1. Multiple Sclerosis in Physiotherapy

2.  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.

3.  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.

5. 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.

6. It is predominantly affects young adults during their most productive years. progresses to disability in majority of cases

7. 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.

9.  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.

11. 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)

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

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

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

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

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

20. - 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.

21. Autoimmune process. viral infection. allergic reaction to infection. familial tendencies.

22. 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.

24. 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.

25. 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.

26. CSF analysis. Magnetic resonance imaging. Computed tomography scan. Positron emission tomography. Evoked potential studies. EEG.

27. 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?

28. 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.

29. 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 dush 20min.  strengthening + gait training + jet dush 5 min  cooling dawn +relaxation 1min. for rest after each exersise because its easy fatigue

31. Goals Of Treatment Goals 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.

32. Treatment : Pharmacological treatment of MS. Hydrotherapy treatment.

33. The differences between the various injectable MS treatments: The differences between the various injectable MS treatments:

34. Hydrotherapy treatment

35. 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

36. 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 MS :

37. Precaution & Contraindication taken 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.

38. 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.

39. 4.Skin infection. 5.Fear of water. 6.Mental retardation. But the main contraindications with MS patient is:

40. Aquatic exercises for MS patient?

41. How can we transfer the patient from land to the water: By Pool hoists: Hydraulic. Electrical. Mechanical. Compressed air.

42. 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.

43. 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.

44. Exercise 2: ‘cheek to cheek’:

45. Exercise 3:

46. Breathing exercises: Play a part in improving posture. Exercising both the diaphragm and abdominal muscles. Repeat this 2-3 times.

47. Exercise 1: Exercise 2:

48. Standing Exercises: Standing up straight with feet slightly apart. Weight evenly placed on both feet. Repeat 3-5 times.

49. Exercise 1: Exercise 2:

50. Exercise 3: Exercise 4:

51. Balance Exercises: Exercise 1: Exercise 1: Exercise 2: Exercise 2:

52. 1.Backhab Exercises: Some Form of Stretching exercises: Hams., and Gluteal stretch.

53. 1.Backhab Exercises: Some Form of Stretching exercises: General Lower limp Stretching.

54. 1.Backhab Exercises: Some Form of Stretching exercises: General Lower limp Stretching.

55. 2.Watsu Exercises: 1-Pain reduction. 1-Pain reduction. 2-Increased range of motion. 2-Increased range of motion. 3- Increased circulation. 3- Increased circulation. 4-Psychological problems. 4-Psychological problems. 5-relaxation, and reduction of stress. 5-relaxation, and reduction of stress.

57. 3.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.

60. 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