Quality of Life for MS Patients: The Impact of Comprehensive Rehabilitation (Part Three in Series)
In Part One, Quality of Life for MS Patients: Is it Health-Related?, we outlined four aspects to quality of life which include clinical health, role-performance, adaptability, and well-being. It is important to note that one aspect can and does affect the others. We are complex beings who are certainly multi-faceted.
In Part Two, Quality of Life for MS Patients: The Role of Disease-Modifying Treatments, we discussed the six FDA-approved disease-modifying agents which are designed to decrease central nervous system inflammation, reduce relapse rates, slow disability and the accumulation of cognitive dysfunction, reduce new lesion formation and the progression of brain atrophy for patients with multiple sclerosis.
In Part Three, we will discuss The Impact of Comprehensive Rehabilitation. But when you think of “rehab” what picture comes to mind?
- recovery from drug abuse?
- learning how to walk again after a stroke?
- cognitive behavior therapy?
With multiple sclerosis, the symptoms of the disease can negatively affect functions of daily living, general well-being, and Health-Related Quality of Life (HRQOL). Symptoms such as fatigue or weakness can lead to inactivity. Inactivity can lead to deconditioning and physical impairment. Physical impairment can lead to psychological impairment. Psychological impairment can lead to inactivity. As this cycle continues, inactivity worsens and daily activities may be avoided altogether, leading to further deconditioning and an even poorer HRQOL.
Comprehensive rehabilitation programs can break this vicious cycle.
After experiencing ongoing difficulties with gait and mobility, I requested that my neurologist prescribe an evaluation and exercise program from a physical therapist specially-trained in neurological disorders. What I thought would be some simple gait training and help with spasticity issues became much more. So, I began twice weekly physical therapy sessions in December to address issues of weakness, spasticity, gait problems, fatigue, and balance. See Free Falling and Other Silly Human Tricks. Valerie, my physical therapist, designed a program which addresses the physical deconditioning I had succumbed to.
When you begin any exercise program, it is best to consult with your medical professional first. An initial appointment would be used to assess your starting point, measuring weakness, spasticity, sensory dysfunctions, gait and balance. Even cognitive function could be considered, as information processing greatly affects a person’s ability to follow through with a program long-term.
Comprehensive rehabilitation addresses the patient as a whole and focuses on maximizing a person’s functional abilities and improving their self-image, psychological well-being, coping skills and adjustment to MS. It may combine aerobic exercise with strength training, gait training, balance exercises, stretching, heat and massage, occupational therapy, self-assessment of fatigue, and perceived benefit upon Quality of Life.
The results I have seen so far after three months of therapy include greater core body strength, a rediscovery of muscles which had suffered from lack of use, increased endurance, decreased fatigue, increased balance and posture. Most importantly, I am walking with greater confidence, have less spasticity, and family members have noted that I do not suffer from as much fatigue. All of these benefits directly improve my mental outlook, physical function and general well-being, thus, my Quality of Life.
I should note that there has not been an improvement in my EDSS (Kurtske disability) score. But this is not uncommon. See Patti F, et al. The impact of outpatient rehabilitation on quality of life in multiple sclerosis. Journal of Neurology. 2002 July; 249(8):1027-1033.
To extend the benefits of physical therapy, MS patients can look to yoga which is easily adapted to varying abilities. Dalia Zwick, Ph.D., PT, has written an article on the benefits of Yoga in Multiple Sclerosis. The Multiple Sclerosis Society in the UK has an excellent webpage designed to highlight the benefits of Exercise and Physiotherapy for any level of MS ability or disability. However, it is very important to note that not one suggestion will fit the needs of every patient with multiple sclerosis. That is one reason which you should consult a professional before beginning any program.