Mobility, Fatigue & Multiple Sclerosis

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Mobility, Fatigue & Multiple Sclerosis

28th May, 2018

Do you have trouble walking?

Does your walking pattern deteriorate the further you walk?

Do your legs become heavy, stiff and hard to lift, or do you have trouble balancing when standing or stepping?

And is the whole process exhausting?

 

People diagnosed with Multiple Sclerosis (MS) often report difficulties with mobility as the most disabling aspect of living with the condition. In addition, fatigue also ranks highly as one of the most common and disabling symptoms experienced. Together, mobility difficulties & fatigue have an enormous impact on all activities of daily living such as employment, home care, shopping or just getting out of the house.

Reduced balance confidence & the experience of fatigue are also the major reasons why it is difficult to increase physical activity and engage in exercise 1 – which is so important for your long-term health. We know that people with MS have much lower levels of physical activity compared with the general population, which leads to several negative consequences in terms of overall health and quality of life.

Over the past 20 years there has been extensive research demonstrating the benefits of physical rehabilitation and exercise for people with MS. Some of the benefits include improved  mobility levels 2, balance, increased strength 3, cardiovascular fitness 4, reduced fatigue 5 and improved confidence and quality of life 6. It is recommended that people with MS seek the advice of health professionals with experience in rehabilitation with MS, as they are familiar with some of the complex signs and symptoms that can be associated with the condition, in additional to  optimal evidence based symptomatic and rehabilitation based interventions.

 

This is where Advanced Neuro Rehab comes in!

 

Our Neurological Physiotherapists spend considerable time updating their knowledge on all aspects of Multiple Sclerosis, symptomatic management, multidisciplinary rehabilitation with an additional focus on movement, balance, mobility and exercise prescription. We are well placed to incorporate person-centred goals into a specific rehabilitation plan which may involve learning new movement skills, strengthening programs, balance/gait retraining, upper limb rehabilitation and cardiovascular fitness. We can also assess other relevant issues that impact on an exercise plan including musculoskeletal injury and pain associated with arthritis, back, neck, hip or knee pain,  movement-based impairments such as weakness, spasticity or incoordination, fatigue & muscle fatigue, balance, ataxia and falls risk and other concurrent medical conditions such as heart and lung conditions. We will also liaise closely with other health professionals as needed, including general practitioners, medical specialists, occupational therapists, Orthotists, specialist MS nurses and speech pathologists.

 

The most recent guidelines from the National Institute for Health and Care Excellence recommend that individualised rehabilitation ‘involve physiotherapists with expertise in MS’ 7. Neurological Physiotherapists at Advanced Neuro Rehab develop very specific physical rehabilitation plans that are individually tailored, considering your own signs, symptoms and personal goals. We understand that exercise programs need to be flexible, giving you choice and control. There are many exercises programs out there, so the key is focussing the program in such a way, so you really notice improvement in real life situations. We also know that if physical activity programs are to succeed, some level of support and supervision is needed within the community 8. Supervision can exist in many forms ranging from supervision that is regular and direct, intermittent, in timely ‘bursts’, in group or classes, or by distance via phone, email and videoconference. Those people within the community involved in supervision and support can include local gym instructors, exercise physiologists, personal trainers, local physiotherapists, care-workers and family members 9. Lack of knowledge amongst community-based health/fitness professionals such as these are known to be a significant barrier to the implementation of physical activity participation for people with disabilities 10. We at Advanced Neuro Rehab believe in developing clear strategy that links us to those people who can assist in the delivery of longer-term sustainable exercise programs.

 

Some of us at Advanced Neuro Rehab have been working closely with people with MS since 1997, and have been involved in MS specific education programs for health professionals as well as important research into the areas of mobility and fatigue 11–13. For more information, advice or support, call us on 8363 0458 or email admin@neurophysiotherapy.com.au to make an appointment.

  1. Smith, C., Olson, K., Hale, L. A., Baxter, D. & Schneiders, A. G. How does fatigue influence community-based exercise participation in people with multiple sclerosis? Disabil. Rehabil. 33, 2362–2371 (2011).
  2. Snook, E. M. & Motl, R. W. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil. Neural Repair 23, 108–116 (2009).
  3. Kjølhede, T., Vissing, K. & Dalgas, U. Multiple sclerosis and progressive resistance training: a systematic review. Mult. Scler. 18, 1215–1228 (2012).
  4. Platta, M. E., Ensari, I., Motl, R. W. & Pilutti, L. A. Effect of Exercise Training on Fitness in Multiple Sclerosis: A Meta-Analysis. Arch. Phys. Med. Rehabil. 97, 1564–1572 (2016).
  5. Pilutti, L. A., Greenlee, T. A., Motl, R. W., Nickrent, M. S. & Petruzzello, S. J. Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis. Psychosom. Med. 75, 575–580 (2013).
  6. Motl, R. W. & Gosney, J. L. Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis. Mult. Scler. (2007).
  7. Multiple sclerosis in adults: management | Guidance and guidelines | NICE.
  8. Rimmer, J. H. Getting beyond the plateau: bridging the gap between rehabilitation and community-based exercise. PM R 4, 857–861 (2012).
  9. Rimmer, J. H. & Henley, K. Y. Building the crossroad between inpatient/outpatient rehabilitation and lifelong community-based fitness for people with neurologic disability. J. Neurol. Phys. Ther. 37, 72–77 (2013).
  10. Rimmer, J. H., Riley, B., Wang, E., Rauworth, A. & Jurkowski, J. Physical activity participation among persons with disabilities: barriers and facilitators. Am. J. Prev. Med. 26, 419–425 (2004).
  11. McLoughlin, J. Gait and Multiple Sclerosis. in Handbook of Human Motion (eds. Müller, B. et al.) 1–13 (Springer International Publishing, 2016).
  12. McLoughlin, J. V., Barr, C. J., Crotty, M., Sturnieks, D. L. & Lord, S. R. Six minutes of walking leads to reduced lower limb strength and increased postural sway in people with Multiple Sclerosis. NeuroRehabilitation 35, 503–508 (2014).
  13. McLoughlin, J. V., Lord, S. R., Barr, C. J., Crotty, M. & Sturnieks, D. L. Dorsiflexion Assist Orthosis Reduces the Physiological Cost and Mitigates Deterioration in Strength and Balance Associated With Walking in People With Multiple Sclerosis. Arch. Phys. Med. Rehabil. (2014).

Associate Professor James McLoughlin

Director, Advanced Neuro Rehab