“This is part of our on-going series of exploring neurological conditions that can affect a number of individuals and specifically how Physical Therapy can help”
Today’s topic is Multiple Sclerosis (MS)…
MS is a disease in which in many respects remains a mystery up to this date but is prevalent in our society. MS is thought to be a type of auto-immune disease that affects the brain, spinal cord and optic nerves; the central nervous system (CNS). In 1868 the disease was first identified by a neurologist named Jean Marin Charcot. Attacks, relapses or exacerbation of inflammation cause damage to the myelin sheath which is a fatty substance that surrounds nerve fibers of the white matter in the spinal cord and brain. These periods of increased inflammation cause damage to these areas which most commonly cause symptoms of fatigue, motor weakness, gait deviations, paresthesias, difficutly with vision, tremors and bowel/bladder dysfunction. Symptoms varying greatly due to severity of attack and location within the central nervous system. The areas inflammation cause damage to the central nervous system and produce scarring commonly called lesions which can produce irreversible damage in some cases.
MS more commonly affects women, individuals between the ages of 16 and 60 years old, Caucasian descent and is more prevalent in areas furthest from the equator. A particular frustrating side of MS is its unpredictable course. There are four main classifications: Relapsing/remitting, Primary progressive, secondary Progressive and Progressive relapsing.
MS is difficult to diagnosis as there is no specific test and the road to a diagnosis can be long and difficult. MRI’s, evoked potentials, cerobspinal fluid examination are a few tests used but are not always indicative of a MS diagnosis. In the end, it is a combination of the above tests, a person’s symptoms, and finding a specialist in MS and other diseases that are similar to be able to pin point a diagnosis. MS can be controlled and managed by a number of medications whose main goals are to modify or interfere with the disease progression dependent on which classification a person might fall into.
Physical therapy along with a combination of speech and occupational therapies are a tremendous asset to individuals who were faced with an acute attack. Many times an acute attack affects one’s mobility, speech and cognition. Once the attack is controlled by medications an individual participates in intensive therapy across all three disciplines to “re-wire” the connections. Treatment techniques can include neuro re-education through treadmill, balance and functional training, strength training with use of tactile cues and manual assistance from the therapists. Adaptive devices for walking, eating and arm use can be employed. A tremendous amount of patient education is given to reduce levels of stress, maintain appropriate body temperature (heat can increase MS symptoms) and techniques to combat and recognize fatigue patterns. These techniques aim to improve the functional independence of individual. Recovery and rehabilitation can vary from individual to individual.
Unfortunately, MS does not get cured or go away so a person is now faced to live with MS. Exercise, has been found to a very effective. A number of research articles have concluded that regular aerobic exercise leads to increased cardiovascular fitness, improved overall muscle strength, improved bowel/bladder function, decrease depression/anxiety, less fatigue, improved cognition and an overall positive attitude. It is best to consult a trained professional when starting an exercise program. Exercises/activities that are beneficial and that I recommend and/or teach my patients are walking with or without a treadmill, riding a stationary bike, water aerobics (excellent to help control body temperature and improve spastic muscles), strengthening/body resistant exercises, equine assisted therapy/riding (horses help to strengthen the whole body and relax tight or spastic muscles), gentle yoga and Tai Chi. A big key to living with MS is also having or establishing a good support team whether family, friends or through a survivor support group.
The bottom line, is MS can affect people is many different manners from mild to severe, just one episode to multiple but many people live happy, healthy and productive lives.