PHYSIOTHERAPY FOR MULTIPLE SCLEROSIS
Multiple sclerosis is a demyelinating disease affecting the white matter of the central nervous system. Although the lesion generally appears to be disseminated, so it’s also called as disseminated sclerosis. The lesion tends to be more or less symmetrical.
The common characteristic clinical and pathological findings that are observed in multiple sclerosis are paralysis, intentional tremor, scanning speech and nystagmus. Multiple sclerosis is a very unpredictable disease with a characteristic exacerbation and remission. The common age group involved in 15 to 40 years.
MANAGEMENT
Sensory retraining: various sensory stimulation like tapping, vibration, stroking and hacking can be used to bring about sensory re-education. The objects of various size, shape, textures and weight may be used to stimulate sensation in these patients. The patient may be advised to use visual sensation as a compensatory mechanism or loss of tactile and Proprioceptive sensations.
TENS may be used for the tingling sensation. Various techniques of home adaptation are necessary to increase the visual input to help the patient in overcoming the blurred vision. Regular inspection of the body parts is necessary to check for any sores or wound.
The patient should also be instructed to maintain good skin hygiene so as to prevent any chances of infection. The patient can be given relief from pain by using electrical modalities like TENS, IFT or even hot packs to relieve muscle spasm.
Spasticity can be reduced by prolonged icing, sustained stretching, gentle passive movement, weight bearing exercises, biofeedback, etc. Mobility and flexibility exercise for the joint is essential to prevent stiffness. Stretching of particular muscles of the lower and upper limb is necessary. The gentle passive movement also helps to maintain range of motion at all joints. PNF techniques like hold relax, contract-relax helps in lengthening tight muscles.
Management of paresis and fatigability can be achieved by improving the strength and endurance of the muscles. Resisted exercises based upon the capacity of the patient may be given. Weight-bearing activities help in increasing the strength and endurance of various postural muscles. In order to overcome fatigue, the patient may be taught some energy conservation techniques.
Coordination exercises need to be given to overcome in coordination. Gait training initially with support and later on without support should be carried out. Infarct some patients may need some orthosis to improve their walking abilities. Good deep breathing exercises and aerobic exercises need to be given to correct cardiorespiratory de-conditioning.