Physical Therapy Role in Multiple Sclerosis Rehabilitation
Unlike most other neurological disorders, including spinal cord injury, traumatic brain injury, and stroke, there is no “fixed deficit” in MS; symptom profile, lesion burden on MRI, and disease course vary over time. Therapists must be prepared to treat each MS patient individually, and with flexibility, over the long term. In Multiple Sclerosis Rehabilitation, there are no protocols or time limits—just a unique opportunity to employ numerous problem-solving skills, interventions, and resources. And because MS affects not just an individual, but a whole family, it is a disease that benefits from a team approach as in Multiple Sclerosis Rehabilitation— making coordination and communication with other health care providers extremely important.
Interventions throughout the Disease Course by Multiple Sclerosis Rehabilitation
At the Time of Diagnosis
Patients newly diagnosed with MS benefit from education, support and a baseline evaluation by an experienced PT. At this time, misunderstandings about the disease and its management, the importance of appropriate exercise/activity, fatigue issues, and any subtle gait or balance impairments can be addressed. Follow up should be on an “as needed” basis by Multiple Sclerosis Rehabilitation.
Following Acute Exacerbations
Physical therapy following an acute exacerbation (also called a relapse or attack) should have the goal of carefully helping the person return to baseline functioning. It is customary to wait two weeks after the attack before starting or resuming outpatient PT, because of weakness, lack of sleep from IV steroids, or other factors.
Progressive Disease
Patients with primary-progressive MS do not have remissions; their functioning declines gradually, but steadily, over time. Patients who transition from relapsing-remitting MS to secondary-progressive MS are not able to return to baseline (due to progression of the disease that occurs between exacerbations) and demonstrate a slow decline in function. Because both groups have a huge emotional burden in addition to their physical challenges, physicians are encouraged to refer a person proactively to PT rather than waiting until he or she is struggling. Focus should be on support, resourcing, avoiding de-conditioning, maintaining safety, and maximizing health and independent function. Assessment of the need for mobility aids now and in the future is essential for these patients, and it is especially beneficial for the PT to assist the physician in assuring that the appropriate detailed prescription or letter of medical necessity (LOMN) is provided.
Advanced MS
Patients in advanced stages of MS have significant disease burden, are non-ambulatory, and at risk for other secondary health conditions. Physical therapy for this population will likely be focused on seated trunk positioning and control, transfers, upper extremity strength, respiratory function, and equipment needs. The use of standing devices or standing wheelchairs can be very helpful, providing weight bearing on the long bones, stretching to ease spasticity, relief for bowel and bladder, and improved respiration and speech projection.
The Therapists at The Balance Center of Las Vegas are specially trained to aid your MS patients in maintaining their balance and strength; specifically, during these Hot Summer Days!
