Multiple Sclerosis (MS) Rehabilitaion


What is MS Disease?

MS is an autoimmune disease that occurs as a result of the attack of one’s own cells against his own brain and spinal cord as a result of a disorder in the immune system.

MS is an autoimmune central nervous system disease characterized by inflammation, destruction of the myelin sheath and axonal damage. MS, which is a chronic disease, is 2 times more common in men than in women. While some of the disease progresses with attacks, some of it shows a progressive course.

Various symptoms such as limitation of movement, weakness, partial paralysis, imbalance, speech and vision disorders are seen in multiple sclerosis.

MS is a disease of the central nervous system, namely the brain, spinal cord and nerve fibers associated with vision. In MS disease, nerve fibers called white matter in these areas are affected. White matter consists of fibers that provide communication within the central nervous system itself and between this part and other parts of the body.

What Causes MS Disease?

According to our current knowledge, the cause of the disease is not known exactly. Although some theories have been proposed regarding the development of MS, none of them can explain the event completely.

Genetic factors have a great effect on the development of MS disease. However, studies have not found a specific gene that can cause the disease.

It is interesting to determine the relation of MS disease with diseases such as thyroid / goiter, SLE (systemic lupus erythematosis), mystenia gravis, diabetes, ankylosing spondylitis, inflammatory bowel diseases, scleroderma and Behçet’s disease. Because autoimmunity is responsible for most of these diseases.

  • Environmental factors; insecticides, herbicides, exposure to mercury, organic solvents, and some environmental toxins we may not even know about.
  • Ethnicity; The frequency of yellow and black race is lower than white race. While it is more common in Northern Europe, America and Northern Canada, it is less common in the equatorial region.
  • The effect of viruses, especially herpes group viruses, although blamed, has never been proven.
  • Genetic factors; the incidence of the same disease in the child of a mother or father with MS is 7-10 times higher than in the same age group in the society. However, genes alone are not a factor in disease formation.
  • Inheritance.

What are the Symptoms of MS?

MS disease is a disease that progresses in different ways, with symptoms that can vary in each patient. The timing of the disease, the location in the brain and / or the spinal cord, differences in the severity of symptoms are characteristic of MS disease.

The present symptoms in the patients continue with a course with attacks and improvements. Over time, the symptoms intensify and progressively worsening. In MS, which has very different symptoms according to the affected area and the person’s immune response, following symptoms are observed;

  • Numbness, tingling, pricking sensation
  • Loss of strength,
  • Muscle spasm, muscle stiffness, cramps and pain (loss of strength can be in the arm and leg on one side of the body, or in both legs)
  • Quick fatigue and prostration
  • Vision loss, double vision
  • Urinary incontinence, constipation,
  • Swallowing disorder
  • Depression
  • Speech disorder, depression, fatigue
  • Sexual dysfunction
  • Loss of balance, nausea
  • Short-term memory loss.

The first symptoms in MS patients usually begin with vision loss of varying degrees.

How Is MS Disease Diagnosed?

It is not easy to diagnose MS disease. Because there is no specific diagnostic test and method for this disease. The diagnosis will be made with a good neurological history, examination findings and tests as in many diseases. In diagnosis, MR, CSF examination, evoked nerve responses can be controlled (in evoked responses, nerve conduction velocities are measured). In the cell where the myelin sheath is damaged, the nerve conduction velocity will also be slower.

How Is MS Disease Treated?

Today, treatments for disease, fatigue and exhaustion are performed in the treatment of MS.

Especially walking problems and loss of balance are among the reasons that limit daily living activities. Restrictions in activity will increase the likelihood of some risky diseases such as obesity, diabetes, osteoporosis and cardiovascular diseases by causing inactivity. For these reasons, regular exercise will be very important in preventing MS disease, increasing the quality of life and making the person feel good, as in all phases of life. Each patient should be evaluated separately and exercise programs should be prepared accordingly.

Rehabilitation plays a very important role in MS patients. Exercises and walking aids should be given to increase functions following acute attacks, and attention should be paid to in-bed positioning in patients who have advanced and lost their ability to walk. Detailed programs should be prepared, including programs for respiratory and trunk control, transfers and increasing upper extremity strength.

In rehabilitation;

  • The patient’s body awareness should be developed,
  • Abnormal muscle tone of the patient should be reduced,
  • Exercises should be started with positioning or stretching,
  • Sensory losses should be helped to reduce,
  • The intensity of the exercises should be from simple to difficult,
  • Functional skills should be practiced for daily life activities,
  • Walking should be improved with walking preparation exercises and assistive devices.
  • Patients should be approached in a multidisciplinary way.

Exercises applied in MS disease are effective in treating and alleviating the symptoms resulting from the disease. For this purpose;

  • Stretching exercises (given to reduce muscle tension and prevent joint movements)
  • Posture exercises (working the deep muscles. These muscles are very effective in maintaining balance and walking)
  • Aerobic exercises (work large muscle groups, support heart and lung function).
  • Strengthening exercises
  • Endurance exercises (exercise given to increase the endurance of the muscles or the respiratory system)
  • Balance, walking, water exercises
  • Home exercise program should be planned specifically for each patient with MS.

Patients with swallowing disorders should be treated, care should be taken to ensure a balanced diet. If the patient has a bladder disorder (incontinence and inadequate emptying), medication should be given and the bladder should be emptied with the help of catheters at regular intervals.