multiple sclerosis in physiotherapy. the basic unit of the nervous system. the basic function is...

Multiple Sclerosis in PhysiotherapyMultiple Sclerosis in Physiotherapy

the basic unit of the nervous

system .

The basic function is to

transmit information.

It consists of a cell body, an

axon, and many dendrites.

There is specialized cells called

Schwann cells wrap around the

axons of some neurons forming

a layer called the myelin sheath.

Without the insulating effect of myelin , nerve impulses passing along one axon can generate impulses in nearby neurons, some of which stimulate muscle contraction. This can cause shivering and jerky movements of the muscles.

Def.: A chronic, progressive neurological disease

characterized by scattered demyelination of nerve fibers in the brain and spinal cord. In MS the body immune system attacks the CNS.

It is predominantly affects young adults during their most productive years.

progresses to disability in majority of cases

people with MS can experience partial or complete loss of any function that is controlled by, or passes through, the brain or spinal cord.

unpredictable course and variety of signs and symptoms, sometimes mistaken for psychiatric disorder.

White blood cells are drawn to regions of the white matter. These initiate inflammatory response.

During the inflammation, the myelin gets stripped from the axons in a process known as demylination.

When the myelin sheath is damaged, the transmission of nerve impulses is slowed, stopped or can jump across into other demyelinated axons.

The age of onset peaks between 20 and 30 years.

Almost 70% of patients manifest symptoms between ages 21 and 40.

Disease rarely occurs prior to 10 or after 60 years of age.

Females > males (approx. 2:1)

White > non-white (approx. 2:1)

This is characterised by relapses during which time new symptoms can appear and old ones resurface or worsen. (40%)

People with secondary progressive may experience good and bad days or weeks, but, apart from some remission following relapsing episodes, no real recovery.

There is significant recovery immediately following a relapse but between relapses there is a gradual worsening of symptoms.

This type of MS is characterised by a gradual progression of the disease from its onset with no remissions at all. (10%)

- Benign MS.- Malignant MS.- Chronic Progressive MS.- Others.

- Viral and autoimmune etiologies are postulated. Genetic and environmental factors are known to contribute to MS, but a specific cause for this disease is not identified.

Autoimmune process.

viral infection.

allergic reaction to infection.

familial tendencies.

Cool, temperature climates.

Stress may also be a risk factor although evidence is weak.

Smoking has also been shown to be an independent risk factor for developing MS.

Several other possible risk factors, such as diet and hormone intake, have been investigated; however, more evidence is needed to confirm or refute their relation with the disease.

MS is a hard condition to characterise because it is very unpredictable and variable. Depending on which areas of the CNS are affected and how badly they are damaged.

Certain signs and symptoms are more common in the early stages of the disease. Patients may be complaining of :

- Double or blurred vision. - Numbness. - Weakness in one or two extremities.- Instability in walking.- Tremors.- Problems with bladder control.- Heat intolerance.

CSF analysis. Magnetic resonance

imaging. Computed tomography

scan. Positron emission

tomography. Evoked potential studies. EEG.

Shereen is a 39 years old lady, teacher .K/c of Multiple sclerosis. Had history of progressive weakness. Use W/C for outdoor activities and walk with Zimmer frame indoor. She is welling to go back to school and climb stairs independently.

Problems?Goals?Does Hydrotherapy indicated?Why you are going to use aquatic therapy?How many therapist will be involved?How you are going to transfer your patient?Water Temperature?Treatment plan?

Problems?- Progressive weakness. - Sensitive to heat.- Reqaird excessive or moderate device will moving.

Goals?-Improve muscle power.-Improve endurance.-Improve gait pattern.-Improve abilatiy to walk.

Does Hydrotherapy indicated? Yes.Why you are going to use aquatic therapy? Because of bouncy will ↓ wight bearing + strengthening. And hydrostatic pressuer help in stability + improve circulation, viscosity.

How many therapist will be involved? 2 therapist.

How you are going to transfer your patient? Pool hoists.

Water Temperature? temp. 24 for 30 min.

Treatment plan? 5 min. warming up +jet dush20min. strengthening + gait training + jet dush5 min cooling dawn +relaxation  1min. for rest after each exersise because its easy fatigue

Goals Of TreatmentGoals Of Treatment:

• Increase R.O.M • Provide balanced exercise. • Promote muscular relaxation.• Decrease muscle spasm and pain

sensitivity.• Increase peripheral circulation.• Strengthening exercises to

increase endurance and strength .

• Provide gait training.

Treatment :Treatment :

• Pharmacological treatment of MS.

• Hydrotherapy treatment.

• The differences between the The differences between the various injectable MS treatments:various injectable MS treatments:

Hydrotherapy Hydrotherapy treatmenttreatment

Benefits of water for MS?Benefits of water for MS?

• Cold water improves mobility and a reversal of symptoms(24 oC).

• Also produces no difference in oxygen consumption & increase in reflex activity.

• Water improves body strength

• Helps circulation and bowel function.

• Mood enhancement.• It helps balance and coordination.

(hydrostatic pressure)• Can assist or resist movements to

increase muscle force. (buoyancy and viscosity)

• Support unstable joints & weak muscles. (Hydrostatic Pressure)

Benefits of water for Benefits of water for MS :MS :

Precaution & Contraindication taken Precaution & Contraindication taken with MS patient:with MS patient:

• We apply aquatic therapy with precaution with patients which suffer from:

1.Dizziness.2.Nausea.3.Excessive shortness of breath like

chest pain.4-Cardiopulmonary condition .

But the main contraindications with MS patient is:But the main contraindications with MS patient is:

1.Sensitivity to heat. (About 80% of patients with MS deteriorate when heated).

2.Direct exposure to the sun light.

3.Vigorous exercise : made their fatigue worse.

4.Skin infection.

5.Fear of water.

6.Mental retardation.

But the main contraindications with But the main contraindications with MS patient is:MS patient is:

Aquatic exercises for Aquatic exercises for MS patientMS patient??

How can we transfer the patient How can we transfer the patient from land to the waterfrom land to the water::

By Pool hoists:By Pool hoists:

• Hydraulic.• Electrical.• Mechanical.• Compressed air.

Sitting Exercises:

• Sitting on the edge of chair upright with shoulders relaxed.

• Head level and eyes looking straight ahead.

• Repeat these exercises from 3-5 times.

Exercise 1:

This is a very important exercise to corrects posture and allows fluidity of movement in the trunk. It will also encourage deeper breathing.

Exercise 2: ‘cheek to cheek’:

Exercise 3:

Breathing exercises:

• Play a part in improving posture .

• Exercising both the diaphragm and abdominal muscles.

• Repeat this 2-3 times.

Exercise 1:Exercise 1: Exercise 2: Exercise 2:

Standing Exercises:Standing Exercises:

• Standing up straight with feet slightly apart.

• Weight evenly placed on both feet.

• Repeat 3-5 times.

Exercise 1:Exercise 1: Exercise 2:Exercise 2:

Exercise 3:Exercise 3: Exercise 4:Exercise 4:

Balance Exercises:Balance Exercises:

• Exercise 1:Exercise 1: • Exercise 2:Exercise 2:

1.Backhab Exercises:1.Backhab Exercises:

Some Form of Stretching Some Form of Stretching exercises:exercises:

Hams., and Gluteal stretch.Hams., and Gluteal stretch.

1.Backhab Exercises:1.Backhab Exercises:

Some Form of Stretching Some Form of Stretching exercises:exercises:

General Lower limp Stretching.General Lower limp Stretching.

1.Backhab Exercises:1.Backhab Exercises:

Some Form of Stretching Some Form of Stretching exercises:exercises:

General Lower limp Stretching.General Lower limp Stretching.

2.2. Watsu Exercises:Watsu Exercises:

1-Pain reduction.1-Pain reduction.

2-Increased range of 2-Increased range of motion.motion.

3- Increased circulation.3- Increased circulation.

4-Psychological 4-Psychological problems.problems.

5-relaxation, and 5-relaxation, and reduction of stressreduction of stress..

3.3. Water Yoga: Water Yoga:

• To improve relaxation.

• In addition, increases in balance and coordination with diaphragmatic breathing and long exhalations.

• Conditions such as arthritis, MS, obesity.

• Floatation equipment may be used.

http://www.mult-sclerosis.org/

http://library.med.utah.edu/kw/ms/overview.html

http://www.youtube.com/watch?v=amHEacfzYUQ&feature=related

http://www.youtube.com/watch?v=RBlSExabHAs&feature=channel