Physical Therapy’s Role in Multiple Sclerosis Treatment
Rehabilitation is an essential component of comprehensive care for individuals with multiple sclerosis. Multiple sclerosis is a chronic, inflammatory condition of the central nervous system that is characterized by relapses and remission of symptoms with a variable progression of disability over time. Physical therapy helps patients manage the disease from diagnosis through relapse and remission stages, using gait and balance training and monitored exercise therapy to improve and enhance functional mobility.
What is Multiple Sclerosis?
Multiple sclerosis is a neurological disease that affects 400,000 Americans and over 2 million people worldwide. It generally manifests between ages twenty to forty-years-old and is more common in women than in men. In multiple sclerosis, the body’s immune system directs repeated inflammatory attacks on the central nervous system, which damages the myelin covering of the nerve fibers, the nerve fibers themselves, and the cells that make myelin.
Symptoms of multiple sclerosis vary from person to person in type, duration, and intensity depending on which part of the nervous system is affected. Common symptoms of multiple sclerosis include:
Fatigue
Pain
Memory problems
Difficulty walking and coordination issues
Numbness or weakness in one or more limbs
Mood and cognitive changes
Sensory loss
Depression
Sexual dysfunction
Bladder and bowel dysfunction
Vision problems (double vision)
Dizziness
Speech or swallowing issues
Spasticity: muscles feel stiff, heavy, and difficult to move
Spasms: sudden stiffening of a muscle that may cause limb to kick out or jerk towards the body
What is Physical Therapy’s Role in Multiple Sclerosis Treatment?
Physical therapy plays a key role in rehabilitating and conserving functional abilities in those with multiple sclerosis. Research has shown that rehabilitation for multiple sclerosis has positive results for the patient and that exercise physical therapy is a safe and effective rehabilitation option for patients with the condition. Studies on exercise therapy for multiple sclerosis patients have shown that moderate endurance and resistance training improves muscle strength, endurance, muscle tone, posture stability, and flexibility in the patient and functional measures like walking speed, fatigue, and exercise tolerance. Physical therapists tailor treatment to the patient based on their specific symptoms and adjust physical therapy interventions based on whether the patient is in a relapsing or remission stage of the disease.
Physical therapy can be applied at nearly any stage of the disease from the first onset of symptoms to highly impaired patients. At the time of diagnosis, the physical therapist completes a baseline evaluation to identify areas of ability and areas for improvement in order to design an initial exercise program based on the patient’s specific needs to alleviate specific symptoms and promote overall function. During periods of stability and remission, the therapist checks in with the patient every few months to monitor mobility and ensure the home exercise program maintains the patient’s function.
During and after a period of relapse, the physical therapist works with the patient to regain the previous level of function and engages in a gradual, progressive exercise program to increase mobility and decrease new or exacerbated symptoms. As the disease progresses, the therapist can also teach the patient how to safely use adaptive and mobility equipment. If the disease is advanced, interventions include stretching and range-of-motion exercises, upper extremity strengthening, and seated trunk positioning and control exercises to maximize function.
Rehabilitation for Multiple Sclerosis
Rehabilitation for multiple sclerosis improves balance, endurance, aerobic capacity, walking ability, and functional independence of the patient. Rehabilitation also decreases the risk of secondary conditions, fatigue, and fall risk and alleviates specific symptoms. Physical therapy helps to prevent complications of deconditioning, muscle weakness, and muscle tightening or shortening due to spasticity.
Physical therapy interventions for multiple sclerosis include:
Stretching exercises to manage spasticity and improve range of motion
Gait training through weight-bearing and weight-shifting drills and body positioning
Balance and coordination training using vestibular exercises and dual-task drills to decrease the risk of falling
Progressive resistance and strength training that focuses on specific muscles groups that are weakest and contribute to decreased function
Aerobic conditioning through stationary cycling or using a treadmill or elliptical at low-to-moderate intensity
As a patient engages in aerobic and resistance training, the therapist carefully monitors the patient for heat tolerance and sensitivity in order to allow the patient to exercise without triggering the onset or exacerbation of symptoms and uses cold packs and other cooling devices to ensure the patient’s temperature remains steady.
Physical therapy is a safe and effective treatment option to address symptoms of multiple sclerosis, improve strength and mobility, and help patients manage the disease from onset through relapse and remission to maintain overall fitness and function.
