Promoting Health, Creating Hope

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Promoting Health, Creating Hope

• DOES EXERCISE MODIFY IMPAIRMENTS IN PEOPLE WITH
  MULTIPLE SCLEROSIS?
• Brian Hutchinson, PT
• President, The Heuga Center

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History of Exercise/Rehab in MS Management

• Previous Perspective
• Restrict all activities/ Bed rest
• Normal physical and psychological stress will
  enhance disease activity
• Current Perspective
• Increased activity/rehabilitation concepts, in
  part, responsible for an almost normal life
  expectancy for the average person with MS

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Result of Decreased Activity
INACTIVITY
DECONDITIONING
PHYSICAL IMPAIRMENT
PSYCHOLOGICAL DISTURBANCES
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Common Impairments in People with Multiple
Sclerosis

• Decreases in
• ROM
• Strength/Weakness
• Sensation
• Balance/Coordination/
• Tremor

• Also
• Fatigue
• Spasticity
• Bowel/Bladder Dysfunction
• Visual Disturbances (Double or blurred vision)

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Impairments Modifiable by Exercise

• ROM/Spasticity
• Strength/Weakness
• Balance/Coordination
• Fatigue
• Bowel/Bladder

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Range of Motion

• Primarily empirical data
• Decrease in spasticity when stretching added to
  medication (Brar, et.al, 1991)

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Strength/Weakness

• Improvements in muscle strength and endurance
  with water exercise program (Gehlsen, et.al.,
  1984)
• Differences in absolute strength measures in
  those with MS (Chen, 1987 Ponichtera, 1992)
• Increased strength with lower body,
  low-resistance training program (Svensson,
  et.al., 1994)
• Increases in upper and lower extremity strength
  with aerobic exercise program (Petajan, et.al.,
  1996)

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Balance and Coordination

• Most studies for elderly and vestibular
  populations (Chan, et. al. 1994)
• Improvements in balance with up to six months
  after physiotherapy treatment (DeSouza, 1984)
• Improvements in balance and balance confidence
  using ATM group class (Stephens, et.al., 2001)

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Fatigue

• Differences in people with MS as it relates to
  aerobic capacity/VO2 max (Schapiro, et.al., 1987
  Ponichtera-Mulcare, et.al., 1993)
• Improvements in fatigue with 4-6 week training
  program (Svensson, et.al., 1994)
• Improvements in VO2 max with aerobic training
  program (Petajan, et.al., 1996)

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Bowel and Bladder

• Improvements in bowel and bladder function as
  measured on Expanded Disability Status Scale
  EDSS (Petajan, et.al.)

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Impairment (EDSS)

• No change in EDSS with rehabilitation program at
  discharge or 3 months post rehab (Kidd, 1997)
• No change in EDSS following inpatient rehab
  (Freeman, et.al., 1997 Solari, et.al., 1999)
• Decline in neurologic status as measured by EDSS
  over long term (Freeman, et.al., 1999)

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Disability/Activity Limitation (FIM)

• Significant improvement in function (FIM) at
  discharge and 3 months post rehab (Kidd, 1997)
• Reduced disability (except ambulation) up to 6
  months (Freeman, et.al., 1997 1999)
• Improvement for up to 9 weeks in FIM scores
  (Solari, et.al., 1999)
• 6 month aerobic training program had minimal
  effect on gait abnormalities (Rodgers, et.al.,
  1999)
• The Potential of Exercise to Improve ADLs
  (Lexell, 2000)
• Improvements in mobility (RMI) following 8 weeks
  of physiotherapy (home or outpatient) (Wiles,
  2001)

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Handicap

• Trend toward improvement in handicap (ESS) (Kidd,
  1997)
• Reduction in handicap (LHS) following IP rehab
  (Freeman, et.al., 1997)
• Reduction in handicap (LHS) up to 6 months
  (Freeman, et.al., 1999)

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The most important factor for development has
been the realization that normal physical and
psychological stress do not activate the disease
process and that persons with MS must be, within
their disease-inflicted limitations, as active as
possible in all ways of life. Jurgen Mertin,
MD Annals of Neurology, 1994
Rehabilitation is clearly the only practical
means of significantly improving function in MS
patients George Kraft, MD The Lancet,
December 11, 1999
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Summary

• Physical Activity/Exercise can improve
  impairment, disability and handicap
• Improvement in quality of life

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References

• Brar, et.al., Evaluation of Treatment Protocols
  on Minimal to Moderate Spasticity in Multiple
  Sclerosis. Arch Phys Med Rehabil, 1991 72
  186-189
• Chan, et.al, Balance and Spasticity What We
  Know and What We Believe. J Neurol Rehabil, 1994
  8 119-130
• Chen, et.al, Force Time Measurements of Knee
  Muscle Fundtions of Subjects with Multiple
  Sclerosis. Phys. Ther, 1987 67 934-940
• DeSouza, A Different Approach to Physiotherapy
  for Multiple Sclerosis Patients. Physiotherapy,
  1984 70 429-432.
• Freeman, et.al., The Impact of Inpatient
  Rehabilitation on Progressive Multiple Sclerosis.
  Ann Neurol, 1996 39 432-441
• Freeman, et.al., Inpatient rehabilitation in
  multiple sclerosis. Neurol, 1999 52 50-56
• Gehlsen, et.al, Effects of an Aquatic Fitness
  Program on the Muscular Strength and Endurance of
  Patients with Multiple Sclerosis. Phys Ther,
  1984 64 653-657
• Kidd, et.al., The benefit of inpatient
  neurorehabilitation in multiple sclerosis. Clin
  Rehabil, 1995 9 198-203.

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References

• Lexell, Muscle Structure and Function in Chronic
  Neurological Disorders The Potential of Exercise
  to Improve Activities of Daily Living. Ex Sport
  Science Rev, 2000 28 80-84
• National Multiple Sclerosis Society website
  statistics
• Petajan, et.al., Impact of Aerobic Training on
  Fitness and Quality of Life in Multiple
  Sclerosis. Ann Neurol, 1996 39 432-441
• Ponichtera-Mulcare, Exercise and multiple
  sclerosis. Med Sci Sports Exerc, 1993 25
  451-465
• Rodgers, et.al., Gait characteristics of
  individiuals with multiple sclerosis before and
  after a 6-month aerobic training program. J
  Rehabil Res Dev, 1999 36 183-188
• Schapiro, et.al., Role of Cardiovascular Fitness
  in Multiple Sclerosis A Pilot Study. J Neuro
  Rehab, 1988 2 43-49
• Stephens, et.al., Use of Awareness Through
  Movement Improves Balance and Balance Confidence
  in People with Multiple Sclerosis A Randomized
  Controlled Study. Neuro Rep, 2001 25 39-49

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References

• Solari, et.al., Physical rehabilitation has a
  positive effect on disability in multiple
  sclerosis patients. Neurol, 1999 52 57-62
• Svensson, et.al., Endurance Training in Patients
  with Multiple Sclerosis Five Case Studies. Phys
  Ther, 1994 74 1017-1026
• Wiles, et.al., Physiotherapy Improves Mobility,
  Subjective Well-Being in Patients with MS. J
  Neurol Neurosurg Psychiatry 2001 70 174-179
• World Health Organization 2000, ICIDH-2,
  International Classification of functioning,
  disability and health World Health Organization,
  Geneva