Physiotherapy in the Early Stage Physiotherapy in the Early Stage

of Multiple Sclerosisof Multiple Sclerosis

Paul Van AschSecretary of RIMSHead of Physiotherapy Dept.National Multiple Sclerosis Centre Melsbroek - Belgiump.vanasch@ms-centrum.be

International MS Conference20 - 24 September 2003DMSG Berlin

National Multiple Sclerosis Centre National Multiple Sclerosis Centre Melsbroek, BelgiumMelsbroek, Belgium

In-patient department: 134 bedsOut-patient department: 80 PwMS / day

Objectives of Symptomatic Management Objectives of Symptomatic Management and Rehabilitation in MSand Rehabilitation in MS

The goal of every treatment approach should be to encourageself management and to provide the PwMS a sense of controlover their disease.

Thus a sensible management strategy for the majority ofsymptoms should include: - Education

- Therapy input - Drug treatment

Due to the progressive condition periodic reassessement is needed. ( A. Thompson, J Neuro Neurosurg Psychiatry( A. Thompson, J Neuro Neurosurg Psychiatry 2001; 71(suppl II):ii22-ii27)2001; 71(suppl II):ii22-ii27)

4 Primary aims of Physiotherapy in MS4 Primary aims of Physiotherapy in MS

+ Maintain and increase of ROM

+ Stimulate postural stability

+ Prevention of contractures

+ Support weight - bearing

L. De Souza, MS: Approaches to Management, 1990

Is there a role for Physiotherapy in the Early Stage of MS?Is there a role for Physiotherapy in the Early Stage of MS?

YesYes

progressive nature of MS without prognosis => sensible approach

Preventative therapeutic role

1/ Providing Information1/ Providing Information

2/ Training Program2/ Training Program

3/ Support3/ Support

1/ Providing Information1/ Providing Information

To Whom ? - PwMS - Partner - Caregivers (professional and non-professional)

How ? - MS - school - Partner sessions - Local MS Self Help Groups

=> In collaboration with the Belgian MS - Society

Potential Impact onPotential Impact onFunctional ActivitiesFunctional Activities

- Walking

- Leisure activities

- Professional activities

Motor SymptomsMotor Symptoms

- Spasticity

- Paresis

- Ataxia, Tremor

- Balance Problems

What ? => The occurence of Motor Symptoms and their potential impact on Functional Activities

What is Physiotherapy ?What is Physiotherapy ?

When to start Physiotherapy ?When to start Physiotherapy ?

Physiotherapy is more than a passive intervention of stretching and mobilizationof specific parts of the body, the PwMSneeds to be an active participant in a functionally oriented exercise program (Mertin, Paeth, Physiotherapy and MS:application of the Bobath concept. MS Management 1:10-13)

IndividualNot continuous

2/ Setting up a Training Program2/ Setting up a Training Program

Why ? => Prevention and management of problems in the locomotor system

INDIVIDUAL PROGRAMSINDIVIDUAL PROGRAMS

= Adapted to the needs and possibilities = Adapted to the needs and possibilities of each PwMSof each PwMS

1/ Evaluation : anamnesis, overall testing

2/ Training Program : variety of techniques

3/ Follow Up : 6 - monthly

Aerobic Training

RelaxationPelvic Floor Exerc.

Stretching

Strengthening

Energy Management

Do we have some evidence ?Do we have some evidence ?

Tentative evidence exists to support rehabilitation in MS - Physiotherapy: Wiles CM et al. Controlled randomised crossover trial ofthe effects of physiotherapy on mobility in chronic multiple sclerosis. J NeurolNeurosurg Psychiatry 2001;70:174-9

- Aerobic Training: Petajan JH et al. Aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996;39:432-41

Mostert S, Kesselring J. Effects of a short term exercise training program on aerobic fitness, fatigue, health perception and activity levelof subjects with mS, Multiple Sclerosis 2002;8:161-168

- Rehabilitation in MS: Freeman, Solari, Rodgers, Ponichtera, Petajan

- Clinical Experience

3/ Support3/ Support

PwMS

Partnerfamily

Professionalhome

Rehab centre

MS-society

ConclusionsConclusions

Successful treatment cannot be measured by wether or not the PwMS improved, but rather by wether or not the best level of activity is achieved with respect to an individual’s life style at each stage of the disease. ( L. De Souza, MS Approaches to management 1990)

Tentative evidence exists to support Rehabilitation in MS.

Within the multidisciplinary team, the physiotherapist has an important role in the prevention and management of locomotor problems in the early stage of MS.

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