Multiple Sclerosis is an autoimmune condition affecting the nerve cells of the brain and spinal cord. In this condition the body’s immune cells attack the myelin sheath which insulates the axons of the nerves and helps with the transmission of nerve signals. It can also attack the cell bodies and the axons themselves. In locations where immune cells have attacked the myelin, areas of sclerosis, also known as plaques or lesions, form and can be seen on an MRI. These plaques impair the transmission of nerve signals between the brain/spinal cord and the rest of the body which affects both motor and sensory nerves. The presence of multiple white matter lesions found on imaging leads to the diagnosis of Multiple Sclerosis.

The symptoms and severity of Multiple Sclerosis depend on the location and extent of these lesions. In some cases, individuals diagnosed with Multiple Sclerosis will have minor symptoms with few lesions. In most cases, however, individuals with Multiple Sclerosis will experience bouts of exacerbation of symptoms followed by periods of remission during which symptoms may improve or remain unchanged. During periods of exacerbation new lesions are typically found on imaging.

Signs and symptoms common to Multiple Sclerosis include:

• Muscle weakness and loss of muscle endurance
• Pain
• Changes in sensation
• Changes in bowel and bladder control
• Clumsiness and loss of coordination
• Impaired balance
• Ataxia
• Foot drop
• Difficulty in walking
• Fatigue
• Vision changes including optic neuritis
• Changes in cognition and concentration
• Dizziness
• Muscle stiffness or spasticity
• Pseudo-exacerbation: a temporary exacerbation of symptoms often related to heat, exercise or activity (Uhthoff’s Phenomenon)
• Lhermitte’s sign

Multiple Sclerosis is broken into several subtypes which are diagnosed by a neurologist:

Relapsing-remitting: This type of Multiple Sclerosis is characterized by relapses or exacerbations of symptoms followed by periods of remission in which an individual’s symptoms return to their usual level of disability. These remissions can last weeks, months or even years. Most individuals are initially diagnosed with this form of Multiple Sclerosis.

Secondary progressive: While relapsing-remitting is characterized by alternating periods of exacerbation and remission, secondary progressive is characterized by a gradual worsening of symptoms and increase in functional impairments. This type of Multiple Sclerosis develops later on in the disease course often after years of having relapsing-remitting type Multiple Sclerosis.

Primary progressive: This type of Multiple Sclerosis is characterized by a steady progression of the disease and decline in functional impairments. Aside from brief periods of minor symptom relief, individuals with primary progressive Multiple Sclerosis do not experience periods of remission.

Progressive-relapsing: Progressive-relapsing Multiple Sclerosis is the rarest form of the disease. It is characterized by a progressive worsening of symptoms and functional impairments but interspersed with acute relapses or exacerbations.

The typical onset of Multiple Sclerosis is between 20 and 40 years of age. Females develop Multiple Sclerosis at higher rates than males but the exact cause of Multiple Sclerosis is still unknown. It is thought to be caused by a mixture of environmental factors and genetic susceptibility. This condition is not inheritable but a person may be able to inherit the susceptibility to developing Multiple Sclerosis from a family member. There is no cure for Multiple Sclerosis but there are a variety of treatments. Medical management includes medications that reduce the number and severity of exacerbations and therefore help to delay functional decline. Physical therapy is also recommended to help individuals at all stages of the disease.

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If you decide to work with a physical therapist to help with MS related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY INTERVENTIONS FOR MULTIPLE SCLEROSIS

Physical therapists play a supportive and rehabilitative role in the management of Multiple Sclerosis. Though there are many overlapping symptoms amongst those living with Multiple Sclerosis, each person will have a unique set of impairments. Your physical therapist will individualize a treatment plan to meet your needs, however, these are some of the physical therapy interventions and services you may receive when working with your PT.

Patient education: education on topics like energy conservation techniques, adaptive equipment, safety, fall reduction, exercise and more to help you improve daily function and quality of life.

Gait training: physical therapists can assist in improving gait mechanics, walking endurance and recommend assistive devices for walking.

Balance training: Multiple Sclerosis can cause impairments in balance. Physical therapy can help train the balance systems for sitting, standing, walking and more.

Strength and endurance training: strength training and endurance training to improve muscle performance in the arms, legs and trunk can help with performing daily tasks, participating in exercise and recreational activities.

Pain management: physical therapists can help with the management of musculoskeletal pain related to Multiple Sclerosis.

Equipment prescription: different types of adaptive equipment and assistive devices can improve mobility, energy conservation and quality of life and your physical therapist can help guide you on which devices are most appropriate.

Aerobic training: Your physical therapist can help you participate in an aerobic exercise program safely.

Living with Multiple Sclerosis can seem overwhelming but physical therapy is a great tool to help manage symptoms of this disease and improve function and quality of life. If you are ready to experience how physical therapy can help you, call Evolve today to schedule your initial evaluation.

Call to Schedule a Consultation! 1-718-258-3300