PT Classroom - The Role of Physical Therapy in Multiple Sclerosis ׀ by Lisa Hawley, RN, BSN, MSM & Sarah Meuler, DPT

Multiple sclerosis (MS) is the most common neurological disorder diagnosed in young adults. Multiple Sclerosis (MS) is an autoimmune inflammatory disease of the Central Nervous System (CNS). In MS, white blood cells, meant to fight infection or disease instead target and attack the body's own cells. This attack causes inflammation in the CNS, which may damage the myelin and ultimately injure the nerve fibers. The white matter is made up of nerve fibers that are responsible for transmitting communication signals both internally within the CNS and between the CNS and the nerves supplying rest of the body, causing reduced or lost bodily function.

Areas of thick scar tissue may eventually form along the areas of damaged myelin. The term “multiple sclerosis” originated from the discovery of these hardened plaques. Multiple refers to many; sclerosis refers to scars. In people affected by MS, patches of damage called plaques or lesions appear in seemingly random areas of the CNS white matter. At the site of a lesion, a nerve insulating material, called myelin, is lost. Clinically, MS is a hard condition to characterize because it is very unpredictable and variable. The changes in size, number, and location of these lesions may determine the type and severity of the MS.

Approximately 400,000 individuals have been diagnosed with MS in the United States and as many as two and a half million worldwide, with an estimated 10,000 new cases diagnosed in the United States annually. Most people with MS experience their first symptoms and are diagnosed between the ages of 15 and 50. Women are three times as likely than men to develop MS. This is especially true for people in North America, Europe, and southern Australia, while Asia continues to have a low incidence of MS. More prevalent among those of northern European or Scandinavian ancestry, Caucasians are far more likely than those of African heritage to develop this disease. Populations living closer to the equator experience a lower incidence of MS (1).

The cause of MS is unknown. However, a variety of theories have been and continue to be studied including viruses (one that could remain dormant for many years), such as measles, herpes, human T-cell lymphoma, and Epstein-Barr, nutritional factors, including fat intake, as well as deficiencies in fish oil and vitamin D.

While MS is not contagious or hereditary, MS susceptibility is increased if a blood relative has MS. For first-degree blood relatives (such as a child or sibling), the risk increases to three or four percent. In instances where one identical twin has been diagnosed with MS, the other twin has a 31 percent risk of developing the disease. The risk for twins who are not identical is five percent - similar to that of other siblings.

The effects of MS differ with each individual. Some people experience symptoms for a short period of time and afterward may remain symptom-free for periods or months or years while others may experience a more steady progression of the disease. Damage to one site usually causes completely different symptoms than damage to another. People with MS can experience partial or complete loss of any function that is controlled by, or passes through, the brain or spinal cord.

MS can be and often is a very serious disease but almost nobody loses function in all possible areas and some people are affected much worse than others. People with MS can experience any of the following problems either fully or partially in the effected area- numbness, tingling, pins and needles, muscle weakness, muscle spasms, spasticity, cramps, pain, blindness, blurred or double vision, incontinence, urinary urgency or hesitancy, constipation, slurred speech, loss of sexual function, loss of balance, nausea, disabling fatigue, depression, short term memory problems, other forms of cognitive dysfunction, inability to swallow, inability to control breathing.

While the disease course cannot be altered by rehabilitation, physical therapy does play an integral role in improving and maintaining function (2). Physical therapy needs vary with each patient’s disease course therefore the timing and degree of need should be tailored to each MS patient. Intervention early in the disease should be considered since behavioral and lifestyle changes may be easier to implement and can prevent the patient from becoming even further debilitated.

Research and professional experience support the use of rehabilitative interventions as part of a comprehensive treatment plan for the following conditions associated with MS: Mobility impairments (strength, gait, balance, range of motion, coordination, muscle tone and endurance), fatigue, pain, dysphagia, bladder/bowel dysfunction, decreased independence in activities of daily living, impaired communication, diminished quality of life due to inability to work or maintain usual life roles or to engage in pleasurable pursuits, depression and cognitive dysfunction. In this unpredictable, fluctuating and progressive disease, maintenance of function, optimal participation, and quality of life are essential outcomes for which to strive. Rehabilitation needs to focus on achievement and maintenance of optimal function and quality of life (3).