Physical rehabilitation of MS

Physical rehabilitation Assessment

At the initial session, going for a thorough history is crucial. The history should include date of diagnosis, date and nature of initial symptom(s), other health problems, medications, prior activity level, and “top three problems” within the order that they hinder quality of life. This prioritization will advice the Multiple Sclerosis Rehabilitation goal-setting.

The PT evaluation in Ms Rehabilitation should be structured to respect fatigue, and still provide a good overview of the patient’s baseline. Some standardized testing may be spread out over several follow-up sessions of Ms Rehabilitation to avoid patient burn-out and frustration. If your patient’s primary problem is “wobbly walking”, for instance, a gait assessment ought to be performed both at the start and the end from the initial session to find out impact of fatigue on weakness and balance. It's also very important to have a number of trial ambulation aids in the clinic-to introduce these to the patient (initial desire not to accept an aid is typical) and to determine “best fit” for that Multiple Sclerosis Rehabilitation.

Using some standardized assessment tools within the assessment process is usually recommended; however few of those tests routinely utilized in PT have been evaluated especially for the MS population. The few measures currently standardized for MS are:

•        MS Functional Composite (MSFC), including the 25-foot walk

•        Expanded Disability Status Scale (EDSS)-performed by trained physicians and healthcare professionals

•        MS Fatigue Impact Scale (MSFIS)

•        Disease Steps (DS)

•        MS Walking Scale-12 (MSWS-12), someone self-report

Other tests which are useful include:

•        Berg Balance Scale

•        Tinetti Gait and Balance Assessment

•        Activities Specific Balance Confidence (ABC)

•        Timed Up and Go (TUG)

•        Dynamic Gait Index (DGI)

•        Functional Independence Measure (FIM)

•        2-minute walk, 6-minute walk

•        Borg’s Rate of Perceived Exertion

The PT evaluation may include a broad overview, so it’s vital that you prioritize time spent, using the patient’s primary issues addressed first.

•        Posture, Trunk Control, Balance, Transfers

You should assess seated and standing posture and static and dynamic balance. Balance impairments are typical in MS, enhancing the risk of falls. When appropriate, gets in and from bed, chair, toilet, car and floor ought to be evaluated-noting quality, safety, and degree of assistance needed. Start a fall risk/safety profile to steer treatment planning in Ms Rehabilitation. A PT can offer balance retraining through exercises that emphasize strengthening and adaptability. Balance can be improved by way of visual cues or strategies to reduce upper-extremity tremors. Relaxation training is usually used as therapy.

•        Ambulation/Mobility

Since walking requires balance, coordination, torso control, strength, and endurance, rehab for walking requires evaluation famous these areas. The various tools for mobility are actually lighter, easier to handle, more appealing, and more comfortable than ever before. A PT can pick which mobility tools work to your needs and educate you on the skills you need to use them well.

For that ambulatory individual, the desire to carry on walking or “to walk better” is generally a primary goal. Vision, sensation, vestibular or cerebellar deficits, spasticity, muscle weakness, fatigue and shoe wear have to be considered in addition to posture and balance for Ms Rehabilitation. The most appropriate ambulation aid(s) should “normalize” the gait pattern with improved alignment, stability, control and confidence along with a decrease in energy expenditure. A person’s needs often vary with degree of fatigue, temperature, distance to become walked or time. Popular options in Ms Rehabilitation are folding canes (with palm grip handles), lightweight forearm crutches, and four-wheeled rolling walkers (with large swivel wheels for easier maneuvering outdoors as well as on carpets, a flip-up seat with no front cross bar for additional erect posture when walking and also the opportunity to sit and rest if needed, a flexible backrest, and user-friendly hand-brakes). Other effective ambulatory aids for patients with foot drop include custom ankle-foot-orthoses (AFOs) made from lightweight plastics-articulated or solid-or the newer ultra lightweight carbon composite materials, hip-flexion-assist-orthoses (HFAO), or even the new wireless functional electrical stimulators (FES).The Lokomat does a lot more than move the legs. Feedback is supplied on the screen for reinforcement.

•        Range of movement (ROM)

Both passive and active functional ROM ought to be assessed in the extremities and trunk, limiting detailed goniometric measurement to noted trouble spots for time and fatigue reasons. Sedentary or inactive persons with MS often present with significant tightness in hip flexors, adductors, hamstrings and heel cords. Limited overhead reach is usually noted in individuals with slumped posture because of tightness in the pectoralis minor, major and latissimus dorsi. Poor head control because of postural and substitution patterns often results in tightness in the upper trapezius and postero lateral cervical muscles.

•        Motor Function

Assessment should concentrate on gross strength, with focus on function, in the extremities and trunk. Focus specific muscle testing on trouble spots to minimize fatigue. Quality and charge of movements, as well as substitution patterns, have to be noted for Multiple Sclerosis Rehabilitation. A vital is to prevent or correct “secondary” or “disuse” weakness, commonly observed in persons with MS who've assumed a sedentary lifestyle or embraced compensatory movement patterns. Weakness because of inactivity and poor posture is often found in the trunk, lower abdominals, gluteus medius and maximus, middle minimizing trapezius, and high anterior neck flexors. Muscle imbalances of anterior/posterior tightness versus weakness (like the iliopsoas and gluteus maximus) frequently respond favorably to some corrective exercise program and postural correction and awareness.

•        Neurological Function

Assessment of neurological symptoms is essential in Multiple Sclerosis Rehabilitation for growth and development of treatment interventions (to supplement pharmacologic therapies) for improved safety, control and performance. Common problems include abnormal tone-usually hyper-tonicity (which can be constant, fluctuating, or intermittent)-clonus, and tremors (could be “resting”, “intention” or both). Note interference with function. Other deficits connect with coordination, sensation (hyper or hypo), proprioception and pain. Referral to some neurologist, physiatrist, or pain specialist for further treatment interventions might be warranted in Ms Rehabilitation.

•        Spasticity

Normal movements need a coordinated sequence: As you muscle contracts, an opposing muscle must relax. MS can disrupt this method, resulting in the simultaneous contraction of opposing muscles. This is known as spasticity. The affected part of the body becomes stiff or hard to move and has a tendency to feel very tight. Spastic sensations may vary from neutral to mildly unpleasant to very painful. In severe cases, spasticity may even cause a limb being “frozen” in a bent position, requiring immediate medical assistance.

Spasticity can be managed in Ms Rehabilitation with the help of your physician and a PT. A mix of medication, exercises, adaptive devices, and relaxation techniques might be prescribed. Exercise programs will probably include stretching and range-of-motion exercises. Exercise inside a cool swimming pool is useful because the buoyancy of the water makes smooth movements easier. Passive exercise (when another person moves your body) is especially effective for managing spasticity. Specific positioning will also help to decrease spasticity.

•        Physical fitness

Appropriately designed exercise programs in Ms Rehabilitation are of enormous help to people with MS. Exercise assists in maintaining or even build endurance. Following a flare-up of MS symptoms, exercise might help restore function and re-energize an individual. A PT, physiatrist, or exercise physiologist in Ms Rehabilitation can provide the best way forward on a good program which includes aerobic and non-aerobic exercises. It is advisable to seek help from someone acquainted with MS.

•        Pain from awkward positions

The medical term is “musculoskeletal dysfunction.” It is a result of unusual positioning from the body caused by MS symptoms. For instance, hip, knee, or back pain can stem from a strange standing position that the person has developed so that they can maintain balance. Fatigue could make this kind of pain a whole lot worse. Overuse of certain muscles to pay for other muscles may also lead to pain. Your physician will need to determine whether your pain is brought on by nerve damage or by musculoskeletal dysfunction in Ms Rehabilitation. If the latter has occurred, a PT can devise a course of strengthening and stretches, practice of proper positioning, and compensatory techniques, for example bracing or utilization of an assistive device, to avoid awkward or unneccessary use of joints or muscles.

•        Pressure sores

Many alterations in the body may occur if mobility is severely impaired. An individual who is immobile runs the chance of developing pressure sores. These occur once the skin breaks down from constant pressure brought on by sitting or lying in a single position. This pressure reduces the blood supply towards the underlying skin, fat, and muscle. These sores usually occur over bony prominences like the tailbone, buttock, heel, shoulder blade, elbow, and perhaps the back of the head. Sores could also develop from friction towards the skin. This is called shear and could result from sliding across a bed or wheelchair. Your skin is much more likely to break up if it is moist or infected. Thus incontinence(the inability to control urine or bowel motions, or both) can also add to the problem.

The easiest method to treat a pressure sore in Ms Rehabilitation is to avoid developing one out of the first place. Pressure sores could be prevented in the following ways: Wake up or change positions frequently, or have somebody assist you to change your position a minimum of every two hours. Keep your skin clean and dry. Check skin for reddened areas or sores during self-care routines. And ensure nutrition and fluid intake is adequate. Treating pressure sores in Ms Rehabilitation becomes more difficult because the sore advances. It's imperative to see your physician if you think that a pressure sore has started.

•        Respiratory Function

It is important to notice that respiratory problems are common in additional disabled patients, but additionally exist in a large number of persons with MS which have minimal disability. Many people find that relaxation techniques and breathing, such as those utilized in yoga or t'ai chi, for instance, help them relax when you exercise. These kind of techniques could be learned with books or tapes, or through classes. Should you join a class, you might like to explain your needs towards the teacher beforehand so they are aware of any adjustments you may want. It is important to take any exercise in a pace that suits you.

•        Wheeled Mobility

Using a wheelchair or scooter is usually appropriate when long distances should be covered and energy conservation is needed, allowing needed community access. Some persons with MS should you prefer a standard wheelchair due to the portability, but adequate torso strength and endurance are essential. In most cases, motorized wheeled mobility is the foremost choice for long term independence. A scooter (or “power operated vehicle”) is wonderful for individuals in Ms Rehabilitation with significant fatigue, weakness, paraparesis or ataxia who retain good dynamic sitting balance and transfer skills. An electrical wheelchair would be appropriate for individuals who are minimally or non-ambulatory and require additional seat and trunk support. In every case Multiple Sclerosis Rehabilitation, consideration should be given to vision, cognition, safety awareness, and use of home and vehicle.

•        Other Important Considerations

Persons with MS have numerous other issues that need to be considered in Ms Rehabilitation as part of the PT evaluation, goal-setting so when making referrals with other team members. In addition to vision, cognition and speech or swallowing problems, it’s vital that you consider each patient’s support/social network, emotional stability (depression is typical), and vocational/homemaking history in Ms Rehabilitation.

Goal Setting and Treatment Plans

It is crucial in Multiple Sclerosis Rehabilitation the short-term therapy goals have patience driven (their “wish list”), functionally focused, realistic and attainable. Each PT should make an effort to teach corrective exercises and activities that may easily be followed in your home or community to supplement any clinic equipment that could be used. Some “food for thought”: If leg weakness, fatigue, and impaired gait are primary issues, the individual will benefit more from functional activities completed in(supported) standing than s/he will from three sets of 10 leg lifts or Twenty minutes on a stationary bicycle. There is lots to be said for specificity of coaching in Multiple Sclerosis Rehabilitation with this particular population. In every case, fatigue should be respected, overheating avoided, and rest intervals provided-excellent opportunities for education and resourcing (that ought to be billed as “therapeutic activities”) throughout the treatment session. Long-term goals in Ms Rehabilitation should include a highly effective home and community program with less reliance on formal physical therapy.

Home Physical rehabilitation Programs

The key aspects of a successful home program are that it's enjoyable, varied, goal-oriented and realistic. Compliance issues include fatigue, poor motivation, depression, insufficient needed support or the help of family and friends, time constraints, and cognitive dysfunction (usually short-term memory, attentional, or sequencing deficits, which necessitates the therapist to provide the exercises in written instructions and photographs). Emphasis needs to be positioned on corrective exercises to: (1) improve function (restoring alignment, mobility, and strength/endurance lost because of inactivity/disuse or compensatory movement patterns), (2) manage spasticity (slow stretching, cold packs, controlled position changes), and (3) control energy management (careful pacing, flexible work and activity schedules, pro-active resting vs. reactive “collapse”, avoiding overexertion/ overheating, and substitution of much easier /strenuous/frustrating activities). Compliance is enhanced when the patient notes slow steady progress toward reaching the goals of improved symptom management and increased activity and participation fitness center in the community.

• Managing heat during exercise in Ms Rehabilitation

Not everyone with MS is impacted by heat, but some are particularly sensitive. Warm weather, an over-heated room and use can all make MS symptoms worse. This can be a temporary effect - once the body cools back off, symptoms return to the amount they were before. If you're sensitive to heat, keeping cool during or shortly before exercise will let you exercise for longer, or even more strenuously, without bringing on heat-related symptoms. This may be done with ice drinks, cooling garments, or with regular breaks to avoid overheating.

Research showing benefits of these cooling techniques isn't conclusive, and they might not help everyone, but they're unlikely to be harmful. Using the support of a medical expert, you may find a cooling method which works for you. Lowering the body’s temperature, with cold baths or cooling garments, may also reduce some people’s muscle stiffness temporarily. Applying cold packs or cold towels straight to affected muscles can provide temporary relief for spasms or stiffness. Again, scientific studies are not conclusive, however, you may find such cooling techniques help your symptoms.

In comparison, some people with MS discover that cool temperatures make their spasms or stiffness worse. Of these people, exercising inside a warm swimming pool might help with stretching and relaxing muscles. Be cautious with hot and cold therapies. When applying cold straight to the skin, or when utilizing cooling garments or cold water for cooling the body, care ought to be taken not to damage your skin. MS can cause changes towards the way you experience temperature, distorting the sensation that would normally let you know when something is simply too hot or freezing. It is sensible to see your doctor, MS nurse or physiotherapist if you're thinking of using such techniques.

Merely a physiotherapist can instruct yourself on the proper way to exercise in Ms Rehabilitation.

Follow-up

Optimal follow-up for outpatient therapy will be different according to individual needs, and typically differs from the “traditional” (orthopedic or fixed deficit neurological condition) type of 2-3 times/week for 6-8 weeks. Dedicated one-on-one sessions ought to be scheduled “as needed” since the requirement for Multiple Sclerosis Rehabilitation is prolonged and likely to increase as we grow older. Consideration must be provided to the numerous compliance challenges, including transportation, weather (cold causes stiffness, high temperature and humidity cause weakness), and insufficient energy, motivation or support. Continuity with therapy provider (s) is yet another important consideration for improved compliance with follow-up. Initially it may be appropriate for patients to become scheduled 1-2 times per week to meet short-term goals. Then your frequency should lessen to weekly or almost every other week until symptoms are controlled as well as an effective home/ community Ms Rehabilitation program continues to be established. At that time follow-up ought to be “prn” to revise or augment this program or trouble-shoot any new problems.

Occupational Therapists (OTs) Role in Ms Rehabilitation

Occupational Therapists (OTs) concentrate on skills that require upper-body strength, coordination, and fine-motor control. Included in this are all the “occupations” of everyday life, such as bathing, toileting, household chores, and dealing at a job. OTs also concentrate on cognitive problems, and may assist with cognitive retraining and techniques to compensate for difficulty in remembering things. Most important, OTs can help with energy conservation.

•        multiple sclerosis fatigue

Fatigue is among the most common symptoms of MS, and often the most disabling one. It affects all you do. Your physician may prescribe medications and regular rest periods. Fatigue can also be managed by conserving energy and dealing efficiently. OTs are the experts on labor saving and energy-conservation techniques. Ask your personal doctor for a referral if fatigue is disrupting your lifetime.

•        Upper body function

An OT can suggest exercises to improve the strength and coordination of the arms and hands. Doing this can improve independence and performance in your daily activities.

•        Driving

Driving could be affected by many MS-related disabilities. An OT can assess your ability to drive and determine whether the available adaptations is useful for you. Testing ought to be conducted both in the OT’s office as well as on the road. Bear in mind that the laws regarding what types of testing and reporting are essential vary from state to state. Hand controls for braking and acceleration are for sale to people who cannot depend on their legs. Steering knobs might help people who have the use of just one arm. And wheelchair lifts could be installed in certain cars and vans for drivers and passengers who use scooters or wheelchairs

•        Computers and electronics

Computers open an enormous amount of recreation and job-related activities, but MS symptoms may need special adaptations. For instance, people with vision problems may use computers with enlarged keyboards, magnifying displays, or text-to-speech programs that read aloud the fabric onscreen.

Electronic controllers can be used for virtually all the appliances within an environment-lights, radios, telephones, televisions, air conditioning units, even doors. An OT will help you determine which devices are most suitable, and where you can have any training that’s needed.

•        Daily occupations

The “occupations” of occupational therapy range from the everyday things you do-caring on your own and your household, holding employment, recreation. Bathing, toileting, dressing, eating, and household chores can become hard to do in the presence of certain impairments. An OT can counsel you about techniques and adaptive devices to pay for particular disabilities.

Vocational Rehabilitation Specialist's Role in Ms Rehabilitation

Vocational Rehabilitation Specialists concentrate on retraining or utilization of adaptations and accommodations at work. They may work independently or perhaps in consultation with your OT.

Psychologist's Role in Ms Rehabilitation

Psychologists help people learn methods to handle their emotional and cognitive problems and cope with the impact of MS around the family.

Sexuality

Neurologists, urologists, sex therapists, specialized nurses, and psychologists may all may play a role in addressing sexual dysfunctions caused by MS. Men might have difficulty achieving or maintaining erections, or reaching orgasm; women can experience impaired sensation, numbness or tingling within the genital area, insufficient lubrication, or difficulty reaching orgasm.

MS also affects sexual responses indirectly. Fatigue, pain, bowel or bladder problems, and also the emotional impact of getting MS can dampen sexual interest. Spasticity may prevent using certain positions.

Taking an energetic approach to sexual problems implies that both partners explore adaptations in sexual expression. If you discover these conversations difficult, a psychologist might help start this process. Treatment to manage symptoms is a component of the solution. Same with attention to the emotional concerns of each partner.

Neuropsychologist's Role in Ms Rehabilitation

Neuropsychologists specialize in memory, problem solving, along with other cognitive problems, and may assess individuals which are more precise diagnosis of these difficulties.

Loss of memory and other cognitive difficulties Poor recent memory is easily the most commonly reported cognitive overuse injury in MS. Psychologists, speech pathologists, and OTs can suggest teach simple compensatory strategies, for example making lists, writing notes, learning memory tricks, and keeping a “memory” notebook.

Individuals with MS can also experience issues with concentration, reasoning, judgment, and also the ability to learn. A neuropsychologist might be recommended for evaluation and style of the best therapy. Restructuring day to day activities and providing supervision may be required in rare situations.

Even very mild cognitive problems can increase fear, anxiety, and depression-emotions that by themselves are disabling. A psychologist can offer supportive counseling.

Speech/Language Therapist's (or Speech/Language Pathologist's) Role in Ms Rehabilitation

Speech/Language Therapists (or Speech/Language Pathologists) use speech when MS makes talking difficult or causes swallowing problems. They are able to also help with problems in cognitive functioning, memory problems, and taking advantage of language, which may stem from MS-related injury within the “thinking” part of the brain.

If it’s tough to speak or swallow, When MS affects areas of the brain that control muscles within the mouth, throat, or voice box, speech and/or swallowing difficulties may result. To enhance speech, the therapist may teach breath control techniques or how you can speak more slowly with focus on key words. Voice amplifiers might help when a person cannot generate volume. If speech is severely impaired, other communication products are available. Swallowing problems might be helped by exercises, altering mealtime routines to advertise relaxation, or by looking into making changes in the diet, or even the position of the body while eating.

When the words are wrong

Common language symptoms involve the inability to find the right word or utilizing an inappropriate substitute word. These complaints can be handled with compensatory techniques.

Urologist's Role in Ms Rehabilitation

Urologists treat urinary infections, bladder problems, and sexual dysfunctions.

Bladder problems

Lots of people with MS experience bladder problems previously or another. The most common troubles are increased frequency or urgency, leakage, difficulty urinating even with the urge to do so, and also the inability to hold urine within the bladder. Sometimes the bladder doesn't empty completely, which could set the stage for bladder infections. Diagnosis is the initial step. Symptoms may then be managed by medications, diet changes, and perhaps self-catheterization, in which a small tube, or catheter, is inserted with the urethra into the bladder so urine can drain. (This sounds difficult or painful, but most people can learn how to do it easily and comfortably.) There's also exercises involving the pelvic floor muscles which may be appropriate.

Gastroenterologist's Role in Ms Rehabilitation

Gastroenterologists focus on serious bowel difficulties.

Bowel irregularity

Constipation may occur due to MS-related neurological damage, or loss of focus, inadequate fluids, or poor diet. The very first line of therapy usually involves modifying this diet to include more fruits, vegetables, and whole grain products , and six to eight portions of water each day. If these measures don’t solve the issue, consult your physician or nurse. A gastroenterologist is going to be needed in difficult situations.

Incontinence, or lack of bowel control, is really a much less frequent complication and could result from leakage around impacted stool. Stool bulkers, a normal “bowel program,” and medication can also be prescribed. A physiatrist can also be very helpful with both bowel and bladder problems.

Nurse's Role in Ms Rehabilitation

Nurses-First and Last.

A nurse could possibly be the linchpin of your rehab program. Nurses are educated to identify health problems, do assessments, and fasten people to appropriate specialists. “Patient education” is on their own job description and nurses can make time to listen to the questions you have and teach you self-help techniques.

Coping with MS

Living well with MS means a lot more than getting strategy to symptoms, adopting new techniques, and adapting to physical changes. This means accepting MS in your life. Accepting without giving was not an easy task, and there's no one right way to get it done.

Multiple Sclerosis Rehabilitation provides a few of the tools you need to moderate your MS rather than having MS manage you. Counseling with a psychologist, social worker, or psychiatrist that has worked with people who have chronic diseases might be extremely helpful.

It may also be useful to meet other people who accept MS. Support groups, self-help meetings, and trained peers with MS all give a chance to share information and concerns.