Multiple Sclerosis

Background

Overview and symptoms

Multiple Sclerosis (MS) is a progressive autoimmune condition affecting the central nervous system meaning it is a condition affecting the brain and spinal cord that progresses over time. In MS, a specific part of the nerve cells in the brain and spinal cord becomes affected causing the nerve cells to not function or function poorly. This part of the nerve that is affected is the myelin sheath.

You can think of nerves as a central body with lots of tentacles. Those tentacles connect nerves with one another and they are used to carry messages between nerves in the form of an electric current. The tentacles are insulated so that the electric current can run along the nerves smoothly and at speed. The insulation of the tentacles is provided by the myelin sheaths. In MS, the myelin sheaths, or insulation, are affected and so the electric messages cannot run along the tentacles smoothly. If you think that one of those messages could be information to tell your leg to lift up and walk and this message cannot be delivered properly, then you will have difficulties lifting your leg.

The nerves affected may be in any area of the brain or spinal cord and depending on what area is affected, you may experience different symptoms. Because of that, the symptoms vary greatly from person to person.

MS is an inflammatory condition and as such any inflammation in the body will make the MS symptoms worse.

MS may be diagnosed with a brain MRI and a lumbar puncture and medical management in conjunction with exercise therapy is key.

POSSIBLE SYMPTOMS IN MS- you may experience a few or a number of those

Muscle weakness (often foot and ankle or fingers first)

Fatigue (80% of individuals report that)

Spasticity

Heat sensitivity

Numbness, pins and needles or other sensory changes

Vestibular changes

Vision changes

Ataxia

Balance impairments

Pain

Speech changes

Swallow changes

Bladder and bowel changes

Cognitive changes

 

How physiotherapy can help

Exercise for MS

There are five types of MS:
- Benign
- Relapsing Remitting (most common)
- Primary Progressive (about 15% of individuals)

- Secondary Progressive

- Progressive Relapsing

The difference between those types is how the symptoms present and how they progress over time. As explained above, in MS the myelin that insulates the nerves degrades. As a consequence, the messages cannot run along the nerves as well and by the time they get to their destination they are weak, disrupted or they don't get there at all. The way MS progresses is by myelin becoming more and more degraded and by more nerves becoming involved. The rate at which those two changes occur varies. What also vary is the ability of the body to restore the myelin sheaths that have degraded. So:

- Benign: the myelin degrades and you have a temporary symptoms until the myelin is fully restored and the symptoms disappear. You may experience this only once or multiple times in your life.
- Relapsing Remitting: the myelin degrades and the body restores it, but it cannot restore it fully so you get an onset of symptoms followed by a relative improvement, but you don't go back to fully recovered. After a certain period, there is another episode of decline where the myelin is affected further. Again, your body restores the myelin, but not fully so you experience more and more decline over time.
- Primary Progressive: in this presentation, the myelin becomes affected and it continues to deteriorate so the person will experience a steady decline rather than having relapses.

- Secondary Progressive: this starts as relapsing remitting and progresses to primary progressive. Most relapsing remitting progress to this. However, with the right exercise there may be potential to not progress to secondary progressive.

- Progressive Relapsing: there is a steady decline but still with relapses.

Some of the decline experienced by an individual with MS is due to the progressive demyelination of the nerves. However, especially in relapsing presentations, when a person loses a certain function after a relapse, they may adapt to living without that function not realising that their body has actually the potential to recover. Physiotherapy can help you restore that function and promote remyelination, or restoration of the myelin sheaths, through tailored exercise.

 

One thing that is important to understand is that exercise does not cause relapse and does not cause fatigue when it is done right. This is backed up by strong research and is included in the NICE guideline. It is also important to understand that exercise for MS should start as soon as possible straight after diagnosis rather than when problems start to present (for example after someone starts tripping over). This is important not only because exercise can prevent secondary complications, but also because exercise has neuroprotective and neuroregenerative properties meaning exercise can protect the nervous system and help it to optimally function whilst also promoting remyelination of nerves.

Another aspect to consider is that individuals with MS often have low level of activity. This places them at cardiovascular and metabolic risk both of which make MS progression worse. Consequently, by addressing the activity level and the type of activity an individual performs with the right guidance, a person with MS can significantly impact their condition.

When specifically looking at what exercise a person with MS should do, there a three main components to look at: the exercise should be enjoyable, it should be intensive and it should be completed in intervals. As MS is a lifelong condition, exercise should also be life long. Because every individual is different and every situation is different, you should always seek expert advice from a qualified therapist. What is included on this page should only be taken as informative rather than guide you through an exercise program.

Exercise should be enjoyable because it needs to be performed a minimum of 3/week (with the most benefits at 6/week) for 30 min/day and it should be intensive, so it is going to be hard work. This being the case, you need to find something you enjoy that you will be able to sustain, perhaps build a routine or have variety, have a support network such as an exercise group or a club or have something you can do with your spouse, family or friends.

Exercise should be intensive to lead to the most benefits in the brain, specifically targeting deficits caused by MS and it should also be performed with intervals to address how MS reacts to exercise. Because MS symptoms are affected by exercise in different ways, it is important that the prescription of exercise is tailored to the individual and it is accompanied by a lot of education. Everyone is different and you need to make sure you have a program that is safe for you and should consult a professional before undertaking this type of activity.

Physiotherapy can also assist with recommending assistive devices to optimize movement, function and to complement rehabilitation. Examples include braces, mobility aids, postural supports and orthotics or referral to other specialized services such as orthotists or occupational therapists.

 

What we offer and how we can help

Neuro Spark Rehab services for MS

Research shows that 80% of individuals with MS are completely inactive and that those that try a program have a high drop out rate. Even more relevant, evidence shows that advice on exercise is one of the most commonly unmet needs of individuals with MS.

As you can see, the treatment of MS from a physiotherapy/physical point of view requires a comprehensive understanding of the pathology of MS and its symptoms, a thorough ability to help individuals implementing and sustaining a lifelong program with support and motivation and a good network of practitioners and groups given the number of specialized practitioners that may be involved in your care at one stage or another (i.e. neurologist or geriatrician, movement disorder nurse, occupational therapist, speech therapist, nutritionist or dietitian, counsellor, etc...).

 

Anna is an MS Get a Head Start instructor. MS Get a Head Start is one of the few programs available worldwide specifically designed by a leading neurological physiotherapist Gilly Davy to provide therapy to individual with MS.

Anna is a committee member of the Darnley Montgomery Foundation in Shepparton and has been involved with a number of support groups in Victoria, Aus. Anna also has a strong local network having worked with Dr Arup Bhattacharya and Sheree Ambrosini in their roles working with individuals with movement disorders in the Goulburn Valley as well as with numerous allied health and health care clinicians.

 

The services that we offer will of course be tailored to your needs. Because the best way to have an impact on your MS is to establish lifelong programs and changes, the first few sessions include a lot of education and discussions on what exercise for MS is and what to expect from exercise, what it involves, how to implement it and how to progress it to allow you to be as independent and as motivated as possible with the program. MS/movement disorders specific group sessions may also be available in the future to help you maintaining your exercise regime whilst being supported by others within the community.