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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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slide1
Physiotherapy in the Early Stage

of Multiple Sclerosis

Paul Van Asch

Secretary of RIMS

Head of Physiotherapy Dept.

National Multiple Sclerosis Centre

Melsbroek - Belgium

[email protected]

International MS Conference

20 - 24 September 2003

DMSG Berlin

slide2
National Multiple Sclerosis Centre

Melsbroek, Belgium

In-patient department: 134 beds

Out-patient department: 80 PwMS / day

slide3
Objectives of Symptomatic Management

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)

slide4
4 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

slide5
Is there a role for Physiotherapy in the Early Stage of MS?

Yes

progressive nature of MS without prognosis => sensible approach

Preventative therapeutic role

1/ Providing Information

2/ Training Program

3/ Support

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1/ 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

slide7
What ? => The occurence of Motor Symptoms and their

potential impact on Functional Activities

Potential Impact on

Functional Activities

- Walking

- Leisure activities

- Professional activities

Motor Symptoms

-Spasticity

- Paresis

- Ataxia, Tremor

- Balance Problems

slide8
What is Physiotherapy ?

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 ?

Individual

Not continuous

slide9
2/ Setting up a Training Program

Why ? => Prevention and management of problems

in the locomotor system

slide10
INDIVIDUAL PROGRAMS

= 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

slide11
Aerobic Training

Stretching

Energy Management

Strengthening

Pelvic Floor Exerc.

Relaxation

slide12
Do we have some evidence ?

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

slide13
3/ Support

Partner

family

Professional

home

MS-society

PwMS

Rehab centre

slide14
Conclusions

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)

slide15
Thank You

www.rims.be

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