Physical Rehabilitation and MS

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Physical Rehabilitation and MS

Postby LisaBee » Thu Jul 06, 2006 6:05 pm

I know I have probably whined too much on this site about the state of MS drug development and the usefullness of existing drugs. I'll probably continue to complain about all that. In the meantime, however, I have been seeing a few interesting articles about physical rehabilitation in MS patients. I became interested about exercise when I saw on TV a few months ago a show about a man in his 60s with Parkinson's disease who ran marathons. He was on Parkinson's meds, and occasionally had problems with "freezing up", but he kept plugging, and his general physical condition was actually very good, much better than most men his age. His doctors were of the opinion that his exercise actually had some neuroprotective components to it and reduced the severity of his Parkinson's disease. It was very inspirational to see him. I don't post this thread to suggest we all just go and become aspiring marathoners - (MS aside, my knees protest too much) but what has caught my eye in MS publications that physical therapy has helped people with MS improve/regain functions.

As a personal testimonial for rehab, I believe a short round of physical therapy greatly helped me with a specific problem - after a knee injury, and months favoring the knee, I lost a lot of physical strength in my legs and was developing some actual balance problems. I suspect MS-related processes contributed to that. I was getting almost tottery. I asked for a physical therapy referral and with about 2-3 sessions and some simple exercises really helped my legs, balance and stabilize the bad knee.

Here's a recent article:

Ann Readapt Med Phys. 2006 May;49(4):143-9. Epub 2006 Feb 28. Related Articles, Links


[Strength, postural and gait changes following rehabilitation in multiple sclerosis: a preliminary study]

[Article in French]

Cantalloube S, Monteil I, Lamotte D, Mailhan L, Thoumie P.

Service de Reeducation Neurologique, Hopital Leopold-Bellan, 21, rue Vercingetorix, 75014 Paris, France.

OBJECTIVE: To evaluate the impact of rehabilitation on balance, gait and strength in inpatients with multiple sclerosis (MS). METHODS: Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation. Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an isokinetic dynamometer at 60 degrees /s speed. The functional independence measure (FIM) was also applied before and after rehabilitation. RESULTS: After rehabilitation, patients showed significant improvement in balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values. Absolute values of gait speed and strength parameters were related as were improvement in velocity speed and the higher hamstrings. CONCLUSION: The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.

Publication Types:
Evaluation Studies

PMID: 16545886 [PubMed - indexed for MEDLINE]




Here's an abstract of a recent review article:
^^^^^^^^^^^^^^^^^^^
Expert Rev Neurother. 2006 Mar;6(3):347-55. Related Articles, Links


Physical exercise in multiple sclerosis: supportive care or a putative disease-modifying treatment.

Heesen C, Romberg A, Gold S, Schulz KH.

Department of Neurology, University Medical Center, Martinistrasse 52, 20246 Hamburg, Eppendorf, Germany. heesen@uke.uni-hamburg.de

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease affecting young adults and leading to considerable disability. For many years, patients have been advised to avoid physical activity. Today, however, an increasing number of studies have shown beneficial effects of exercise training in MS. It has been reported that such programs not only improve fitness parameters but can also enhance quality of life and beneficially affect some suggestive disability measures. Pilot studies even indicate a neuroprotective potential. This review summarizes the findings of the major clinical trials on exercise in MS. Possible biological effect mediators, such as neurotrophic factors or anti-inflammatory cytokines, will be discussed. Exercise management guidelines will be proposed and possible further research strategies are presented.

Publication Types:
Review

PMID: 16533139 [PubMed - indexed for MEDLINE]


^^^^^^^^^^^^
I'll post some more on this thread later - there are articles that deal with specific problems like foot drop, head stability, etc. Maybe people will find something helpful in these abstracts.
- Lisa
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physical rehab

Postby jimmylegs » Thu Jul 06, 2006 7:59 pm

hi there, if you consider just doing whatever you still can every day, and pushing your boundaries, to be physical rehab, then i feel i've been doing that successfully so far.

while i was in the midst of sensory loss, i still kept driving myself to do things without that internal feedback. i had to do everything with visual feedback only, but i kept at it. slowly the sensory came back (mostly).

partway through that process, my brother dropped off a book "dancing with ms" by eva marsh. she is from the same neck of the woods as i and she is associated with the same hospital where i was diagnosed.

she pushed through each attack and kept practising things that had become way more difficult for her than i've ever experienced. so i think physical work is really important.

the fact that my ms doc, i mean the one i've seen once at the hospital, who wanted me to go on rebif, said i should walk 1 hour each day, speaks to me about its importance. he wouldn't recommend anything that wasn't really, really, thoroughly scientifically supported.

my 2 cents :)
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Postby bromley » Fri Jul 07, 2006 3:26 am

I've had two sessions of physio - the physio identified the things I was doing wrong - i.e. keeping legs stiff when standing upright, tending to put more weight on one leg. She showed me this in the mirror and recommended some exercises etc.

The slight downside was the other three patiets getting physio were 75+ and probably stroke victims. Also the physio clapped when I did steps on a plastic step. As someone who ran 6 mile twice a week for 15 years - slightly difficult to take.

But overall, well worth doing. Can't do to much about atrophy in the CNS but we can do something to keep our muscles from atrophing.

Ian
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Soon to be released...

Postby Minai » Fri Jul 07, 2006 10:51 am

Just found a new book, soon to be released, "Exercises for Multiple Sclerosis: A Safe and Effective Program to Fight Fatigue, Build Strength, and Improve Balance," by Brad Hamler.

Am considering ordering it, so thought I'd share. Here's a link to it, on Amazon:

<shortened url>

Also, on the subject of physical therapy/re-hab...

Was fortunate enough to have a home physical therapist, during my first and most recent relapse. Only qualified for it, while homebound. Helped me keep my muscles working and learn how to walk with a cane so I actually could start to get out of the house.

Haven't started any further physical therapy, since I now only need a cane occasionally for balance problems, when walking long distances.

Just another idea for those to whom this service may be available.

Minai
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For Ian

Postby Minai » Fri Jul 07, 2006 10:58 am

Ian,

How wonderful that you are finding this worthwhile.

But...

The slight downside was the other three patiets getting physio were 75+ and probably stroke victims. Also the physio clapped when I did steps on a plastic step. As someone who ran 6 mile twice a week for 15 years - slightly difficult to take.


Had to laugh with you, not at you, at this. Would find that difficult to take, too. But, what else can one do in situations? I guess if I didn't laugh, I'd cry. :wink:

Minai
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Postby bromley » Fri Jul 07, 2006 12:01 pm

Minai,

I start back with the physio in two weeks time as she has been off for a month ill.

At the last visit there was a woman of 55ish and her "mum". The "mum" looked 75-80, was slim and had thick white hair. She was completely with it and told the other physio that she had done all the exercises and her walking was now much better and she had started walking to the shops again. She walked without a cane and was very mobile. At the end the daughter (55ish) said well done nan (Gran). I looked across and the daughter said to me "she's 101", still lives on her own.

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Postby LisaBee » Fri Jul 07, 2006 1:49 pm

Ian,

I cringed a little at your statement about the physio applause - I'm sure she meant to be encouraging, but bah. That would not have made my day either. As to the elderly folks, well, it might be different next time you go. At my most recent trip to physical therapy, no one there was more than 5-10 years older than me, if they were indeed older at all. There are all sorts of problems people have, from accidents to strokes, etc. The lady that is 101 sounds quite impressive. There is also a lot of research coming on elderly people without a specific health condition, and how physical therapy has helped with strength and balance and reducing falls.

Here's another abstract - this is a Cochrane report on MS and exercise. Basically, exercise is no overall MS cure but it is a big help, and based on the studies they looked at, there is no one form of exercise shown to be better than another. Greatest effect is on muscle power, mobility and exercise tolerance, moderate effect on mood. More studies have come out since this was published.

Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003980. Related Articles, Links


Exercise therapy for multiple sclerosis.

Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G.

BACKGROUND: No intervention has proven effective in modifying long-term disease prognosis in Multiple Sclerosis (MS) but exercise therapy is considered to be an important part of symptomatic and supportive treatment for these patients. OBJECTIVES: To assess the effectiveness of exercise therapy for patients with MS in terms of activities of daily living and health-related quality of life. SEARCH STRATEGY: We searched the Cochrane MS Group Specialised Register (searched: March 2004), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (from 1966 to March 2004), EMBASE (from 1988 to March 2004 ), CINAHL (from 1982 to March 2004), PEDro (from 1999 to March 2004) . Manual search in the journal 'Multiple Sclerosis' and screening of the reference lists of identified studies and reviews. We also searched abstracts published in proceedings of conferences. SELECTION CRITERIA: Randomised Controlled Trials (RCTs) that reported on exercise therapy for adults with MS, not presently experiencing an exacerbation; outcomes that include measures of activity limitation or health-related quality of life or both. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and methodological quality of the included trials. Disagreements were resolved by discussion. The results were analysed using a best-evidence synthesis based on methodological quality. MAIN RESULTS: Nine high-methodological-quality RCTs(260 participants) met the inclusion criteria. Six trials focussed on comparison of exercise therapy versus no exercise therapy, whereas three trials compared two interventions that both met our definition of exercise therapy. Best evidence synthesis showed strong evidence in favour of exercise therapy compared to no exercise therapy in terms of muscle power function, exercise tolerance functions and mobility-related activities. Moderate evidence was found for improving mood. No evidence was observed for exercise therapy on fatigue and perception of handicap when compared to no exercise therapy. Finally, no evidence was found that specific exercise therapy programmes were more successful in improving activities and participation than other exercise treatments. No evidence of deleterious effects of exercise therapy was described in included studies. AUTHORS' CONCLUSIONS: The results of the present review suggest that exercise therapy can be beneficial for patients with MS not experiencing an exacerbation. There is an urgent need for consensus on a core set of outcome measures to be used in exercise trials. In addition, these studies should experimentally control for 'dose' of treatment, type of MS and should include sufficient contrast between experimental and control groups.

Publication Types:
Meta-Analysis
Review

PMID: 15674920 [PubMed - indexed for MEDLINE]
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Postby amelia » Thu Jul 13, 2006 11:59 am

My husbands mother was killed tragically in a car wreck in Nov of 02. By new Year's day, 03, he started an attack. Once again, he lost the ability to walk within a day or two. This time, the only time, he started intensive PT as outpatient at hospital. When he started, he could barely transfer from car to wheel chair. Within 6 weeks, he wallked about about 75 feet on a regular cane, by himself to and from therapy. Although he has had attacks like this before and worse, this is the only time that he had PT the whole time during the attack. You know, not a little stretching in the hospital bed only. I feel he came out of the attack and regained almost everything MUCH quicker than the times before. Consider he has had MS over 20 years.
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physio

Postby jimmylegs » Thu Jul 13, 2006 5:02 pm

sounds awesome am, reminds me of eva marsh's book - she always pushed herself physically to recover from her attacks
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