Physiotherapy and occupational therapy
The aim of the physiotherapist and/or occupational therapist is to help the patient to perform the activities of daily living as easily as possible and so improve their quality of life. The approach is somewhat different in MS from the majority of cases that the physiotherapist deals with, where the patient has suffered some injury and treatment is designed to return them to as near normal as possible.
MS is characterised by a progressively increasing level of disability and the job of the physiotherapist is to maximise the patient's functional ability. This is achieved through education, exercise, specific treatments and the provision of necessary aids.
A course of physiotherapy following careful assessment can be started off as an inpatient and then continued as an outpatient or be given as an outpatient throughout.
The occupational therapist is mainly responsible for helping the patient cope with the practical aspects of living with disability, including choice of wheelchair, use of aids and adapting the home.
Typically, the problems that are associated with the level of disability addressed by the physiotherapist are:
Spasticity
In addition to the drug therapies that are used to relieve muscle spasm, the following physical therapies can be tried:
Cooling and stretching - a cold pack is applied to the area and then stretched for approximately 10 minutes
Slow stroking of the skin for about 3 minutes
Electrical stimulation - the muscle is stimulated by a series of electrical pulses (often followed by stretching)
Weakness
Muscle weakness as well as reducing the ability to perform daily tasks can produce pain through muscle overuse and poor posture. The physiotherapist can improve this with strengthening exercises aimed at specific muscles, sometimes using weights. In some cases, such as foot drop, electrical stimulation of the muscle is used to strengthen the muscle.
Standing for increasing lengths of time of up to 30-45 minutes, if necessary using a frame for support, is an exercise widely encouraged by physiotherapists to improve strength and posture.
Fatigue
One standard technique for helping with fatigue is work simplification so that everyday tasks can be performed in a more efficient and less tiring way, e.g. tasks that are normally performed standing up (peeling vegetables, ironing) can be carried out sitting. Also aids such as transferring equipment, electric scooter or wheelchair and adjustable furniture can all help reduce fatigue.
Aerobic exercise under carefully controlled conditions can also help to overcome fatigue.
Poor posture
It is important that, even when sitting or lying down, an MS patient adopts the correct posture. The physiotherapist tries to ensure this through education and the use of pillows and foam wedges.
