Multiple sclerosis physical therapy

Multiple Sclerosis: Treatment with Physical Therapy

Multiple sclerosis (MS) is a progressive neurologic disease that damages the nerves. This damage often leads to serious symptoms, such as the following:

  • numbness and tingling
  • weakness
  • muscle pain
  • vision problems

In some people, MS can be aggressive and advance quickly. In other people, it can be mild and progress at a much slower pace, with long periods of inactivity.

In any case, physical therapy (PT) can be an important part of treatment for people with MS. Read on to learn what PT can do to help you manage your MS.

Why PT can be helpful with MS

PT for MS involves exercises to strengthen your muscles and improve your gait (how you walk) and your balance and coordination. It also involves stretches to help you maintain mobility and prevent muscle spasms. PT can also include training on how to use mobility aids like a cane, walker, or wheelchair.

PT can be helpful even in the earliest stages of MS. It can help you:

  • learn how to support and cope with your changing body
  • avoid exacerbating symptoms
  • develop strength and stamina
  • regain abilities after a disease relapse

A discussion with a physical therapist can help you understand how your body will change as the disease progresses. Getting PT can help you prepare for these changes and help you maintain or improve a healthy lifestyle.

Physical therapy at different MS stages

PT may be helpful at various stages of your condition, and for different types of MS.

At diagnosis

At the time of your MS diagnosis, it’s important to meet with a physical therapist for a baseline evaluation. This exam allows the therapist to see what your body is capable of now so they can compare that with your future abilities. You can also discuss your physical limitations and understand what levels of exercise and physical activity are appropriate for you.

After the initial exam, you may not need to continue seeing a physical therapist. But, you’ll likely want to continue with PT if you have an aggressive, rapidly progressing type of MS.

During a relapse

A relapse — also called a flare or exacerbation — is a period of time when symptoms of MS are more frequent or severe. During this period, you may have greater difficulty with everyday tasks that include:

  • working
  • cooking
  • walking
  • bathing

Your physical therapist will know how the relapse is affecting you by conducting a physical exam and comparing it with your baseline evaluation. After a relapse you should meet with your physical therapist to resume PT. Therapy after a relapse may help you regain some of the strength you might have lost during the relapse.

For progressive multiple sclerosis

If you have primary progressive MS, you don’t experience relapses. Instead, your disease is on a gradual, constant decline.

If you’re diagnosed with this type of MS, ask your doctor to refer you to a physical therapist right away. It’s crucial to your health and well-being that you start PT as soon as you can. PT can teach you how to compensate for the changes you’ll experience. You may also need to learn how to use a mobility aid, such as a standing device or wheelchair.

Read more: Treatment for PPMS “

For advanced multiple sclerosis

People with advanced MS have severe MS symptoms. In most cases, people with advanced MS are nonambulatory. This means they cannot walk or get around without help from another person or a motorized device. Also, people at this stage have an increased risk of developing other health conditions such as osteoporosis or epilepsy.

People with advanced MS can still benefit from PT. For instance, PT can help you learn to sit properly, develop upper body strength, and maintain the ability to use mobility aids.

Where you’ll have physical therapy

Physical therapy can be done in several locations that include:

  • your home
  • an outpatient facility
  • an MS treatment center

PT for MS may be different based on where it’s provided. In some cases, the stage of the disease determines where you should have your PT. In other cases, you may be able to select the option that works best for you.

Inpatient PT

You’ll receive Inpatient care while you’re staying at a healthcare facility. PT conducted in an inpatient facility is often done in a hospital, MS treatment center, or long-term care facility.

Most people who require inpatient PT have experienced a fall or some type of injury due to MS. People with advanced-stage MS may also be living in an assisted-living center, and PT may be required as part of treatment.

Outpatient PT

Outpatient care takes place in a doctor’s office, physical therapy office, or therapy center. People who have outpatient PT come to the venue for therapy and leave afterward.

Outpatient PT can be a good choice for people who are recovering from a relapse or learning to handle the physical changes MS causes.

Home care

With home care, a physical therapist will come to your home to provide PT. People in all stages of MS can use home care.

This type of therapy may be especially useful for people who’ve been recently diagnosed with MS and are learning to deal with slight changes in their physical abilities. Home care can also be good for people who have late-stage MS and are nonambulatory.

Making your treatment plan

If you have MS, talk with your doctor about your course of treatment. If you would like to begin working with a physical therapist, ask your doctor for a referral.

MS is different for everyone, and some people may respond well to certain exercises while others won’t. Be honest with your doctor and your therapist about your symptoms and how you’re feeling so that they can create a PT program that’s right for you.

If you’re looking for a way to ease many of your multiple sclerosis (MS) symptoms and get around better, physical therapy can be a big help.

A physical therapist can work with you to improve balance problems and to move better. You’ll learn how to save energy and find better ways to do everyday tasks. Physical therapy can also help you tackle fatigue, pain, and weakness.

You may start working with a physical therapist right after you get a diagnosis. You can schedule follow-up appointments with her when you need them. Some hospitals have physical therapists on staff who specialize in MS treatment. You will need to ask your doctor for a formal referral, but check with other people who have MS for suggestions on where to go in your area.

On your first visit, your therapist will talk to you about your symptoms, see how well you can handle different tasks, and show you exercises you can do at home.

One to three sessions may be enough. On follow-up visits, you may learn:

  • Stretches to prevent or ease muscle spasms
  • Moves to keep muscles strong
  • Range-of-motion exercises, like straightening and bending your arms and legs
  • Tips to prevent falls
  • How to use canes, crutches, scooters, wheelchairs, or other aids, if necessary

Your therapist will also help you come up with a fitness program that’s good for your strength and goals.

Regular exercise helps with all types of MS, but it can be hard when you’re tired or you get overheated easily. You’ll learn how to work around these issues to get the most from your workouts.

Most therapists can give you more sessions to help you reach any specific goals you have, like overcoming a foot drag that slows your pace. Some may be able to come to your home to work with you.

If your MS symptoms make it hard to do your job, your therapist can take you through some tests and document the kind of trouble you’re having. It’s called a functional capacity evaluation. It measures whether you are able to work an 8-hour day and may help if you need to apply for Social Security disability benefits.

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Case Study: Exercise in MS

Medical Management

Acute Relapse Management

Management work as immunosuppressants and anti-inflammatory drugs to reduce CNS swelling. There are numerous medications available in assisting acute attacks, disease progression, and to help manage symptoms .

  • Prednisone: Typically, a high dose of a corticosteroid, such as – methylprednisolone is the first line of treatment against an attack of MS. Corticosteroids help to reduce and inflammation by suppressing the immune system, and when given intravenously can work quickly . Oral doses are often given as follow-up treatments during acute exacerbations . Side effects include sleep disturbance, headache, excessive sweating, or increased hair growth. Prolonged corticosteroid use can also lead to skin problems, edema of face or lower extremities, arthralgias, irregular menstruation, muscle cramps, and pain. Brand Name: Deltasone

  • Plasmapheresis: As a supplemental or secondary treatment, plasmapheresis (plasma exchange) can be used in relapsing forms of MS to help control MS attacks . During the plasmapheresis procedure potentially harmful components of plasma are separated and removed from blood, then replacement plasma and blood cells are returned to the body This method is thought to be useful as a secondary treatment option for severe relapsing forms of MS, but is not recommended for PPMS or SPMS.

Disease-Modifying Agents

work to slow progress or reduce the number of MS attacks: They are most commonly used for decreasing relapses in patients with RRMS . Prior to initiating disease-modifying treatment, a complete diagnostic workup is crucial to help begin treatment at the appropriate time. Early intervention using disease-modifying drugs has been shown to be most effective however the risks involved in prematurely starting treatment for MS if this is not the true diagnosis can cause an individual to become susceptible to the serious side effects of taking some of these drugs . The following disease-modifying drugs work to slow progress or reduce the number of MS attacks.

  • Beta Interferons
  • Glatiramer acetate – Injectable disease-modifying drugs that may help alter immune cells from attacking myelin.
  • Mitoxantrone – an injectable drug is given four times per year that suppresses immune functions thought to attack myelin. This drug is approved for treating SPMS, PRMS, and RRMS. Brand Name: Novantrone
  • Natalizumab
  • Fingolimod

Symptom Management

It is an integral component to helping patients with MS function in their daily life. Numerous pharmacological agents can be used to relieve common symptoms of MS. eg Spasticity, Pain, Fatigue, Tremor, Cognitive & Emotional Impairments, Bowel & Bladder Impairments.

For more information and drug listings on symptom management, please visit the following link:

www.nationalmssociety.org/Treating-MS/Medications

Resources

MS Ireland

National Multiple Sclerosis Society
Multiple Sclerosis Association of America

The Role of Physical Therapy in Treating Multiple Sclerosis (MS)

What is the goal of physical therapy in treating multiple sclerosis?

The goal of physical therapy in treating multiple sclerosis (MS) is to improve your independence and quality of life by improving movement and function, and relieving pain. Physical therapy can help with:

  • Balance problems
  • Incoordination
  • Fatigue
  • Pain
  • Weakness
  • Posture
  • Difficulty physically performing daily activities (such as walking or getting up from a sitting position)

Why do I have symptoms with multiple sclerosis?

MS damages the myelin sheath surrounding the nerve cells of the brain and spinal cord. Scarring from this damage can block or slow nerve impulses in areas of the brain (neurological damage). As a direct result of MS, you may lack coordination and feel tired, and have weakness, involuntary movements, muscle stiffness (spasticity), or pain. Symptoms such as these are called “primary symptoms.”

Primary symptoms of MS can make you move less. As a result, you may feel tightness, pain and weakness, especially in the muscles and joints. These symptoms, which are not a direct result of MS, are called “secondary symptoms.”

How can I receive physical therapy?

If you feel you can benefit from physical therapy, you will need to ask your doctor for a referral to physical therapy.

How many visits will I need?

The number of appointments depends on your specific situation. The first appointment includes an evaluation and recommendations for exercises. The following appointments check your progress and build a new program. The therapist will work with you until you reach a certain level of improved function. At that point, a home exercise program will be developed.

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