Multiple Sclerosis

Multiple sclerosis remains the commonest cause of neurological disability in young adults and is one of the most prevalent neurological conditions.

Estimated that 3,500 New Zealanders have MS. The true incidence of MS in this country is unknown. Currently, estimates range from 25 to 70 cases per 100,000 New Zealanders,
MS is an inflammatory demyelination condition. Myelin is a fatty material that insulates nerves, acting much like the covering of an electric wire and allowing the nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and co-ordinated movements to be performed with little conscious effort.
In multiple sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in multiple sclerosis these scars appear at different times and in different areas of the brain and spinal cord. The term multiple sclerosis means, literally, many scars.
Almost any neurological symptom can appear with the disease, and often progresses to physical and cognitive disability

People with MS ask for help in improving their ability to function. Often, they ask for help in moving about. Frequently they ask if anything can be done to help them remember things better or feel less tired or depressed.

In addition to being essential to general health and well-being, exercise is helpful in managing many MS symptoms. A study published by researchers at the University of Utah in 1996 was the first to demonstrate clearly the benefits of exercise for people with MS. Those patients who participated in an aerobic exercise program had better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities. Since 1996, several additional studies have confirmed the benefits of exercise.

An exercise program needs to be appropriate to the capabilities and limitations of the individual, and may need to be adjusted as changes occur in MS symptoms. A physical therapist experienced with the unique and varied symptoms of MS can be helpful in designing, supervising and revising a well-balanced exercise program.

Periods of exercise should be carefully timed to avoid the hotter periods of the day and prevent excessive fatigue. With some guidelines, a good exercise program can help to develop the maximum potential of muscle, bone and respiration, thereby avoiding secondary complications and gaining the benefits of good health and well-being.

People with MS do not require constant physiotherapy input; however, there are benefits to bursts of rehabilitation following a relapse or a change in functional capacity.

It is known that adults with MS are less physically active and weaker than other adults, they have less leg strength than their peers, as well as impaired balance, which has lead to an increased prevalence of falls in this population.

We at Rope Neuro Rehabilitation take a holistic approach.

  • Follow up visits assessing if they have absorbed/processed/understood previous info – gives us insight to their cognitive function/abilities.
  • Provide information/education to family, support.
  • Provide general information re: other services, support etc - increase their knowledge to enable their independence and decision making etc.
  • Apart from Field officers we may be one of the only health professionals seeing these patients regularly. Build rapport, monitor over time.
  • Trying to enable clients to remain as independent as possible for as long as possible and quality of life.
  • HEP – tailored to the individual in their environment, progressed as able. Includes selection of strength, balance, stretching , tone management, CV fitness, gait re-education, functional tasks e.g.: on/off floor transfers. Use of electrotherapy e.g.: FES or other modalities as appropriate. Falls prevention exercises. Addressing musculoskeletal injuries as they occur.
  • Home exercise programs evidence supported by Debolt and McCubbin 2004. – 8 week home based program.
  • Outdoor mobility – assessing ability to mobilise outside. Outside their house, down to local dairy, around shopping malls (more distractions and other people about), stairs, slopes, grass/uneven surfaces. Assessing aids e.g.: w/s inside but may actually need frame or scooter to access community. ? Refer for scooter assessment.
  • Pain management – TENS, ice, heat therapy, positioning/stretching, hydro, time of medication prior to exercise/PT, refer back to GP or chronic pain team
  • Accessing local community – e.g.: pools, gyms, groups e.g.: Tai Chi, yoga etc.
  • Splinting /orthoses – referring onto Orthotic centre or hand works when required, trialling different splints/AFO’s etc. Also able to do soft and scotch casts/splints as appropriate.
  • Fatigue – pacing ADL/social outings/appointments, time of day re: heat – when better to exercise/physical tasks etc.
  • Assessing for equipment or suggesting options
  • Referring on when need e.g.: OT assessment, SLT assessments, back to GP, support groups etc, Royal NZ Foundation of the Blind (visual problems or to a ophthalmologist), liaising between other health professional – GP, neurologist, field officer etc.

Multiple Sclerosis Auckland

Was set up in 1964 to support, educate, advocate and advice people with Multiple Sclerosis, their families, carers and their support networks.

We offer education to the general public, employers and health professionals about Multiple Sclerosis.

We actively encourage and partake in on-going medical research to find the cause and a cure for Multiple Sclerosis.

MS Auckland feels it captures 70% of Multiple Sclerosis population in Auckland but encourages all newly diagnosed to join our Society and receive the many benefits on offer.

In Auckland – there are 4 Field Workers whose role is to: make contact and liaise with Multiple Sclerosis patients and their families, personalise support as everyone’s symptoms are different, provide education to groups e.g.: AUT, nursing/caregivers. – and empower people with Multiple Sclerosis to lead fulfilling lives despite the disease.

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