Efficient rehabilitation interventions in MS and novel directions

SPECIALIST TALK // Peter Feys, PT, professor, University of Hasselt, Belgium

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Persons with Multiple Sclerosis (pwMS) suffer from a chronic condition affecting the central nervous system. PwMS may manifest many different functioning problems, that should be addressed from a multi-disciplinary perspective. For a long time, many clinicians were not regarding rehabilitation as an effective treatment strategy. Accumulating evidence is however now available on the effects of physical exercise (resistance and endurance training) and physical rehabilitation (balance, gait training).

It was shown that pwMS can benefit at the body function (muscle strength and physical fitness) and activity (walking) levels of the ICF, in the domain of health related quality of life while also personal factors as depression and fatigue can be reduced. Interestingly, recent studies do also propose practical applicable training programs that are considered to some extent as neuro-protective, and may also impact on cognitive function. It seems to be possible to reach also benefits in more disabled patients.

There are also novel directions in MS rehabilitation research. The concept of exercise therapy has also been incorporated in technology-supported rehabilitation for gait and upper limb training. Task-oriented rehabilitation for the upper limb seems also effective. Besides, there is increasing attention to phenomena of cognitive-motor interference and motor fatigability. It is thought that disabled persons with MS show a higher cognitive-motor dual task cost than healthy controls, that is impacting on daily life and may be related to falls.

Motor fatigability refers to the difficulty, that pwMS may experience to sustain muscular activity during a prolonged task. At body function level, reductions in maximal muscle strength have been found during 30” isometric contractions or repeated dynamic contractions. At activity level, half of disabled pwMS are likely slowing down by more than 15% during the six-minutes walking tests. There is emerging research in these domains, that likely will lead to novel rehabilitation approaches in the near future.