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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

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Exercise and MS

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  1. Exercise and MS Patricia G. Provance, PT, MSCS Maryland Center for MS & Kernan Rehabilitation Hospital

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Fatigue in MS (continued) • Aggravating factors • Obesity • Sleep disruption • Restless leg syndrome • Inactivity/over-activity • Side effects of medications • Depression • Stress • Other medical conditions, e.g., anemia, hypothyroidism

  8. Energy Management Strategies • 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

  9. Energy Management Strategies • 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

  10. 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

  11. 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

  12. Weakness: Common Gait Deviations • “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

  13. 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

  14. Corrective Exercises Should be: • Functionally focused • Done throughout the day • Successful in demonstrating improvement • Performed independently, if possible

  15. 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

  16. 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

  17. Elements of Mobility • Bed mobility • Transfers • Ambulation (independent or aided) • Wheeled mobility (manual, power, scooter) • Driving: hand controls, left gas pedal

  18. Spasticity Weakness Fatigue Impaired balance Impaired sensation Pain Contractures Vestibular Disturbances Impaired cognition Limited range of motion Heat intolerance Vision problems Ataxia (incoordination) Environment MS Symptoms That May Interfere with Mobility

  19. 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, 4-wheeled, wheeled with seat) • Wheelchairs: manual, power, scooter (controls, positioning) • Car/van modifications

  20. Effects of Exercise -Improvements in Impairments • Improved range of motion • Improved strength • Improved endurance/ decreased fatigue • Decreased pain

  21. Effects of Exercise –Improvements in Disability • Improved mobility - bed mobility - transfers - ambulation • Improved independence with ADLs

  22. Effects of Exercise –Improvements in Quality of Life • Improved emotional behavior • Improved social interaction • Recreational enjoyment • Improved home management independence

  23. 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

  24. Remember… If you don’t USE it… You LOSE it!

  25. 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 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 Useful Websites

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