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Physiotherapy in the Early Stage of Multiple Sclerosis. Paul Van Asch Secretary of RIMS Head of Physiotherapy Dept. National Multiple Sclerosis Centre Melsbroek - Belgium p.vanas[email protected] International MS Conference 20 - 24 September 2003 DMSG Berlin.
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In-patient department: 134 beds
Out-patient department: 80 PwMS / day
and Rehabilitation in MS
The goal of every treatment approach should be to encourage
self management and to provide the PwMS a sense of control
over their disease.
Thus a sensible management strategy for the majority of
symptoms should include: - Education
- Therapy input
- Drug treatment
Due to the progressive condition periodic reassessement is needed.
( A. Thompson, J Neuro Neurosurg Psychiatry
2001; 71(suppl II):ii22-ii27)
+ Maintain and increase of ROM
+ Stimulate postural stability
+ Prevention of contractures
+ Support weight - bearing
L. De Souza, MS: Approaches to Management, 1990
progressive nature of MS without prognosis => sensible approach
Preventative therapeutic role
1/ Providing Information
2/ Training Program
To Whom ? - PwMS
- Caregivers (professional and non-professional)
How ? - MS - school
- Partner sessions
- Local MS Self Help Groups
=> In collaboration with the Belgian MS - Society
potential impact on Functional Activities
Potential Impact on
- Leisure activities
- Professional activities
- Ataxia, Tremor
- Balance Problems
Physiotherapy is more than a passive
intervention of stretching and mobilization
of specific parts of the body, the PwMS
needs 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)
When to start Physiotherapy ?
Why ? => Prevention and management of problems
in the locomotor system
= Adapted to the needs and possibilities
of each PwMS
1/ Evaluation : anamnesis, overall testing
2/ Training Program : variety of techniques
3/ Follow Up : 6 - monthly
Pelvic Floor Exerc.
Tentative evidence exists to support rehabilitation in MS
- Physiotherapy:Wiles CM et al. Controlled randomised crossover trial of
the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol
Neurosurg 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 level
of subjects with mS, Multiple Sclerosis 2002;8:161-168
- Rehabilitation in MS:Freeman, Solari, Rodgers, Ponichtera, Petajan
- Clinical Experience
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.
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)