Multiple Sclerosis: What is it?
Multiple sclerosis is a chronic disease characterised by demyelination of the neurologic system. It is a completely unpredictable and disabling pathology of the central nervous system. It attacks the myelin sheath, the protective covering wrapped around the central and peripheric nerves. Studies identified four types of MS disease states relapsing-remitting MS, primary-progressive MS, secondary-progressive MS, and progressive-relapsing MS.
What are the causes of Multiple Sclerosis?
The cause of MS is still unknown, there have been studies that reveal the interaction of several different factors, which might have a role in the etiology.
- Immunologic factor: Explained by the attack on the immune cells to the Central Nervous System destroying nerve conduction.
- Environmental factor: Multiple sclerosis is more prevalent in areas further from the Equator in a colder climate. There is evidence that shows Vitamin D may play an important role.
- Genetic factor: The risk is high in a person with a first-degree family member with this disease despite it not being considered a hereditary disease.
- Infectious factor: Different studies are been evaluating the possibility that viruses and other infectious agents may trigger the onset of the disease.
- Gut microbiome factor
How can physiotherapy help with multiple sclerosis?
Physical therapy plays an important role in keeping a patient active and functional within the community. The assessment should evaluate the posture, movement, and function. During the early stages of the disease, patients can present only minimal impairments. At this time, the physiotherapy includes different actions such as the education of the patient and family members about disease progression and the compensatory strategies to conserve energy. During the middle stage of the disease, the therapy should be directed to improve or maintain motor functions through strength, endurance, flexibility, balance, respiratory training and assistive device training. Advanced stages of MS usually are present with multiple impairments compared to earlier stages. At this stage, the primary goals are to maximize independence postural and training, respiratory function.
Aerobic exercise is proven to be beneficial through use of an elliptical machine, treadmill, or a stationary bike. The aim is to improve leg strength, the ability to walk, and exercise endurance, balance and mood. Other types of exercise include: general strengthening, balance training, stretching exercises, and relaxation techniques. Aquatic exercise, tai chi and yoga are all clinically proven to be effective forms of exercise.
Exercise therapy has a positive effect on MS fatigue. Aerobic exercise is recommended in all stages of the disease. During the Acute Relapse Management, the use of immunosuppressants and anti-inflammatory drugs to reduce CNS edema is indicated. Typically, a high dose of prednisone is prescribed, as part of the first line of treatment with the aim to suppress the immunological system.
The Physiotherapy management includes: active/passive and active/assisted exercises; techniques like Bobath, Vojtas, Proprioceptive Neuromuscular Techniques. The aerobic exercise training must be done with low to moderate intensity. It can result in the reduction of fatigue. Comprehensive exercise interventions can facilitate improvements in balance impairments and spasticity.