Transcript Exercise and MS

Exercise and MS
Patricia G. Provance, PT, MSCS
Maryland Center for MS
&
Kernan Rehabilitation Hospital
The Rehabilitation Team
• Always has something to offer
• Should have knowledge about the unique
and individual nature of MS
• Can provide education, sensitivity,
resources and monitoring of functional
needs.
Function and Quality of Life
• The goals of both patients and therapists
are to achieve and maintain an acceptable
level of functional independence and
control.
• The need for therapy intervention will vary,
but should be timely and appropriate, as
the need will increase over a lifetime.
• The “orthopedic strengthening model” is
usually a failure.
Periodic Assessments are
needed
• To determine need for adaptive tools,
ambulation aids, wheelchairs, safety
equipment, community resources,
exercise program modifications, etc.
• To continue support and education
regarding energy management, work
issues, wellness and conditioning
Deconditioning can have a
major impact on function
• Often overlooked as a symptom
• Often preventable
• Secondary weakness from disuse is
common and is reversible
• Adaptive muscle shortening from inactivity
can be resolved with corrective exercise
Fatigue in MS
• MS fatigue: Persistent, overwhelming
sense of tiredness and exhaustion
• Causes
– Reduced conduction of nerve impulses
– Excessive spasticity and/or muscle
tightness
– Increased core body temperature due to
weather, fever, or exertion
– General deconditioning
– Poor trunk stability
Fatigue in MS (continued)
• Aggravating factors
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Obesity
Sleep disruption
Restless leg syndrome
Inactivity/over-activity
Side effects of medications
Depression
Stress
Other medical conditions, e.g., anemia,
hypothyroidism
Energy Management Strategies
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Effective pacing
Flexible home and work schedules
Recognition of warning signals
Successful use of compensatory
strategies
• Acceptance of a request for assistance
• Home/work modifications
Energy Management
Strategies
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Appropriate ambulatory aids
Maintenance of mobility
Control of spasticity
Improved trunk control
Correct compensatory movement
patterns
ADL assistive devices
Heat control
Habit change/Lifestyle modification
Medications
Adaptive Muscle Shortening
• Occurs with inactivity
• Most often affects the Iliopsoas (1-joint hip
flexor that attaches on the lumbar spine).,
Hamstrings, Gastrocnemius, Pectoralis
major and minor (slouched posture) and
posterior neck (fwd head & substitution)
• Impact: Low back pain, spasticity, poor
posture, limited overhead reach
Secondary Weakness Common in MS
• Trunk, abdominal and gluteal weakness
secondary to prolonged sitting
– Often exacerbated by adaptive shortening of hip
flexors and contributes to poor posture and
balance problems in standing
• Neck and trapezius weakness secondary
to poor sitting posture and inactivity
– Affects arm function in overhead reach and is
exacerbated by tightness in pectoralis major and
minor, latissimus dorsi and upper trapezius
Weakness: Common Gait
Deviations
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“Hip-Hiking”
Circumduction (swinging leg out to the side)
Trunk lean to the side
Backward trunk lean
Foot drag
Shuffling
Vaulting to clear weak leg
Management of MS Weakness
• Primary weakness
– Strengthening muscles
– Requires compensatory intervention (mobility
aids, bracing, etc.)
• Secondary weakness
– Often overlooked
– Can be minimized with early intervention and
appropriate follow-up to maintain posture &
stability, correct compensatory gait, encourage
healthy lifestyle, and teach energy management
strategies
Corrective Exercises
Should be:
• Functionally focused
• Done throughout the day
• Successful in demonstrating improvement
• Performed independently, if possible
Heat Intolerance
• Treatment: Reduce core temperature
– Cool environment (Room 62-68 degrees,
Water <85 degrees F)
– Hydration with cool liquids
– Popsicles, “slurpees”
– Light/loose clothing
– Rest after activity/exercise
– Cooling vest/garment
– Ice/cooling gel packs
– Use of an oscillating fan when exercising
– Avoid hot baths/showers
Mobility
• Mobility: Ability to move
independently from one location to
another
• Mobility limitation leads to
increased risk for ADL dependence
• Mobility limitation leads to
increased risk for other health and
psychosocial problems
Elements of Mobility
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Bed mobility
Transfers
Ambulation (independent or aided)
Wheeled mobility (manual, power,
scooter)
• Driving: hand controls, left gas pedal
MS Symptoms That May
Interfere with Mobility
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Spasticity
Weakness
Fatigue
Impaired balance
Impaired sensation
Pain
Contractures
Vestibular
Disturbances
• Impaired
cognition
• Limited range
of motion
• Heat intolerance
• Vision problems
• Ataxia
(incoordination)
• Environment
Mobility: Interventions
• Equipment prescription
– AFO (ankle-foot orthosis or “foot drop”
brace)
– Assistive devices
• Cane (straight or “sure-foot”)
• Lightweight forearm crutch(es)
• Walkers (standard, 2-wheeled, 4wheeled, wheeled with seat)
• Wheelchairs: manual, power, scooter
(controls, positioning)
• Car/van modifications
Effects of Exercise Improvements in Impairments
• Improved range of motion
• Improved strength
• Improved endurance/ decreased
fatigue
• Decreased pain
Effects of Exercise –
Improvements in Disability
• Improved mobility
- bed mobility
- transfers
- ambulation
• Improved independence with ADLs
Effects of Exercise –
Improvements in Quality of Life
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Improved emotional behavior
Improved social interaction
Recreational enjoyment
Improved home management
independence
Summary
• MS and accompanying
symptoms can cause
difficulty with exercise
• The benefits of exercise
outweigh the potential
difficulties because of the
positive potential for
reducing disability,
improving quality of life
and improving overall
health
Remember…
If you don’t USE it…
You LOSE it!
Useful Websites
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www.abledata.com
www.beabletodo.com
www.abilityhub.com
www.assistivetech.net
www.rehabtool.com
www.Infogrip.com
www.ocelco.com
www.maxiaids.com
www.orthoticmobility.com
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www.clarkehealthcare.com
www.invacare.com
www.sunrisemedical.com
www.sammonspreston.com
www.walkeasy.com
www.gaiam.com
www.medicalmailorder.com
www.phc-online.com
www.allegromedical.com