Physical Therapy for Multiple Sclerosis

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Approximately 350,000 people in the United States have a diagnosis of Multiple Sclerosis.  Celebrities with a diagnosis of Multiple Sclerosis include talk show host Montel Williams, actress Annette Funicello, actress Teri Garr, journalist Neil Cavuto, former first lady of Massachusetts Ann Romney, singer/actress Lena Horne, and comedian Richard Pryor.

Annette Funicello with Frankie Avalon

Lena Horne

Richard Pryor (photo by Alan Light)

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system.  MS is usually diagnosed between 20 and 40 years of age and is more common in women than in men.  Inflammation from MS causes damage to the outer layer of nerve cells, which slows down or stops nerve signals. The cause of MS is not known, though it is believed that it may be the result of genetics, a virus, or environmental factors.

Symptoms of Multiple Sclerosis

MS has a multitude of symptoms, which include:

• Fatigue
• Weakness
• Impaired balance
• Muscle spasms
• Tremor
• Abnormal sensations (including numbness, tingling, or a crawling sensation)
• Difficulty with gross motor movements, such as walking
• Difficulty with fine movements, such as writing, eating, and manipulating clothing fasteners
• Bowel problems (including constipation and/or leakage of stool)
• Problems with urination
• Double vision
• Gradual vision loss
• Hearing loss
• Difficulty swallowing
• Difficulty speaking clearly
• Decreased attention, memory, and decision-making ability
• Depression

Since there is such a wide range of symptoms, the abilities of people with MS can vary greatly.  Symptoms usually come in episodes, which come and go over the course of several days, weeks, or months.   Heat, fatigue, and stress often exacerbate symptoms. 

Physical Therapy for Multiple Sclerosis

While Physical Therapy cannot help all symptoms, it can help to build up endurance, increase strength, improve balance, assistance with moving more normally, to learn energy conservation techniques, and to provide caregiver training.  These PT sessions can take place in a home health care setting, as part of an adult day care program, at an assisted living facility, in skilled nursing facilities, and in outpatient clinics.

During the initial evaluation, the physical therapist will record a thorough history, including other medical diagnoses, medications that the patient is taking, and difficulties that the patient is experiencing. The PT will then assess a patient's range of motion, strength, sensation, balance, and functional mobility, paying close attention to the quality of movement and any compensatory patterns.

Direct PT treatments will include endurance training to help patients increase their physical endurance.  This training may make use of a stationary bike, a pool, a treadmill, or while performing everyday activities.  PT will also incorporate strengthening activities , which may help patients avoid compensatory movements, enhance joint stability, and allow them to perform activities of daily living more easily and efficiently.  Balance training also will be a major part of PT treatment to help patients decrease their risk of falls, allowing them to move throughout their homes and in the community safely.  Finally, transfer and gait training are vital parts of PT treatment, as a physical therapist will help patients learn to perform common movements such a moving in bed, standing from a chair, and walking in the safest and most efficient way possible.

A physical therapist may recommend varying types of adaptive equipment to aid MS patients with mobility, safety, and energy conservation.  The physical therapist may want to schedule a home visit to perform an assessment of the home’s safety and accessibility.  A cane or walker will help people with balance difficulties to walk with more stability.  A commode helps to make toileting easier since the seat is elevated and it includes armrests that a person can push off from to facilitate standing up.   A shower chair allows people to sit while they bathe to ensure safety and to help them conserve energy as they perform hygiene tasks.  Grab bars, particularly in the bathroom help to give support when a person with MS tries to move in a confined and possibly slippery room.  Finally, a wheelchair or electric scooter may be recommended for those who are unable to walk safely or who are unable to walk in the community for long distances due to deficits in balance, decreased strength, or impaired endurance.  

During the course of PT treatment, patients with MS will learn to make lifestyle changes to help avoid exacerbation of symptoms and to help conserve energy.  Lifestyle changes often include eating a balanced diet, avoiding heat, stress, and fatigue, and modifying one’s home to make it safer and more accessible.  

Conclusion

While there is no cure for Multiple Sclerosis, Physical Therapy treatment can help slow a person’s functional decline and allow a person to live independently for as long as possible.  In the case of functional decline, a Physical Therapist can help patients adapt to their changing abilities and recommend the best equipment and lifestyle changes to accommodate them.  Hopefully, with the help of a Physical Therapist, people with Multiple Sclerosis will be able to postpone having to move to an assisted living facility or skilled nursing facility.