MS Research Unit, Bristol General Hospital, Bristol UK
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`THE PSYCHOLOGICAL AND EMOTIONAL EFFECT OF A STRESS MANAGEMENT PRO'IDCOL
`ON PERSONS WITH MULTIPLE SCLEROSIS
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`This study examined the effect of a behavioral stress management intervention, including relaxation and visualization components, on the psychological and emo—
`tional aspects of patients’ response to MS. Subjects were randomly divided into treatment and control groups, which upon completion of the study had 227 subjects
`and 150 subjects respectively. The treatment group participated in a one-day workshop where they learned systematic relaxation techniques and a visualization exer-
`cise specific to the effects of MS on the participant’s neural system and functioning. The treatment group was asked to practice these techniques on a regular sched-
`ule. Participation was monitored weekly via telephone contact or e-mail. Anxiety and depression were assessed using the State-Trait Personality Inventory (Speil
`berger, Ritterband, Sydeman, Reheiser & Unger, in Butcher, 1995), Self Efficacy was assessed with the Multiple Sclerosis Self Efficacy (MSSE) scale (Schwartz,
`Coulthard-Morris, Zeng, & Retzlaff, 1996) and the Attributional Style Questionnaire (ASQ-Peterson, et al, 1984). Pretesting of both groups was done immediately pri-
`or to the stress workshop and post-testing was 12 weeks later. Initial data analysis suggests self»efficacy is negatively correlated with depression and anxiety. Males
`tended to present themselves as more hostile than depressed and anxious.
`
`Joan B. Read, PhD, and G. Dean Ericson, PhD, MS Center at Shepherd, Atlanta, GA
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`ACOUSTIC ANALYSIS :
`A PREDICTIVE INSTRUMENT FOR DIAGNOSIS AND CONTROL OF DYSARTHRIA IN MS
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`Acoustic analysis provides an interface between speech production and perception and can be used to detect and document the progressive course of motor speech
`disorders and identify subclinical manifestations.
`
`Material and Method: All analyses are performed on the Computer Speech Lab (Model 43008) of Kay. Acoustic characteristics are identified in wide»
`band spectrograms, with frequency range from 0 to 50.000 Hz and time intervals of 3 sec. The linear predictive coding (LPC) method and the analysis of
`the variations of amplitude and fundamental frequency from cycle to cycle may detect symptoms such as phonatory instability and nazalisation. Addi-
`tional acoustic data are obtained through the Multidimensional Voice Profile and the Motor Speech Program. These programs analyze the intonation
`variations, the diadochokinetic rate, the voice tremor and second formant variations during speech productions. All subjects had to sustain the vowel
`/a/ for at least 5 sec., to repeat the syllabes /pa<ta-ka/ and /i-u/ as quickly as possible, and speak standard productions at “normal” rate without un-
`necessary pauses.
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`Subjects: All subjects performed a perceptual screening of dysarthria (Frenchay — Enderby); 20 normal adult subjects are defined as non dysarthric (10 males, 10 fe-
`males) and 20 individuals with MS (10 males, 10 females) present dysarthria (spastic, spastic ataxic) at different grades (moderate, mild, severe).
`
`Discussion: At this stage of the study, it seems that some acoustic parameters are sensitive to the fluctuations of voice and speech disorders in MS. Degree of voice-
`less, deviation of fundamental frequency, variations of amplitude, tremor, temporal deregulation (dysdiadochokinesy) and imprecise articulation could be considered
`as predictive parameters of specific voice and speech disorders in MS. Results of clinical cases will also be discussed.
`
`Guy Ganty, Speech Therapy Department, National MS Centre, Melsbroek, Belgium
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`MYLAN INC. EXHIBIT NO. 1028 Page 2
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`MYLAN INC. EXHIBIT NO. 1028 Page 2
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