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A review of current rehabilitation practices and their benefits in patients with multiple sclerosis

Published:December 08, 2022DOI:https://doi.org/10.1016/j.msard.2022.104460

      Highlights

      • Many beneficial rehabilitation therapies exist for patients with multiple sclerosis.
      • Patient-centred plans that include goal setting are crucial aspects of therapy.
      • Exercise therapy offers physical, cognitive and psychological benefits for patients.
      • Both in- and out-patient settings can provide patient condition-dependant benefits.
      • Measurable improvements should be seen in impairment, activity and participation.

      Abstract

      Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination of the nerves of the central nervous system that results in patients progressively losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation therapy is an important aspect of care; assisting patients to regain or retain function and improve their physical, mental and social wellbeing. At present there is no current consistent model of care for MS, likely due to the variable symptom presentation. Various forms of rehabilitation therapy are available, and these include physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy. Contrary to previous understanding, exercise-based therapies have shown various benefits for patients with MS, and in addition to improving MS-related physical symptoms, have been shown to reduce the risk of developing cardiovascular disease and can improve cognitive function. Cognition rehabilitation therapy specifically focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation, which offers cognitive functioning benefits, and restorative rehabilitation, which offers memory benefits. Excitation therapies include cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy and these non-invasive techniques may improve patient's physical ability. Additionally, more novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation, both of which are expected to play progressively more prominent roles in the future of rehabilitation therapy. The structure of the care team has been found to impact patient outcomes, and both in- and out-patient care settings have been found to be beneficial, dependant on the patient's circumstances, with certain patients better suited to a particular setting. While a single point of care is recommended for patients, a multidisciplinary care team and regular reassessment is recommended to manage changing symptoms and ensure continuity of care. The importance of the critical components of rehabilitation have been identified, and these are of vital importance in achieving beneficial outcomes. These components include the patients’ participation in the treatment, goal setting with a multidisciplinary care team, a guiding-light purpose for the patient, which focusses on recognizing their personal potential and obtaining improvements through a tailored plan. The final critical component of rehabilitation is the results measurement, which highlights the need for a quantifiable reduction in impairment and improvement in activity and participation. Overall, a lack of standardisation in outcome measurements makes comparison challenging. This is particularly important when comparing standard methods of care with more novel rehabilitation techniques. However, within the broad area of rehabilitation therapies, it is clear that patients with MS can benefit from rehabilitation practices; physically, mentally and socially.

      Keywords

      Abbreviations:

      6MWT (6-minute walk test), AFO (ankle foot orthoses), CI (confidence interval), EDSS (expanded disability status scale), FES (functional electrical stimulation), FMV (focal muscle vibration), IL (interleukin), MS (multiple sclerosis), NIBS (non-invasive brain stimulation), NICE (National Institute of Health and Care Excellence), PAS (penetration and aspiration scale), RAGT (robot-assisted gait training), SWAL QOL (swallow-related quality-of-life assessment), QoL (Quality of Life), TENS (transcutaneous electrical nerve stimulation)
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