By Karolina Kozlova, PT, DPT, Neurologic Clinical Specialist
What causes Multiple Sclerosis?
Multiple Sclerosis (MS) is a progressive neurodegenerative disease that destructs a fatty tissue called myelin in your central nervous system (brain and spinal cord). Although the cause of MS is unknown, we know that the autoimmune system attacks the central nervous system damaging and destroying the myelin (tissue that wraps around your nerves to help with speed of nerve conduction) and forming scar tissue “sclera” in its place making it difficult for the brain to communicate with the body.
Diagnosis/functional limitations summary
Based on patient presentation and physical/functional complaints, a brain MRI is completed with a follow up scan usually 6 months later to confirm the development of sclera for a concrete diagnosis. Common symptoms include spasticity (muscle stiffness), fatigue, sensory and cognitive changes, decreased balance and gait impairments.
Recommended activity levels/precautions
Due to high levels of fatigue, it is recommended that to get the most benefit from exercises and decrease factors that contribute to fatigue, patients should choose to exercise when they are least fatigued – typically in the morning. It’s important to keep moving to avoid secondary complications.
Precautions: 85% of patients with MS suffer from heat intolerance which can temporarily increase symptoms. It’s important to plan ahead when participating in exercises and to keep core body temperatures down.
Most recent evidence to support exercise
For individuals with MS, research has recommended that they engage in moderate intensity exercise.
Stretching: daily range of motion, with or without a helper, Tai chi, yoga and Pilates to help improve range.
Aerobic Conditioning: 3-5x/week for 20-30 min, walking on ground or treadmill, stationary bike, etc.
Strengthening: 3-5x/week, 1-3 sets to fatigue each muscle group. Focus should be on the weakest muscle groups that contribute to decreased function.
Balance: Static/dynamic balance and coordination training to decrease risk of falls.
Breakdown of types of exercises that will be addressed with therapy
Therapy will be based upon initial examination by a physical therapist to address impairments. Programs will include stretching, aerobic conditioning and strengthening and/or balance training. During evaluation, the physical therapist will assess function using multiple scales/measures to determine endurance, walking, hand function, balance, dizziness and/or MS impact on function.
Summary of progression/therapy expectations/outcomes
Upon evaluation, your physical therapist will discuss the findings and how your health and fatigue affect your daily activities. They will develop a course of treatment based on your specific needs to address strength, endurance, balance, breathing, movement, and techniques to prevent tightness. You will be taught how to keep your energy high so that the movements don’t overfatigue or overheat your body. Therapy will require 1-2x/week commitment up to 3-4 months, depending on clinical evaluation. Throughout treatment, initial exams will be re-evaluated and outcomes/progress discussed with patient.