What strategies are effective in managing a patient with Multiple Sclerosis (MS) who is experiencing weakness and frequent sliding out of bed and chair due to decreased mobility?

From the Guidelines

To manage a patient with multiple sclerosis who is experiencing weakness and frequently sliding out of bed or chair, implement a comprehensive approach that includes physical exercise, management of comorbidities, review of medication(s), environmental modifications, and use of mobility assistance devices, as recommended by the most recent expert guidelines 1. This approach should prioritize interventions that enhance safety, independence, and quality of life, while addressing the underlying MS-related muscle weakness and spasticity.

Key Interventions

• Physical therapy consultation to develop a personalized strengthening program focusing on core and lower extremity muscles
• Occupational therapy to recommend adaptive equipment like transfer boards, grab bars, and hospital-grade bed rails
• Environmental modifications, such as using bed wedges, positioning rolls, or a specialized mattress with raised edges to create physical barriers
• Use of mobility assistance devices, like a reclining wheelchair with proper pelvic positioning straps and anti-slip cushions
• Regular review of medications that could contribute to weakness, such as certain antispasmodics or sedatives 1

Additional Considerations

• Regular position changes every 2 hours to prevent pressure sores and improve comfort
• Consideration of a low bed with floor mats if falls occur
• Encouragement of normal movement patterns and resting postures, as recommended for functional neurological disorders 1
• Avoidance of interventions that may exacerbate symptoms, such as splinting, which can lead to increased attention and focus on the affected area, accessory muscle use, and immobilization leading to muscle deconditioning 1

From the Research

Effective Strategies for Managing MS-Related Weakness and Mobility Issues

To manage a patient with Multiple Sclerosis (MS) who is experiencing weakness and frequent sliding out of bed and chair due to decreased mobility, several strategies can be employed:

• Skilled rehabilitation strategies, including therapeutic exercise and physical modalities, can help improve mobility and reduce spasticity 2, 3
• Oral medications, such as baclofen, tizanidine, and gabapentin, can be used to manage spasticity, with diazepam or dantrolene considered if no clinical improvement is seen with first-line options 4, 5
• Alternative therapeutic approaches, such as the endocannabinoid system modulator Sativex (nabiximols), can provide additional relief for MS spasticity 4
• Intrathecal management, including the implantation of an intrathecal baclofen pump, can be effective for severe spasticity and suboptimal response to oral drugs 2, 5
• Occupational therapy can help enable individuals to participate in self-care, work, and leisure activities, although more research is needed to determine its effectiveness in improving outcome in MS patients 6

Assessment and Management of Spasticity

Assessment of spasticity is crucial in determining the extent of the condition and culpable muscles, with tools such as the Ashworth scale and numerical rating scale available 4

• A careful assessment of the patient's history and physical examination can help determine the functional impact of spasticity and potential exacerbating factors 2
• Treatment strategies for spasticity management should be individualized, taking into account the extent of symptoms, patient preference, and availability of services 2, 3