Multiple Sclerosis Physical Therapy

Role of physical therapy
The role of physical therapy in MS changes as the patient’s needs change,

due to relapse, disability progression, or disease course. However, the goals
of physical therapy will remain the same, to help you achieve and maintain
physical functioning, safety, quality of life, and independence. To achieve
these goals, your PT will use tools that include education and instruction,
emotional support and encouragement, and appropriate equipment and
assistive technologies. The specific interventions that your PT uses will
depend on your symptoms and disease course, but a successful physical
therapy program for a person with MS will:
 Educate you and your caregivers (family and/or friends) about

physical symptoms of MS and what you can do to alleviate these
symptoms
 Develop an individualized exercise program to address symptoms
and maximize health and function
 Introduce aids and adaptive equipment for home, office, and
automobile to enhance mobility and functionality
 Design physical therapy interventions to address specific impairments
 Identify community resources that support goals of physical therapy
Physical Therapy Goals and Interventions Vary

According to Disease Course
Time of diagnosis

 Baseline evaluation of physical functioning should be performed

 Education concerning disease and its management, including
appropriate exercises and activities, how to deal with fatigue, and
addressing subtle impairments in gait or balance
 Support and encouragement
Following exacerbation

 Goal of return to baseline functioning

 Often a wait of 2 weeks is recommended before physical therapy
because of weakness, side effects from medications, and other factors
Progressive disease

 Physical therapy should be used proactively due to the steady decline

in functioning
 Goals include support, resourcing (assistive tech), preventing de-
conditioning, safety, and maximizing health and functioning
Advanced disease

 Since person is typically non-ambulatory, physical therapy will focus

on seated trunk positioning and control, transfers, strength in upper
extremity, breathing, and assistive tech needs
 Standing devices are useful in allowing stretching to Release
spasticity, bowel and bladder relief, weight on long bones, and
improved breathing and speech projection
Physical therapy assessment

Your PT will make an initial assessment at your first meeting. He or she will
take a thorough medical history, asking you about what symptoms affect
you the most, the medications you take, other medical conditions you have,
and the top three problems that most affect your quality of life. This initial
assessment will establish a good baseline (where you’re starting from) by
which to measure progress during therapy. Tools that your PT may use to
evaluate your physical functioning include a walking test (how quickly you
can walk 25 feet or how far you can walk in 2 or 6 minutes), a standardized
disability assessment called the Expanded Disability Status Scale (EDSS),
tests of your ability to feel sensations including heat, cold, pain, and
pressure, and assessments of balance, gait, physical exertion, and
joint/muscle flexibility. An important goal of the assessment is to find out
how well you function in the range of areas shown in the table below.
Physical Therapy Assessment of Functioning

Posture, trunk control, balance, and transfers

 Seated and standing posture

 Static and dynamic balance
 Ability to transfer from bed, chair, toilet, car, and floor (as
appropriate)
Ambulation and mobility

 Consider factors including vision, sensation, deficits in balance,

spasticity, weakness, shoe wear
 Goal of normalizing gait pattern (for ambulatory individuals)
 Assess need for ambulatory aids
Range of motion

Assess for extremities (legs and arms) and trunk
Motor function

Focus on strength in extremities (legs and arms) and trunk, with emphasis
on function
Neurologic function

Check for problems including abnormal tone, clonus, tremors, sensory
deficits, and pain
Respiratory function

Assess for breathing capacity
Wheeled mobility

Assess for need for wheelchair or scooter
Physical therapy treatment plan

After a thorough assessment, your physical therapist will begin to work with
you to put together a treatment plan which will typically include a home
exercise program tailored to your specific symptoms and challenges. Often
this will include corrective exercises to improve alignment, mobility, and
strength. If you experience spasticity, the program may include slow
stretching, use of cold packs, and controlled position changes. If you
experience fatigue, your plan may focus on energy management, including
careful pacing, flexible schedules for work and activity, and avoidance of
overexertion.
Why is an individualized exercise program beneficial to people with Multiple Sclerosis
What types of exercises are beneficial for people with Multiple Multiple Sclerosis is a neurologic disease
that can lead to weakness, decreased walking, decreased balance and coordination, and a decreased
activity level that in turn can lead to a sedentary lifestyle. For a long time exercise was thought to be
detrimental to Multiple Sclerosis, but in recent years studies have shown that exercise is not related to
worsening of Multiple Sclerosis; in fact, exercise has many positive benefits associated with it, including:
 Improved strength and mobility
 Improved balance and endurance
 Improved lung function
 Improved bowel and bladder function
 Decreased fatigue and spasticity
 Improved function and quality of life, and sense of well-being
 Decreased depression
 Decreased risk of heart disease There are a wide variety of symptoms that can be experienced by
someone with Multiple Sclerosis. Because no two people with Multiple Sclerosis present with the same
symptoms, each person should be evaluated by a skilled Physical Therapist to determine their specific
exercise needs. Some components of a comprehensive exercise program are listed below. Stretching
Program:
 Should be performed daily, and helps manage spasticity and reduce risk of contractures
 Can be done individually or with a helper
 T’ai Chi, yoga, and pilates have also been shown to improve range of motion Aerobic Conditioning:
 Performed 3-5 times per week for 20-30 minutes, may need to gradually work up to 20 minutes
 Can be done by participating in walking programs over land or on a treadmill, using the Nu-Step, upper
or lower body ergometer, elliptical, or stationary bike Strengthening:
 Should be performed 3-5 times per week, 1-3 sets of repetitions to fatigue for each muscle group
exercise

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Role of physical therapy

The role of physical therapy in MS changes as the patient’s needs change,

 Educate you and your caregivers (family and/or friends) about

Physical Therapy Goals and Interventions Vary

 Baseline evaluation of physical functioning should be performed

 Goal of return to baseline functioning

 Physical therapy should be used proactively due to the steady decline

 Since person is typically non-ambulatory, physical therapy will focus

Physical therapy assessment

Physical Therapy Assessment of Functioning

 Seated and standing posture

Ambulation and mobility

 Consider factors including vision, sensation, deficits in balance,

Physical therapy treatment plan

Why is an individualized exercise program beneficial to people with Multiple Sclerosis

 Improved strength and mobility

 Improved balance and endurance

 Improved lung function

 Improved bowel and bladder function

 Decreased fatigue and spasticity

 Improved function and quality of life, and sense of well-being

 Can be done individually or with a helper

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