Multiple Sclerosis (MS) is the most common disabling neurological condition affecting young adults. Around 85,000 people in the UK have MS. It is the result of damage to the myelin sheath, which protects the nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body. For some people, MS is characterised by periods of relapse and remission while for others, it has a progressive pattern. For everyone, it makes life unpredictable.
Treatment focuses on our joint assessment of your condition and objectives. This will be a very individual exercise as Multiple Sclerosis varies enormously in its physical effect and you may have long-standing difficulties or objectives to address. Physiotherapy can help support your general mobility and function, allowing you to maintain greater independence and control at home and work.
4 types of Multiple Sclerosis
There are 4 different types of Multiple Sclerosis which are named according to the way the disease acts on the body over time.
Recognised as the most common form of Multiple Sclerosis, individuals experience clearly defined relapses or flare-ups that result in episodes of intensive worsening of your neurologic function. Following which the individual will go into either a partial or complete remission phase during which the disease stops progressing. Symptoms vary in their degree of intensity and the period of which the relapse or remission phase lasts varies from either days to months.
Individuals with an initial diagnosis of Relapsing-Remitting Multiple Sclerosis after approximately 10 years may transition to Secondary-progressive Multiple Sclerosis which means that the disease will begin to progress more steadily with or without relapses.
Affects 10-15% of people with Multiple Sclerosis with onset being at an average age of 40 with equal number of men and women being affected. This form of Multiple Sclerosis progresses slowly yet steadily from the time of its onset. Symptoms stay at the same level of intensity without decreasing, and there are no remission periods. In essence, patients with primary-progressive Multiple Sclerosis experience a fairly continuous worsening of their condition. However, there can be variations in the rate of progression over the course of the disease—as well as the possibility of minor improvements (usually temporary), and occasional plateaus in symptom progression.
In this relatively rare form of Multiple Sclerosis, people experience their condition as steadily worsening, yet also experience clear relapses in the form of acute flare-ups. In some cases, there is no recovery from these flare-ups, although in other cases there is recovery. The difference between progressive-relapsing Multiple Sclerosis and relapsing-remitting Multiple Sclerosis is that in the former type, the periods between relapses involve continuing progression of the disease.
Multiple Sclerosis Physiotherapy
Physiotherapy addresses both the motor and sensory symptoms of Multiple Sclerosis. It is common for individuals to experience changes in their sensation of their limbs and hence lose awareness of where their limb is in space in relation to their body. Making walking on uneven surfaces, gradients up/down steps extremely challenging. Use of vibration, weight and brushing are just a few examples which can improve sensation in the limbs. Improved sensation will in turn improve voluntary control of the muscles.
Individuals with Multiple Sclerosis may also experience changes in their ability to coordinate their movements and grade their muscle activity leading into impairment in their balance and in turn to undertake functional tasks. These difficulties can be addressed in all postural sets; lying, sitting and standing focusing on the switching off and on of specific muscle groups to achieve smooth coordinated movement patterns. These skills will then be transferred to functional activities such as transition from sit to stand or walking.
Multiple Sclerosis can cause significant muscle imbalance as certain muscles may weaken and others may exhibit spasticity or spasms. It is essential that this imbalance is continually being assessed, monitored and addressed with specific exercises, use of functional electrical stimulation and functional task practise such as walking, focusing on the quality and pattern of movement.
Functional Electrical Stimulation can be used functionally, for example in the form of a drop foot device which is worn by the individual and activates the muscles to lift the toes automatically when walking. Or it could be used therapeutically, such as the functional electrical stimulation bike to work on global strengthening of the lower limbs and cardiovascular fitness.
Many feel one of the main limitations of multiple sclerosis to be fatigue. Physiotherapy will not only assist in improving and maintaining muscle strength, coordination and cardiovascular fitness but also to teach about pacing, recognising your limitations and identifying trigger factors which can induce significant fatigue.