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Advanced Remedial Massage. Multiple Sclerosis. What is MS?. Chronic, disabling disease Randomly attacks the central nervous system Progression, severity and symptoms cannot be predicted Range of symptoms from tingling and numbness to paralysis and blindness No cure. Who gets MS?.
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Advanced Remedial Massage Multiple Sclerosis
What is MS? • Chronic, disabling disease • Randomly attacks the central nervous system • Progression, severity and symptoms cannot be predicted • Range of symptoms from tingling and numbness to paralysis and blindness • No cure
Who gets MS? • 2 times as many women as men • Onset between 20 and 40 • No evidence that MS is directly inherited • More common among Caucasians, especially those with northern European ancestry
Causes MS • Unknown • Body’s immune system attacks it own myelin, this disrupts the nerve transmission • Could be genetic or environmental factors that trigger this disease but no one knows for sure • Symptoms result from the inflammation and breakdown of the myelin, causing scar tissue, called “sclerotic” patches
Is MS fatal? • No • MS suffers have normal to near-normal life expectancy
Does MS always cause paralysis? • No • Majority of people with MS do not become severely disabled • Studies have shown 50% of people with MS are independently mobile after 15 years
Is MS contagious? • No • Neither contagious or directly inherited, genetic studies have shown some individuals more susceptible to the disease
Can MS be cured? • Not yet • Medications can help with the symptoms • Medications are now available that have been shown to affect the underlying disease course
Why is MS so difficult to diagnose? • Complex process • Symptoms could be from a number of other disorders • No single laboratory test • MRI has aided the diagnosis but is often not conclusive
Medications • Betaferon, Copaxone, Rebif and Avonex for relapsing forms of MS • Helped to lessen the frequency and severity of MS attacks • Reduce the accumulation of lesions in the brain
Multiple Sclerosis Types • Relapsing Remitting – Most common form with acute episodes followed by partial or complete recovery • Primary-Progressive – After an initial period of relapsing/remitting, disease takes a progressive course with remission • Progressive-Relapsing – Continuous worsening from onset, but unlike primary-progressive includes distinct acute flare ups and remissions.
How many people have MS? • 2,500,000 people in the world • 15,000 Australians • (national health Survey 2001)
Typical Symptoms • Unpredictable • Extreme tiredness • Impaired vision • Loss balance and muscle coordination • Slurred speech • Tremors • Stiffness • Bladder and bowel problems • Difficulty walking • Short term memory loss • Mood swings • Severe cases • Partial or complete paralysis
Consultation questions • When was the diagnosis of MS made? • When were the first symptoms first experienced? • What were your symptoms? • How has the MS progressed? • What are your current symptoms? • What kind of MS do you have? • How long did it last? • Have any of the symptoms remained? • Are you taking any medications? • Is their any pain? • Do you have an diminished sensory perception? • Do you get fatigued from massage? • How long does it take you to recover? • Do you have any reactions to heat? • When was the last attack? • Have you had a massage before?
Contraindications • Techniques or modalities that will fatigue the client are contraindicated • DTF’s, vigorous work increase sympathetic nervous system firing • Heat over a large area will affect nerve conduction and exacerbate fatigue • Deep techniques over areas with altered sensation • Any red, inflamed areas over bony prominences notices, inform client (ulcers)
Testing • ROM’s Active, passive and resistive • Sensory testing • Specific orthopedic tests for presenting conditions
Treatment strategies • Decrease sympathetic nervous system firing • Avoid inducing fatigue • Caring touch in a supportive environment • Positioning may be limited due to spasticity, size of client or wheelchair • Cold can something reduce edema, inflammation and spasticity, it depresses afferent and efferent firing • Heat to trigger points (small areas)
Treatment goals • Avoid exacerbating spasiticity • Maintain proper body alignment • Decrease sympathetic nervous system firing • Prevent fatigue • Provide emotional support • Improve and maintain tissue health • Reduce oedema
Goals continued • Limit contracture if possible • Address postural changes and muscle imbalances • Decrease pain • Address secondary conditions • Decrease spasticity temporarily • Maintain joint health • Provide emotional support • Encourage whole body integration
Self-care goals • Increase functional ability through improving strength, range of motion and balance • Educate about the maintenance of tissue health • Encourage relaxation • Refer client if necessary
Rx frequency • 1 hour treatment on a weekly basis beneficial for stress reduction, increased functional ability and greater sense of well being • If client needs painful work distributed the work over several shorter session, ½ hour sessions twice per week
References • 2000, Rattray and Ludwig; Clinical Massage Therapy – Understanding, assessing and treating over 70 conditions • http://www.msaustralia.org.au