Multiple sclerosis is a neurological disease in which the myelin sheath surrounding nerve fibers in the central nervous system is affected. Due to the damage of the myelin sheath, the signal transmission between the brain and the body is interrupted and various complaints occur.
Physical therapy is necessary in multiple sclerosis (MS) disease to preserve functional skills and keep them at the highest level. MS can affect people in many different ways, and disability can progress over time. For this reason, individual physical therapy should be applied for each MS patient. The necessary treatments change over time according to the course of the disease. Rehabilitation requires teamwork, as MS can affect a person’s life in many ways.
MS can cause many different symptoms.
MS disease can lead to very different and complex symptoms. For example, complaints of fatigue and muscle weakness are common in MS patients due to physical or neurological disorders. However, fatigue and weakness in MS patients can have many causes. Sleep problems, stress, depression, anemia, side effects of drugs used to treat pain or spasticity, increased body temperature due to infection or excessive exercise, or activation of the disease are some of these reasons. MS is a disease that can cause many system-related problems such as vision problems, sensory disorders, cognitive problems, sexual dysfunction, bladder and bowel problems. Due to this complex situation, physical therapy and rehabilitation specialists have an important role in the treatment of MS disease.
MS physical therapy should be personalized
The role of physical therapy in multiple sclerosis varies according to the needs of the patient, the course of the disease, relapses, and disability. However, the goals of physical therapy are in any case to improve the quality of life of the person, to maintain physical functions and to protect independence. In order to achieve these goals, besides physical therapy methods, education of patients and their relatives, psychological support and appropriate assistive devices and tools are used. The physical therapy method applied for each multiple sclerosis patient may differ.
Education is fundamental
Education is essential in the management of MS. Patients and their relatives should be informed about the physical symptoms that MS can cause and what can be done to reduce these symptoms. Health and functionality can be improved with an exercise program specially designed according to the symptoms of the disease in the person. Where necessary, assistive devices should be provided for use in the home, workplace and automobile. Physical therapy sessions should be planned specifically for the patient’s complaints. Relatives of patients are informed, and referrals are made to relevant non-governmental organizations such as patient associations and public institutions so that individuals with MS can maintain their productivity in their home and social life.
Initial examination and evaluation in multiple sclerosis
At the time of the diagnosis of MS, the physical functions of the person should be evaluated and recorded. Gait test, balance test, muscle strength, sensory and reflex examination, joint range of motion measurement, tests of independence in daily living activities are part of the initial examination and follow-up examinations. Education should be given in terms of what the disease is, how it progresses, appropriate exercises and activities, how to deal with fatigue, and possible walking and balance problems.
Initial training in MS physical therapy
In MS disease, education is given to protect the energy of the person. Taking regular breaks during activities and finding more efficient ways to carry out the daily tasks that need to be done can be counted among the energy conservation techniques. Stretching exercises, range of motion exercises are taught to reduce muscle spasms. Tips are given to reduce the risk of falling. Information is given on the correct use of assistive devices such as crutches, walking sticks, canadians, and wheelchairs.
Physical therapy during exacerbations
When MS disease flares up, the person’s physical limitations increase. During this period, physical therapy targets for returning to initial functionality are set. In general, during the exacerbation period, it is waited for 2 weeks before starting physical therapy in order to relieve the possible side effects of drugs and the fatigue and weakness due to the disease.
Physical therapy in progressive disease
Sometimes MS disease can follow a progressive course, this is called progressive disease. In this situation, physical therapy focuses on preserving functions as much as possible and preventing complications in a predictive way. Assistive devices and compensatory techniques may come to the fore.
Physical therapy in advanced MS disease
When MS disease progresses, the person may become unable to walk. In this period, physical therapy focuses on the patient’s trunk control, improvement of sitting balance, increasing the independence of the transfer activities from bed to chair by increasing arm strength, breathing-breathing exercises. Devices that enable the person to stand upright or passively and make leg movements (tilt table, robotic bed, robotic walking device, etc.) provide benefits in terms of reducing spasticity, bladder and bowel functions, preventing osteoporosis by overloading the bones, relieving breathing, and improving blood pressure. .