Multiple Sclerosis

Multiple sclerosis (MS) can present from any age, however has peak influence at 25 – 35 years. The course of the illness is unpredictable, and is twice as common in women as in men. The course of the disease ranges from a single transient neurological deficit with full recovery to permanent disability within weeks or onset. Many people remain mobile and can live a near-normal life.

MS is a demyelinating disease that has immune mediated destruction of myelin as the primary pathological finding, with relative sparing of the other elements of the CNS. It has episodes of acute neurological disturbance, affecting non-contiguous (unconnected) parts of the CNS, are separated by periods of remission. The disease can be progressive in nature and initially, recovery following a relapse is normally complete. However some attacks do not recover completely and leave remains of continuing disability.

Classification

·      Benign MS

·      One or two relapses, separated by some considerable time, allowing full recovery and not resulting in disability

·      Relapsing Remitting MS

·      Characterised by a course of recurrent discrete relapses, interspersed by periods of remission when recovery is either complete or partial

·      Secondary Progressive MS

·      Progressive deterioration after relapses and remissions, with or without identifiable relapses where disability increases even when no relapse is apparent

·      Primary Progressive MS

·      Typified by progressive and cumulative neurological deficit without remission or evident exacerbation

Early Signs & Symptoms

·      Visual loss

·      Double vision

·      Weakness

·      Numbness

·      Imbalance

·      Slurred speech

·      Nystagmus (rapid involuntary mvts of the eyes)

·      Intention tremor

·      Trigeminal neuralgia (intermittent stabbing pain in the face)

Signs & Symptoms During MS

·      Fatigue

·      Optic atrophy

·      Opthalmoplegia, with facial sensory and motor symptoms

·      Cerebellar disease causing nystagmus, ataxia and tremor

·      Hypertonia

·      Spasticity

·      Pain

·      Tremor

·      Weakness

·      Brisk reflexes

·      Impaired walking ability

·      Sphincter disturbances

·      Psychiatric and psychological disturbances

·      Possibly epilepsy (generally focal)

Symptoms are exacerbated by heat and cold.

Physiotherapy Interventions

·      Stretching

·      Reduce hypertonia

·      Active exercise

·      Retraining function

·      Muscle strengthening

·      Retraining of balance and co-ordination

·      Maintaining ROM

                           Therapeutic exercises causing fatigue were widely thought to be damaging and the consensus is that moderate exercise is appropriate but that too much, which precipitates fatigue, is too much. Exercises can lead to worsened motor impairments, however leads to significantly less deterioration.

                           Weight-resisted exercises are deemed inappropriate.

                           Aerobic exercises aim to increases overall physical activity and cardiovascular effort, prevent general muscular weakness and reduce health risks due to deconditioning and disuse.

·      Walking aids

·      Aims to maintain ambulation

·      Need to avoid postural instability and deformity with long term use

·      Hydrotherapy

·      Inconclusive. Similar argument to on land exercises.

·      Heat & cold

·      Heat aids muscle stretching exercises

·      May exacerbate clinical and subclinical deficits

·      Cold could further compromise circulation with vasoconstriction

·      Electrotherapy

·      As an adjunct to active exercise and stretching

·         Is not suitable for all MS patients