Physiotherapy Management

1. PT MANAGEM ENT
OF MULTI PLE
SCLEROSIS
KEERTHI PRIYA MPT NEURO,
ASSISTANT PROFESSOR

2. CONTENTS
ASSESSMENT
PROBLEM LIST
GOALS
MANAGEMENT

3. ASSESSMENT
 Demographic data
 Chief complaints
 History
 Pain assessment :Mc Gill Pain Questionnaire ,
Neuropathic Pain Scale

4. ASSESSMENT
Observation : Involuntary movements: eye balls, upper & lower limbs
Posture; abnormal posturing
Gait: abnormalities (may be ataxic)
Limb attitude: abnormal attitude (synergies)
Abnormal Respiratory pattern
Locomotion
Skin integrity

5. ASSESSMENT
VITALS: B.P
H.R
R.R
TEMPERATUTE

6. ASSESSMENT
EXAMINATION:
Cognitive: MMSE
Minimal Examination Of Cognitive Function In Multiple
Sclerosis
Emotional: Beck Depression Inventory

7. ASSESSMENT
EXAMINATION:
Cranial Nerves: 2, 3,4,5,6,8,9,10 & 12, absence of Gag Reflex
Sensory : superficial
Deep
sensation in QOL by Nottingham sensory assessment

8. ASSESSMENT
EXAMINATION:
Motor : Tone : MASS
Power: MMT, Dynamometer
DTR
ROM
Amended Motor Club Examination For Motor & Functional Deficits In
Multiple Sclerosis

9. ASSESSMENT
POSTURE:
sitting
standing
• Plumb line
• Still photography with
light emitting diode

10. ASSESSMENT
BALANCE:
BBS
POMA
GAIT:
step length & stride length
cadence
6 minute walk test
Dynamic gait index

11. ASSESSMENT
LOCOMOTION:
Usage
Dependency
Shifting
AEROBIC CAPACITY:
Dyspnea Scale
Borg Rating Of Perceived External Scale

12. ASSESSMENT
FUNCTION:
FIM
Barthel Index
Disease specified scales:
Expanded Disability Status Scale
Multiple Sclerosis Impact Scale
FATIGUE scales: Modified Fatigue Impact Scale

13. GOALS
SHORTTERM
1. Minimize progress
2. Prevent/ decrease complications
3. Maintain respiratory function
4. Manage fatigue
5. Maintain optimal level of functional
impedance
LONG TERM
1. To decrease spasticity
2. To increase muscle strength
3. To increase ROM
4. To improve balance
5. To improve ADL

14. MANAGEMENT
WEAKNESS:
1. Prescribe exercise based on FITS principle
2. Low to moderate exercise
3. Resistance exercise by ISOKINETIC device, Pulley,Therabands,UnderWater
4. PNF to improve functional rotation component
5. Strengthen proximal musculature to decrease fatigue

15. MANAGEMENT
SPASTICITY:
1. cryo stretches
2. Self stretches
3. PNF hold relax
4. Stretching inlying & sitting
5. Rotation exercise of pelvic girdle
6. ROM exercise to increase flexibility

16. Stretching exercises

17. Rotation exercise of pelvic girdle

18. MANAGEMENT
ATAXIA:
1. Weight bearing
2. PNF: ISOMETRICS, rhythmic stabilisation, slow reversals
3. Weight belts, vest exercises
4. Frankel’s exercise
5. Biofeed back

19. MANAGEMENT
FATIGUE:
1. Energy conservation technique
2. Change of task
3. Change of environment

20. MANAGEMENT
LOCOMOTION :
1. Treadmill training
2. RATT(ROBOT ASSIATEDTREADMILTRAINING)
3. BODYWEIGHT SUPPORTEDTREADMILTRAINING
4. FES(FUNCTIONAL ELECTRICAL STIMULATION)

21. MANAGEMENT
SWALLOWING :
1. Tracheal stimulation
2. Thermal tactile stimulation
3. Oropharyngeal exercises

22. REFERENCES
• PHYSICAL REHABILITATION BY SUSSAN O SULLIVAN
• NEUROLOGICAL INTERVENTIONS FOR PHYSIOTHERAPY BY MARTIN