Multiple Sclerosis

Multiple sclerosis is a gradual, progressive disease caused by sporadic patches of demyelination of nerve cells in the brain and spinal cord. This demyelination results in widely varied neurological symptoms to include fatigue (MS lassitude), visual problems, problems with walking, muscle dysfunction to include weakness, abnormal increases in muscle tone, and intention tremors, bowel or bladder problems, abnormal sensations to include numbness or tingling, changes in ability to problem solve, with memory or attention, pain, and emotional liability to include mood swings, irritability, euphoria or depression.

Fatigue is one of the most common symptoms of MS and can significantly limit a person’s ability to function at home and work. Fatigue generally occurs on a daily basis, tends to worsen as the day progresses, is typically more severe than normal fatigue, and tends to be aggravated by heat and humidity. The cause of this fatigue is unknown.

Problems with walking or gait can stem from several different factors. Weakness may lead to problems such as toe drag or drop foot. Abnormal muscle tightness (spasticity) can also arise and may interfere with a person’s ability to walk. Balance problems generally result in a drunken type of gait called ataxia; persons with severe ataxia may need an assistive device to ambulate safely. Numbness in the soles of one’s feet and fatigue also contribute to gait problems.

In most patients, visual problems and sensory impairment are the first symptoms to arise. Average age of onset is 27 and typically begins between the ages of 20 and 40. MS afflicts 3 women for every 2 men and is most common in Caucasians. It is generally higher in urban populations and living in cold, damp climates seems to increases risk. Symptoms may be transient or may last for days to weeks. Symptoms may also be unpredictable and difficult to describe. The disease may progress quickly, however most patients lead productive lives with prolonged remissions.

As the majority of people with MS are young, it is a major cause of chronic disability and impairment in young adults. Currently there is no cure for the disease, however, there are a number of drugs used to reduce the frequency of relapses, hasten remission, and relieve symptoms. Rehabilitative care may also be indicated and, for some, essential in assisting to restore a person’s ability to function and participate in daily living activities.

Physical Therapy aides in restoring and maintaining useful movement. Common interventions include active, resistive, and stretching exercises to maintain or increase strength, mobility, and coordination, gait training and instructions in the use of appropriate assistive devices, strategies for maximizing a person’s ability to transfer from one spot to another, and safety training to include fall prevention. Occupational or speech therapy may also be indicated depending on severity and degree of involvement and should be discussed with the patient’s physician. In most cases, a referral from a physician is required.

The National MS Society’s website is an excellent resource for those in want of more information, or, questions may be directed to John Loar at Progressive Physical Therapy at (310) 729-3485.