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Multiple sclerosis
The document discusses physiotherapy for managing multiple sclerosis (MS), detailing its clinical features, physiotherapy roles, and management strategies for various symptoms such as sensory deficits, pain, fatigue, spasticity, balance, and swallowing. It also highlights recent advances in physiotherapy interventions and their effectiveness, particularly regarding spasticity and pain management. The document concludes with references to key literature supporting these approaches.
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Multiple sclerosis
- 1. PHYSIOTHERAPY IN MULTIPLE SCLEROSIS Dr. ManasiKulkarni MPT-Neurophysiotherapy
- 2. Content ■ Introduction ofMS ■ Clinical features ■ Role of Physiotherapy ■ PT management ■ Recent Advances ■ References
- 3. Introduction ■ It wasfirst defined by Dr. Jean Charcot in 1868 ■ Multiple Sclerosis is an autoimmune disease characterized by inflammation, selective demyelination, and gliosis. Intension Tremor Nystagmus Charcot’s Triad Scanning Speech
- 4. Incidence and prevalence 5-20Cases per 100000 in the India are present (Atlas of MS-2013)
- 5. Types • Clinical subtypes• Features 1. Relapsing Remitting MS (RRMS) • Characterized by discrete attacks of neurological deficits (relapse) with either full or partial recovery. • Local inflammatory activity that is clinically silent. 2.Secondary Progressive MS (SPMS) • Characterized by an initial relapsing-remitting course, followed by a change in clinical course with progression to steady and irreversible decline with or without continued acute attacks. 3. Primary Progressive MS (PPMS) • Characterized by disease progression and steady functional decline from onset; patients may experience modest fluctuations in neurological disability but discrete attacks do not occur. 4. Progressive Relapsing MS (PRMS) • Characterized by a steady deterioration in disease from onset (similar to PPMS) but with occasional acute attacks.
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- 7. Aim of Physiotherapy ■To reeducate and maintain all available voluntary control ■ Re-educate and maintain postural mechanisms ■ Inhibit abnormal tone ■ Prevent abnormal movement ■ To stimulate all sensory and perceptual experience ■ Incorporate treatment techniques into ways of life by relating to ADLs.
- 10. Physiotherapy Management 1. Managementof Sensory deficits The skin should be kept clean and dry. Soiled skin should be cleansed and dried promptly. The skin should be inspected regularly Clothing should be breathable and comfortable (soft, not too loose or wrinkled, or too tight). Seams, buttons, and pockets should not press on the skin Regular pressure relief is essential. Patients should be instructed to change their position or be changed frequently, typically every 2 hours in bed and every 15 to 30 minutes when sitting in a wheelchair
- 11. 2. Pain Management 4categories Pain directly from MS Pain secondary to other symptoms of MS Pain due to DrugT/t of MS Pain Independent of MS Lhermitte’s sign Cervical collar Musculoskeletal pain Regular stretching or exercise Massage Ultrasound Painful Dysesthesias Hydrotherapy or pool therapy Malalignment and pain Orthotic devices
- 12. 3. Exercise training Strengthand conditioning • Resistance training with Weight machines, latex resistance bands or isokinetic machines • Circuit training • Progression should be slow Aerobic Conditioning • 3 to 5 days/week • Intensity 50% to 70% peak VO2 • 30 min per session • Type- cycling, walking, swimming, or water aerobics Flexibility exercises • For tight hip flexors, adductors, hamstrings, plantarfelxors, PM ,LD – Adequate stretch at end range for min 30 to 60 sec hold • 2 reps each • Tai chi exercises for additional benefit
- 14. 4. Fatigue management •Patients are instructed to keep an activity diary in which daily activities by hour, and how costly those activities were. • For each activity, they can be asked to rate their level of fatigue (F ), the value or importance of the activity (V ), and satisfaction perceived with performance of the activity (S ) by assigning a number between 1 and 10 • Multiple SclerosisScreenshot (241).png Energy conservation techniques Activity pacing
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- 17. 6. Management ofBalance and co-ordination
- 19. 7. LocomotorTraining Standing and walking StableBOS Maximum Wt bearing through LEs Adequate Wt transfer Forward progression with trunk, limb and pelvic kinematics
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- 21. 8. Management ofspeech and swallowing • Application of transcutaneous neuromuscular electric stimulation (NMES) to the submental muscles (suprahyoid triangle) to facilitate muscle reeducation. • Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to improve swallowing reflexes and the pharyngeal phase of swallowing.
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- 23. ■ Stage waisemanagement of MS.png Stagewise management Early/Mild stage Middle/ Moderate stage Late/ Advanced stage
- 24. RecentAdvances ■ Mohhamand Etoomet al Conducted a review (2018) Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis: A systematic review • 29 studies were included • PT interventions- Electrical stimulation, exercise therapy, radical shockwave therapy, vibration and standing • Results were positive regarding acute effects, follow up measurements and safety • Physiotherapy management can e a safe and beneficial option for spasticity management in people with MS.
- 25. ■ Demanuef T.et al conducted a review on effectiveness of exercise intervention on Pain in people with MS. • 10 randomized controlled trials were included for meta-analysis and systematic review. • This review concluded that Current pain management strategies are costly and have significant adverse effects, but exercise therapy has many benefits to health and is generally low-cost and accessible.
- 26. References ■ O’Sullivan S,SchimtzT,Fulk G. Physical Rehabilitation 6th edition ■ Umphred D, Lazaro R, Roller M, Burton G. Umphred’s Neurological Rehabilitationm. 6th edition ■ Bhatia R., Bali P, Choudhari R. Epidemiology and genetic aspects of multiple sclerosis in india.Annal of Indian academy of neurology 2015; 18(1): s6. ■ Etoom M, KhraiweshY, Lena F et al. Effectiveness of Physiotherapy intervention on Spasticity in people with Multiple sclerosis: a systematic review and meta analysis.Am J Phys Med Rehabil 2018; 97(11):793-807. ■ DemanuefT. et al Effectiveness of exercise intervenions for pain reduction in people with multiple sclerosis:A systematic review and meta analysis of Rendomized controlled trials.Arch of Phys Med & Rehabil 2018
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