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  • Robin R Varghese, PT.

Yes, you heard it right. Physical therapy plays a major role in treating Multiple Sclerosis!!!

What is multiple Sclerosis?



  • It is an autoimmune disorder that affects the central nervous system (CNS). When a person has an autoimmune disease, the immune system attacks healthy tissue, just as it might attack a virus or bacteria..

  • In people with MS, the immune system attacks cells in the myelin, the protective sheath that surrounds and protects the nerves in the brain and spinal cord, causing its inflammation.

  • Damage to the myelin sheath interrupts nerve signals from your brain to other parts of your body. The damage can lead to symptoms affecting your brain, spinal cord and eyes.

  • Myelin allows the nerves to conduct electrical signals quickly and efficiently.

  • Multiple sclerosis means “scar tissue in multiple areas.”

  • When the myelin sheath disappears or sustains damage in multiple areas, it leaves a scar, or sclerosis. Doctors also call these areas plaques or lesions. They mainly affect:

  1. the brain stem

  2. the cerebellum

  3. the spinal cord

  4. the optic nerves

  5. white matter in some regions of the brain

  • As more lesions develop, nerve fibers can break or become damaged. As a result, the electrical impulses from the brain do not flow smoothly to the target nerve. This means that the body cannot carry out certain functions.

  • Multiple sclerosis (MS) causes damage to nerve fibers in the central nervous system. Over time, it can lead to vision problems, muscle weakness, loss of balance or numbness. Several drug therapies can limit nerve damage and slow the disease’s progression.


Types of multiple sclerosis:

  • Clinically isolated syndrome (CIS): When someone has a first episode of MS symptoms, healthcare providers often categorize it as CIS. Not everyone who has CIS goes on to develop multiple sclerosis.

  • Relapsing-remitting MS (RRMS): This is the most common form of multiple sclerosis. People with RRMS have flare-ups -- also called relapse or exacerbation -- of new or worsening symptoms. Periods of remission follow (when symptoms stabilize or go away).

  • Primary progressive MS (PPMS): People diagnosed with PPMS have symptoms that slowly and gradually worsen without any periods of relapse or remission.

  • Secondary progressive MS (SPMS): In many cases, people originally diagnosed with RRMS eventually progress to SPMS. With secondary-progressive multiple sclerosis, you continue to accumulate nerve damage. Your symptoms progressively worsen. While you may still experience some relapses or flares (when symptoms increase), you no longer have periods of remission afterward (when symptoms stabilize or go away).


What are the complications of multiple sclerosis?

If MS progresses, worsening symptoms may lead to complications such as:

  • Difficulty walking that may result in needing a cane, walker or wheelchair.

  • Loss of bowel or bladder control.

  • Memory problems.

  • Sexual difficulties.

How can I prevent a multiple sclerosis flare-up?

  • Take medicines on time

  • Rest

  • Eat healthy

  • Quit alcohol and smoking

  • Relax

  • Exercise regularly


Medical management

These are aimed at :

  • Symptom management

  • Disease modifying agents

  • Acute relapse management

What role does Physical Therapy play in MS?

Physical therapy plays a very important role in keeping the patients active and functional in the community.


Aims of Physiotherapy

  • To re-educate and maintain all available voluntary control

  • Re-educate & maintain postural mechanisms

  • Incorporate treatment techniques into ways of life by relating to ADLs

  • Inhibit abnormal tone

  • Stimulate all sensory and perceptual experience.

Treatment:


Exercise is essential.

  • Exercise is beneficial at multiple levels and has an important role in delaying negative symptoms of the disease.

  • Your Physical therapist will choose exercises that are appropriate to client’s strengths and weaknesses and prescribe the right dose( which includes the frequency, intensity and duration) of exercise.

  • Exercise is considered as a safe effective means of rehabilitation. Exercise also has beneficial on mood and quality of life.

  • Use of therapeutic corticosteroids and inactivity due to fatigue and weakness may lead to osteoporosis and pathological fractures. Weight-bearing exercises are hence beneficial.


Strength and aerobic training:

  • The physical activity guidelines for MS people state that those with mild to moderate disability need at least 30 minutes of moderate-intensity aerobic activity (2 times per week) and strength training exercises for major muscle groups (2 times per week).

  • There is sufficient evidence that these exercises may reduce fatigue, improve mobility, and enhance health-related quality of life


Aquatic exercise programs

  • Aquatic exercise programs have a positive effect on persons with progressive multiple sclerosis.

  • It promotes general health, improves energy levels and mental health, and aids social interaction in the presence of physical disability.

  • Because of the reduced impact of gravity, aquatic training allows patients with even severe paresis of the lower extremities to perform standing and moving exercises.

  • A systematic review and Meta-Analysis recommends combining aquatic therapy with conventional physical therapy for MS patients


Balance Exercises

  • MS patients have increased sway in quiet stance, delayed postural perturbations and reduced ability to move towards limits of stability.

  • These postural impairments are likely causes of falls.

  • Reduced gait speed, decreased stride length, cadence, and joint movement are observed in most studies of gait in MS Specific balance exercises can improve balance.


Motor imagery and rhythmic auditory stimulation

  • Motor Imagery is increasingly used in neuro-rehabilitation in-order to facilitate motor performance.

  • Motor imagery and rhythmic auditory stimulation can be used for walking rehabilitation in MS patients.

  • Randomized controlled trial studying the effects of motor imagery showed significant improvement in walking speed, walking distance, perception and quality of living


Gait Rehabilitation

  • Gait pattern in people with multiple sclerosis (MS) shows a decrease in speed and stride and step length, increase in the step width, decrease in hip extension during the stance period, a reduction in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantarflexion during the pre-swing phase. Gait rehabilitation can help in combating asymmetrical gait characteristics.


ADLs

  • Any impairments or limitations will be given immediate attention and assistance.


Education

  • Educating the patient and family members or caregivers on disease progression and compensatory strategies to conserve energy.

  • Benefits of sunlight in MS must be incorporated. Education about correct postures is important to prevent further complications.


Psychological support

  • Throughout all stages of MS, PT can offer psychological support to the patient and family/caregiver


Pain

  • PT helps relieve pain through exercise, stretching, massage, ultrasound, postural training, or hydrotherapy.


Sensory Deficits.

  • Tapping and verbal cues during exercise and resistance training can help improve proprioception losses.

  • Vision issues, such as blurred or double vision, often occur in patients with MS. PT can offer education on how to be safe at home and offer strategies to improve balance and coordination in dimly lit settings.

  • PT treatment interventions for decreased sensation to light touch include education on awareness, protection, and personal care to desensitized body parts.

  • Pressure-relieving devices are a primary prevention strategy along with proper transfer techniques and daily skin inspections for maintaining skin integrity

Fatigue

  • PT strategies to help patients combat feelings of excessive tiredness include aerobic exercise, energy conservation, and activity pacing.

  • Aerobic exercise activities is closely monitored by a PT to ensure a patient does not overheat, but is able to work on increasing their endurance capacity which will help them be more functional throughout the day.

  • PT’s can also teach energy conservation strategies and activity pacing to help someone sustain their daily activities by minimizing fatigue.

Spasticity

  • PT interventions range from cryotherapy and hydrotherapy to therapeutic exercise, stretching, range of motion activities, postural training, and electrical stimulation.

  • A combination of therapeutic interventions is often the route taken.

Balance, Coordination, & Postural Deficits.

  • PT techniques to address these issues include postural exercise, core strengthening, rhythmic stabilization, static/dynamic balance training, aquatic therapy, proprioceptive loading, and resistance training.

Mobility issues

  • PT's work to help the patient's overcome their mobility limitations through locomotor and functional training.

  • Locomotor training focuses on increasing thigh and hip strength along with posture and balance training through walking activities.

  • Orthotics and assistive devices are added as necessary.

  • Functional training involves bed mobility, transfers, and developing strategies with the patient on how to be able to safely navigate around the home and out in the community.

At Valley Healing Hands, we provide the best Physical Therapy and Occupational Therapy treatment for Multiple Sclerosis. Our highly skilled therapists will be happy to serve you with their expertise in this field. A personalized programme is taken for each patient and we will be with you throughout each step that you take.


Our Patients are completely satisfied with our services and you may learn about it here. You may also get connected to us here. Our patients love us and you too will!!!






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