From the Guidelines
Physical therapy management for coordination issues in multiple sclerosis patients should prioritize early intervention, prevention of severe joint contractures, and restoration of range of motion, strength, mobility, and pain relief, with a focus on task-specific training and balance exercises. Although the provided evidence 1 primarily focuses on rehabilitation among children with cancer, it highlights the importance of early intervention, orthotics, and assistive devices in preventing falls and improving function, which can be applied to MS patients.
Key Considerations
- Early intervention and prevention of severe joint contractures and deconditioning are crucial in managing MS patients 1.
- A comprehensive assessment is necessary to identify specific coordination deficits and implement targeted interventions.
- Task-specific training, balance exercises, and sensory integration techniques can help improve coordination and reduce the risk of falls.
- Orthotics, assistive devices, and bracing may be beneficial in preventing falls and improving function 1.
- A progressive home exercise program with regular reassessment and modification can help adapt to the patient's changing symptoms and promote neuroplasticity.
Management Strategies
- Focus on early intervention and prevention of severe joint contractures and deconditioning 1.
- Implement task-specific training, balance exercises, and sensory integration techniques to improve coordination and reduce the risk of falls.
- Use orthotics, assistive devices, and bracing as needed to prevent falls and improve function 1.
- Incorporate a progressive home exercise program with regular reassessment and modification to adapt to the patient's changing symptoms.
- Prioritize quality over quantity of movement, with 15-20 minute sessions, 3-5 times weekly.
From the Research
Physical Therapy Management Strategies for Coordination Issues in MS Patients
- The individualized exercise program should be designed to address a patient's chief complaint, improve strength, endurance, balance, coordination, fatigue, and so on 2
- Physiotherapy based on the Bobath concept can improve balance and gait in patients with MS, with the Berg Balance Scale (BBS) and the Rivermead Visual Gait Assessment (RVGA) demonstrating the highest change 3
- Exercise interventions, such as aerobic exercise training, resistance training, and flexibility exercises, can improve different areas of physical and mental symptoms in MS patients, including coordination 2
- Therapeutic exercise is one of the options for spasticity management in MS patients, which can help improve coordination and reduce spasticity 4
Specific Exercise Interventions for Improving Coordination
- Aerobic exercise training with low to moderate intensity can improve aerobic fitness and reduce fatigue in MS patients affected by mild or moderate disability 2
- Resistance training can improve fatigue and ambulation in MS patients, which can also help improve coordination 2
- Flexibility exercises, such as stretching the muscles, can diminish spasticity and prevent future painful contractions, which can help improve coordination 2
- Balance exercises have beneficial effects on fall rates and better balance, which can also help improve coordination 2
Other Management Strategies for Coordination Issues in MS Patients
- Intrathecal baclofen pump can be used to manage spasticity in MS patients who have intractable spasticity uncontrolled by drug therapy, or who experience intolerable side effects to oral baclofen, which can help improve coordination 5
- Physical modalities, complementary/alternative medicine interventions, oral medications, chemodenervation, and implantation of an intrathecal baclofen pump are other options for spasticity management in MS patients, which can help improve coordination 4