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The Challenges And Treatments Of Multiple Sclerosis

What Is Multiple Sclerosis?

Multiple sclerosis (MS), is an autoimmune disease which is progressive in nature. It is characterised by episodes of inflammation and degradation of the myelin sheath surrounding the axons of the brain and spinal cord. MS relapses may lead to inflammation and injury to the myelin sheath results to impaired nerve signals. This may lead to difficulty in controlling vision, muscle coordination, fatigue, strength, sensation, and other bodily functions.

In India, neuro epidemiological studies demonstrate that the prevalence of MS has more than doubled in the past 30 years (1.33 vs. 3 cases/100,000). MS-related hospital admissions have nearly doubled in the last decade (1.58% vs. 2.54%).

Social service programs and disability centers that are able to address specific disabilities from MS, along with long term care and support, are much needed.

Symptoms Of Multiple Sclerosis

Physiotherapy Intervention For MS

A person dealing with MS for long period of time will have learnt many ways to treat his/her stressors on a day to day basis. However, pain and fatigue management is still something that requires professional help.

MS related fatigue is commonly associated with Thermal Stress. Hence, it becomes important for the attending physiotherapist to manage core temperature and prevent overheating. The environmental temperature (clinic exercise area) should be carefully controlled.

Hydrotherapy Or Pool Therapy

Hydrotherapy or Pool Therapy for MS has proven itself to be a great technique in managing painful dysesthesias - a symptom where unpleasant sensation is felt when touched due to the damage of the nerve. When treating a patient with MS, it is important for the temperature of the pool to be maintained at 26 º - 29 ºC or 80º - 85 ºF as heat may worsen the condition. 

Non-Weight Bearing Activities

Individuals with balance problems may require use of more stable postures. Due to loss of proprioception, individuals with MS will require more non-weight bearing activities. These exercises can be easily achieved with static cycling, swimming, leg press, Mat Pilates, or Reformer Pilates.

Functional Training

Activities such as Functional Training in closed kinetic chains should be introduced to promote strength and endurance. This will develop better control around limbs while standing, walking, and climbing stairs.

 

Exercise Considerations And Recommendations For Treating MS

1. Time Of Activity

Patients suffering from MS has to be aware of the time of activity of the exercises. It is recommended to exercise in the mornings as energy levels are better compared to late evenings. When performing these exercises, the physiotherapist should never reach the “Point of Fatigue”.  Allowing a patient to fully rest and recover is key for them to get stronger in the next session. Hence, a distributed practice with multiple rest periods are always preferable.

2. Frequency

The physiotherapist should keep the frequency of the aerobic exercise sessions for MS individuals to be 3 - 5 days per week depending upon the duration of the recovery phase. The exercise sessions can last upto 30 - 45 minutes, keeping in mind that the point of fatigue should be avoided.

Manual therapy, massage, relaxation, and stretching should be incorporated by the physiotherapist in between these exercises. 

 

Remember The 5 Ps

As a clinician, it's a duty to remember the 5 Ps when treating an inividual with MS.

Planning the session

Pacing of the exercise intensity

Prioritizing the treatment requirement

Positioning of the person while treating them

Practicing the planned routine

 

We're Here To Help You

A person dealing with MS is handling his/her condition with the need of constant support from their family, friends, and other caregivers. As physiotherapists, our role is not just confined to make them mobile and independent. It extends beyond our abilities to manage pain and discomfort. The constant counseling, spending the time understanding the requirements of each MS person plays a huge role in the prognosis of their condition.

The body and mind connects with each other in ways which we might never understand, but as a professional, we can assure that they are not alone in their journey. We strive our best to include their family and friends to provide as much support as they can give so that MS individuals will not have to go through it alone. At Prohealth Asia, we will always inspire and uplift this community.

Written by: Neha Kumar (Physiotherapist)

With an experience of 15 years, Neha has been deeply interested in musculoskeletal and sports injuries management. Treating various cases of spine, hip, knee, and neck pain have only given her a better insight of the body, mind, and how physiotherapy can be beneficial in the larger scheme of rehabilitation. She often incorporates her clinical skills with understanding of human behaviour in creating the required plan of care.

Author by Neha Kumar, Aug 15, 2022,

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