Physiotherapy in the Early Stage of Multiple Sclerosis Paul Van Asch Secretary of RIMS Head of Physiotherapy Dept. National Multiple Sclerosis Centre Melsbroek - Belgium p.vanasch@ms-centrum.be International MS Conference 20 - 24 September 2003 DMSG Berlin

National Multiple Sclerosis Centre Melsbroek, Belgium In-patient department: 134 beds Out-patient department: 80 PwMS / day

Objectives of Symptomatic Management and Rehabilitation in MS The goal of every treatment approach should be to encourage self management and to provide the PwMS a sense of control over their disease. Thus a sensible management strategy for the majority of symptoms should include: - Education - Therapy input - Drug treatment Due to the progressive condition periodic reassessement is needed. ( A. Thompson, J Neuro Neurosurg Psychiatry 2001; 71(suppl II):ii22-ii27)

4 Primary aims of Physiotherapy in MS + Maintain and increase of ROM + Stimulate postural stability + Prevention of contractures + Support weight - bearing L. De Souza, MS: Approaches to Management, 1990

Is there a role for Physiotherapy in the Early Stage of MS? Yes progressive nature of MS without prognosis => sensible approach Preventative therapeutic role 1/ Providing Information 2/ Training Program 3/ Support

1/ Providing Information To Whom ? - PwMS - Partner - Caregivers (professional and non-professional) How ? - MS - school - Partner sessions - Local MS Self Help Groups => In collaboration with the Belgian MS - Society

What ? => The occurence of Motor Symptoms and their potential impact on Functional Activities Potential Impact on Functional Activities - Walking - Leisure activities - Professional activities Motor Symptoms - Spasticity - Paresis - Ataxia, Tremor - Balance Problems

When to start Physiotherapy ? What is Physiotherapy ? Physiotherapy is more than a passive intervention of stretching and mobilization of specific parts of the body, the PwMS needs to be an active participant in a functionally oriented exercise program (Mertin, Paeth, Physiotherapy and MS:application of the Bobath concept. MS Management 1:10-13) When to start Physiotherapy ? Individual Not continuous

2/ Setting up a Training Program Why ? => Prevention and management of problems in the locomotor system

= Adapted to the needs and possibilities INDIVIDUAL PROGRAMS = Adapted to the needs and possibilities of each PwMS 1/ Evaluation : anamnesis, overall testing 2/ Training Program : variety of techniques 3/ Follow Up : 6 - monthly

Aerobic Training Stretching Energy Management Strengthening Pelvic Floor Exerc. Relaxation

Do we have some evidence ? Tentative evidence exists to support rehabilitation in MS - Physiotherapy: Wiles CM et al. Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol Neurosurg Psychiatry 2001;70:174-9 - Aerobic Training: Petajan JH et al. Aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996;39:432-41 Mostert S, Kesselring J. Effects of a short term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with mS, Multiple Sclerosis 2002;8:161-168 - Rehabilitation in MS: Freeman, Solari, Rodgers, Ponichtera, Petajan - Clinical Experience

3/ Support Partner family Professional home MS-society PwMS Rehab centre

Conclusions Tentative evidence exists to support Rehabilitation in MS. Within the multidisciplinary team, the physiotherapist has an important role in the prevention and management of locomotor problems in the early stage of MS. Successful treatment cannot be measured by wether or not the PwMS improved, but rather by wether or not the best level of activity is achieved with respect to an individual’s life style at each stage of the disease. ( L. De Souza, MS Approaches to management 1990)

Thank You www.rims.be