New bilingual graphic aims to raise awareness of early MS symptoms

A bilingual graphic educational message, dubbed VISIBL-MS, has been developed by researchers at the University of Connecticut (UConn) to raise awareness about the early symptoms of multiple sclerosis (MS).

The graphic — bearing the word “VISIBLY” in English and “VISIBLE” in Spanish — uses the letters in each phrase to link to illustrations about early MS symptoms. “VISI” is shown with a picture highlighting vision disturbances common in early MS, while the “B” is tied to belly or back numbness and balance problems, and the “L” portrays limb numbness and weakness.

The “Y” on the English version and the “E” in Spanish both link to images illustrating the young age at which MS onset can occur.

“Awareness about a disease in [an] at risk-population [improves] outcomes,” states a university press release announcing the creation of the two graphics.

Details of the VISIBL-MS graphics’ development were outlined in a new study, “VISIBL-MS: A bilingual educational framework to increase awareness of early multiple sclerosis,” published in the Multiple Sclerosis Journal.

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Jaime Imitola, MD, chief of UConn Health’s division of MS and translational neuroimmunology, said university researchers embarked on the graphics as a collaborative project, with an aim of raising awareness of the early signs of the degenerative disease.

“In the last two years, with input of medical students, scientists and patients, we created a bilingual tool that collects, in a very clear, succinct manner, both compelling graphic and in words, the most relevant and alarming symptoms in early MS,” Imitola said.

“We put it together in a framework that helps anyone to be educated about the initial red flags for multiple sclerosis,” Imitola added.

MS is characterized by an autoimmune attack on parts of the brain and spinal cord. This attack leads to inflammation and nerve cell damage, triggering a wide range of neurological symptoms.

While the development of highly effective disease-modifying therapies for MS has resulted in improved outcomes, there remains a lack of awareness of early MS symptoms — especially among medical students and general practitioners, as well as the general public — which contributes to delays in diagnosis and treatment.

This is a particular concern in diverse communities, including Hispanic and African American populations, who generally have worse disease outcomes but face multiple barriers to MS care.

Hoping to improve awareness, Imitola and his team reviewed the literature to determine if there were any educational tools or mnemonics that could help in identifying early MS symptoms among patients and medical students. Mnemonics is any learning technique that helps retain or retrieve information using easy-to-remember words or pictures. The BE FAST mnemonic, for example, has proven very useful in the diagnosis of stroke.

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VISIBLE in Spanish and VISIBLY in English both link to MS signs

From a total of 369 publications that addressed education in MS, the team found 21 that mentioned education tools — but just one was for MS signs.

“We found no specific publications of education tools or mnemonics of early awareness of MS,” the researchers wrote.

Thus, they created their own mnemonics that simplify MS-specific messaging for both English- and Spanish-speaking populations with variations of the same word: VISIBLY in English and VISIBLE in Spanish.

“We hope to integrate our new tool into medical students’ education, but also [hope] that it can be helpful for patients and families, since the design is simple but very informative and the mnemonic can be used in English or Spanish,” Imitola said.

Because visual impairment is an important early sign of MS, the team started the mnemonic with “VISI.” Optic neuritis, or inflammation of the nerves that transmit signals between the eyes and the brain, is a common early sign of MS — one that more than half of patients will experience at some point in their disease course.

Optic neuritis can cause acute painful vision loss in one eye. But it also can be painless and/or affect both eyes. Impairment in color vision, weakness of the eye muscles, known as ophthalmoplegia, and double vision, or diplopia, also are associated with optic neuritis in MS.

The following letter, “B” in the mnemonic, refers to numbness in the belly and back, caused by inflammation of the spinal cord, and balance problems due to damage in the brainstem, which can be an early sign of MS. Another early sign is gait impairment after exercise, which becomes more severe as the disease progresses.

Limb numbness and weakness, or “L,” are hallmark features of MS and are common at the disease’s onset. Such symptoms often can be accompanied by tingling or burning sensations, as well as the feeling of electric shocks traveling down the spine to the limbs, which is called Lhermitte’s sign.

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Graphics were designed to raise awareness of MS in real world

Age at disease onset is a particularly unique characteristic of MS, which typically affects young adults between the ages of 20 and 45. The last mnemonic letter, “Y,” refers to young age in English, while “E” in Spanish is for “edad joven,” also meaning young age.

The graphic displaying the mnemonic also includes a color gradient for each letter: green for English and red for Spanish. These gradients were added to illustrate color desaturation, a symptom associated with optic neuritis.

We posit that VISIBL-MS provides a framework for MS awareness that addresses the interconnection between language, culture, health literacy, and health outcomes and can be a useful educational tool to tackle the effects of health literacy on diverse communities.

The researchers noted that VISIBLY/E is designed to raise awareness of early MS symptoms but should not be used as a diagnostic tool.

Also, it’s important to remember that MS can present itself in several ways, but this mnemonic does not include all potential symptoms. One that didn’t get included in the graphics is facial numbness.

“We posit that VISIBL-MS provides a framework for MS awareness that addresses the interconnection between language, culture, health literacy, and health outcomes and can be a useful educational tool to tackle the effects of health literacy on diverse communities,” the researchers concluded.

Imitola said his team has worked to make UConn’s MS center a nationally recognized one, and has spent the last five years seeking to improve care for MS patients in the state. This latest work builds upon those efforts, he said.

“These tools … encompass the strategic vision and identification of gaps in the real-world for our patients in Connecticut, harmonizing the mission of UConn Health, to bring solutions to the people of Connecticut through care, education and research,” Imitola said.