| The Role Of Rehabilitation And Exercise In The Management Of Multiple Sclerosis |
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Historically, people with MS were discouraged from increasing their activity because
it was felt that physical and psychological stress may enhance disease activity.
Over the past 10 years, research has dispelled those myths and exercise and
rehabilitation have been proven effective in improving function and quality
of life for those with MS.
The results of inactivity are well documented. Those who are less active
develop a greater risk for coronary artery disease. In addition, decreased
activity in people with MS can lead to secondary complications such as
joint contractures, decubitus ulcers and depression. The cyclical nature
of decreased activity leading to deconditioning which leads to physical
impairment or psychological problems will, in turn, lead to decreased activity.
Rehabilitation seeks to interrupt this unhealthy cycle.
Research, done by Freeman1,2 and his colleagues, demonstrated the
effects of inpatient rehabilitation on patients with MS. Benefits
included reduction in disability and handicap as well as improvement
in emotional well-being and health related quality of life (HRQL).
Solari3, et. al., also demonstrated the positive effects of rehabilitation
on ambulatory patients with MS. There was improvement in disability and HRQL
as the result of a 3-week rehab program. Petajan4 and colleagues examined the
effects of a 15-week exercise program on people with MS and found that exercise
training resulted in improved fitness and had a positive impact on quality of life.
Because of the complexity and unique nature of MS, an interdisciplinary approach to
rehabilitation is preferred. An interdisciplinary approach is one in which
healthcare professionals from different disciplines coordinate patient treatment.
The coordination of treatment provides the teamwork necessary to optimize treatment.
Members of the interdisciplinary team often include neurologists, physiatrists,
nurses, physical therapists, occupational therapists, speech/language pathologists,
social workers and psychologists. It may also include other specialty physicians
and allied healthcare professionals. The “team approach” provides expertise from
many areas with the ability to prioritize goals and coordinate treatment.
In order for this approach to be effective the patient must be an integral
and active participant. It is extremely important to center treatment around
the patients’ goals. Also, it is extremely important for the patient’s family
to be involved in the treatment planning and implementation.
Common rehabilitation goals for people with MS include:
- Reducing disability and handicap
- Improving physical, cognitive and emotional function
- Maintaining vocational pursuits
- Maintaining or increasing leisure activities
- Patient and family education
- Improving quality of life
Exercise is often the focal point of rehabilitation. Therefore an exercise program
can be used as a “therapeutic ritual”. This “therapeutic ritual” provides the
person with MS something to organize their day around with the residual benefit
of maintaining and/or improving their physical and emotional health.
Rehabilitation and exercise have large roles in the management of a person with MS.
Many improvements can be achieved including increased mobility, increased
independence, increased overall function, increased endurance, return to
employment, greater socialization and improvement in quality of life.
An interdisciplinary approach is recommended to provide the most coordinated,
comprehensive program possible.
REFERENCES:
- Freeman JA, Langdon DW, Hobart JC, et al. Ann Neurol. 1997;42:236-244.
- Freeman JA, Langdon DW, Hobart JC, et al. Neurology. 1999;52:50-56.
- Solari A, Filippini G, Gasco P, et al. Neurology. 1999;52:57-62.
- Petajan J, Gappmaier E, White AT, et al. Ann Neurol. 1996;39:432-441.
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| - reprinted with permision from- The Heuga Center . |
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