Multiple Sclerosis

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. Although we have in the past covered many aspects of Multiple Sclerosis and the help that our physiotherapist provide to patients with Multiple Sclerosis in various areas such as Lichfield and Sutton Coldfield, I thought that because it is such a complex and serious condition it might be helpful to do take a more in depth look at the condition

What is Multiple Sclerosis (MS)?

To begin we need to understand what exactly Multiple Sclerosis (MS) is. Well, Multiple Sclerosis which is commonly shortened to MS, is a fairly common but very disabling neurological condition which varies in its effects from mild weakness and reduction in co-ordination to a complete loss of mobility. 

In patients with Multiple Sclerosis the insulating substance around nerves in the brain and spinal cord - myelin is progressively destroyed. This is because the body’s immune system mistakes this myelin around the nerves for a foreign body and decides to attack it. Myelin is important in transmission of nerve signals because it insulates the nerve from interference and makes signals pass more quickly and accurately along the nerve. This destruction of the myelin insulation in Multiple Sclerosis causes many difficulties for patients including difficulties walking, weakness in muscles and loss of coordination. Multiple Sclerosis gains its name from the scars (sclerae) that are seen on the nerves of the brain and spinal cord under a microscope in patients with Multiple Sclerosis.

What are the Symptoms of Multiple Sclerosis (MS)

As Multiple Sclerosis (MS) is such a variable disease and it can affect any area of the brain and spinal cord, this means that it can cause virtually any neurological symptom that you can think of. The symptoms from Multiple Sclerosis (MS) will depend upon the severity of damage to the myelin sheath and also the specific areas of the central nervous system that have been affected. The symptoms of Multiple Sclerosis can vary from mild pins and needles in fingers or extremities to a complete loss of mobility and needing help with breathing. Commonly symptoms will begin mildly with a change in sensation in a body part or a loss in co-ordination and initially may just be a one off event after which the patient returns to normal. Usually the symptoms of MS will slowly progress with losses of strength, sensation, eye sight and mobility worsening over the years. Some common symptoms of MS are listed below, although please remember that if you are worried you have Multiple Sclerosis then you need to contact your doctor, as the symptoms below could also be indicative of many other conditions and the fact that you or someone you know has one of these symptoms does not in any way mean you have MS.

• Pins and needles in the hands, feet, face or other parts of the body.
• Altered sensation in the limbs or other parts of the body can be a sign of MS.
• Reduced co-ordination in the hands, arms, legs or just general lack of co-ordination in the trunk and pelvis.
• Poor balance and general feelings of dizziness or unsteadiness
• Changes in vision: including double vision, blurred vision and nystagmus.
• Difficulties with swallowing and speech due to weakening of the muscles controlling speech and swallowing.
• Difficulties controlling the bowel or bladder.
• Weakness in any of the muscles of the body and a loss of ability to walk or even breathe unaided.

As mentioned above the symptoms of MS are extremely varied and it is very important that if you have any concerns that you seek help immediately.

 

What Causes Multiple Sclerosis (MS)?

As with many aspects of Multiple Sclerosis this is frustratingly unclear at present despite a large amount of research into the causes of MS. The exact cause and underlying pathophysiology of MS remains unclear with many hypotheses being currently researched, certainly there are some geographic patterns (such as you are more likely to have MS the further from the equator you live) and it is much more common in the Northern Hemisphere. Genetics is thought to play a role and if both parents have MS then their children are at a greater risk of developing Multiple Sclerosis.  Other factors such as an infectious agent have been proposed in the past due to specific areas and islands where the incidence of MS is greatly elevated but as yet little evidence has been found to support this. Currently it is thought that MS is likely caused by a combination of genetic predisposition and environmental factors, although as I say research into the causes of MS is still continuing.

How is Multiple Sclerosis Diagnosed?

Initially diagnosing Multiple Sclerosis can be difficult as many of the symptoms that are the early stages could also be caused by many other pathologies and so initially it will often be a case of ruling out other more likely causes. However, generally a patient who suspects they have Multiple Sclerosis (MS) will most likely go to the GP possibly complaining of some weakness, reduced coordination, vision problems or strange tingling at which point the GP will likely order some blood tests and perform some examinations to check blood pressure and signs of an infection. If these come back clear then most likely the GP will refer the patient on to a neurologist to assess what could be the underlying cause.

The consultant neurologist will at this point conduct an assessment and perform a series of physical tests designed to look at strength and reflexes to see if there is any obvious weakness and then most likely order an MRI to assess the nerves and brain and see if there are any changes. In combination with these tests and the patient's history a diagnosis of Multiple Sclerosis (MS) will be made. Sometimes a lumbar puncture will be needed to look at the spinal fluid and see if there are any changes indicative of Multiple Sclerosis (MS). 

What Types of Multiple Sclerosis are there?

There are 4 main types of Multiple Sclerosis but it is important to note that there is fair amount of crossover between the types and it may only be clear in retrospect which type of MS someone has.

Clinically Isolated Syndrome:

Here a person has a single event where they present with neurological symptoms but these then go away and the person eventually returns to normal. The patient will at this point likely have a series of tests but these will often come back as inconclusive and although the neurologist will likely suspect that this person has MS they will be unable to form a firm conclusion due to a lack of evidence. Often (but not always) these patients will then go on to develop MS at a later date.

Relapsing-Remitting MS

This is the most common form of Multiple Sclerosis and involves patients experiencing periods where their symptoms worsen significantly (relapse) but then they improve (remit) – usually though they do not regain all of their lost function. Often periods between relapses and worsening of symptoms can be length (months and maybe even years).

Primary Progressive MS

This occurs less commonly and is when after an initial appearance of symptoms, the MS worsens and there is no remitting or improving of symptoms. This by far the most aggressive form of Multiple Sclerosis.

Secondary Progressive MS

In this type of MS a person will usually be diagnosed with secondary progressive MS if their symptoms continue to worsen with no improvement after a period when it appeared that they had relapsing-remitting MS.

 

What Professionals Will Be Involved With Multiple Sclerosis?

There are likely to be an array of medical professionals involved in the early stages of a diagnosis of Multiple Sclerosis which will change as the condition develops over time. As this will often be the first experience a patient has of hospitals and dealing with medical professionals it can be very confusing and I have attempted to help by listing some of the people involved and their likely roles:

1. Neurological Consultant: although over a long period with Multiple Sclerosis you are likely to see many doctors with lots of different titles. The most important (or at least most senior) will be your neurological consultant. This will be the senior doctor that makes the official diagnosis of Multiple Sclerosis and will be the doctor in overall charge of your case. In reality, unless things change greatly, after your initial diagnosis of Multiple Sclerosis you are unlikely to see this doctor much apart from for yearly reviews of your MS.

2. GP: in reality the doctor likely to have most involvement with yourself, especially in the early stages of Multiple Sclerosis, will be your GP. They are the gatekeepers to other services and will be responsible for making referrals onwards and getting in other services such as Occupational Therapy and physiotherapy. I

3. MS Nurse: every patient with Multiple Sclerosis will be assigned a specialist MS nurse who will be responsible for managing their case, providing advice and adjusting medication. This person along with your GP will be the person you have most contact with regarding your MS and will be your key contact point.

4. Occupational Therapist: most likely in the early stages of Multiple Sclerosis there will be little need for OT involvement but as things progress often Occupational Therapy becomes a vital help in assessing needs for varying pieces of equipment and adaptations. Your occupational therapist will help with adaptations to your house, such as ramps, handles and specials seats to help with mobility problems caused by MS. They will also be able to help with any equipment such as perching stools, special cutlery, wheelchairs and other mobility aids such as walking frames that allow someone with Multiple Sclerosis to continue to live well.

5. Physiotherapist: well obviously physiotherapy is likely to play a fairly important role at some point in helping with Multiple Sclerosis but in the early stages most likely it will just involve an assessment and a discussion about what is best to do and how best to manage things. Later on as the condition develops physiotherapy to maintain strength and range of motion will become more important. It is very much a personal decision as to how much involvement you will want with a physiotherapist, personally I would advise building a good relationship over a period of time with a physio, so that they are able to understand your condition and your needs and know what can be worked on to help maximise your function.

How Much Rehab Will I Get To Help With Multiple Sclerosis?

This is a fairly common question from patients but in all honesty is not exactly easy to answer as NHS services are generally very stretched. Usually at the early stages of diagnosis once you have had an assessment by the neurological physiotherapists you will be discharged but allowed to refer back into the service if things change or you relapse. There is often a wait to access the service at this point and also as resources are limited you will usually be limited to 6 - 8 weeks of physiotherapy which is not a great deal to be honest when dealing with a complex and long-term condition like Multiple Sclerosis.

How Much Physiotherapy Do I need To Help With Multiple Sclerosis?

Now, this is a completely different question and the answer will very much depend upon how your MS is affecting you and the level of help that you personally feel happy with. Clearly, I am going to be biased in my advice here, as I am a big believer in the benefits of physiotherapy and seeing a physiotherapist for your MS but I will try my best to give a balanced point of view. As, I said how much physio you need for your MS will very much initially depend upon how it is affecting you. If your symptoms are very mild and you have only just had a diagnosis I would suggest that you do not need a whole lot of involvement from a physiotherapist, however I would advise that you get an assessment and get a plan of ideas and exercises that can help you manage things independently for as long as possible. I would also suggest that even if your have very few symptoms it is probably reasonable to be reviewed by your physiotherapist every 6 months to see how things are going and if there are any specific exercises that could help. This will mean that over a number of years you form a good relationship with your physio and they get to know you and your condition well and they will have a better idea of how to help with your MS. As your symptoms from Multiple Sclerosis change and potentially become more severe over time it would seem reasonable that you have more help from a physiotherapist and have more regular sessions where you work on specific things that are causing you difficulty.

Another thing to consider is that as described above NHS physiotherapy is very limited for MS and I would generally advise that you should also try to supplement this NHS physiotherapy with building a relationship with a local private physiotherapist experienced in helping with Multiple Sclerosis. This will mean that if you have relapses or any specific concerns you will easily be able to book an appointment with them to discuss things and will also be able to have access, if needed, to much more regular sessions to help with your MS.

What Resources Are There to help With Multiple Sclerosis?

The level of help that you need with your Multiple Sclerosis will depend upon how it is affecting you but the following are a list of some useful resources to help you or options to try:

1. The MS Society: this is a fantastic way to meet people in the same situation as yourself and discuss things. The MS Society website has a ton of information about Multiple Sclerosis and really is a good starting point for finding out more.  More information can be found here  

2. Hydrotherapy: okay, technically this not really a resource but as I am a big fan of hydrotherapy to help with neurological conditions such as MS I really can't leave it out. Hydrotherapy can be a great way of accessing exercises and movements that are impossible to do against the full effects of gravity plus it is fun and can make rehab and exercise more interesting. I am quite an advocate of hydrotherapy and have written a whole blog on the subject here.

3. Your GP: yes I know this seems obvious but your GP will be the main gatekeeper for NHS services and will know what is available locally and what you can access to help with your Multiple Sclerosis. So, it really is vital that you keep your GP informed of changes and what is happening.

4. Seated Exercise Classes: Obviously if you are currently mobile and walking then these won't be of interest but many patients with Multiple Sclerosis have great difficulty with mobility and balance and are unable to do normal exercise classes.

5. Pilates/Yoga: okay, I know that these are actually really different types of exercise but from my perspective as a physiotherapist I tend to think of them offering similar challenges to balance and core strength. Certainly if you are fully mobile and have Multiple Sclerosis you want to really work hard on yoru balance and core strength and pilates or yoga could really help with this.

How Can ThreeSpires Physiotherapy Help Me With Multiple Sclerosis?

Well, obviously, as mentioned earlier I may be a bit biased here! However, I really do believe that physiotherapy and especially our home visit physiotherapy service can make a big difference to patients with Multiple Sclerosis. Our home visit physiotherapy service can help, anyone with MS, in a number of ways and we have testimonials available on our website, Facebook page and Google+ page.  Our chartered physiotherapists are all experienced at assisting patients with Multiple Sclerosis and are able to provide a physiotherapy service at home to anyone who has Multiple Sclerosis. Often our physiotherapists work alongside and in conjunction with NHS neurological physiotherapists to maximise mobility and function for patients with Multiple Sclerosis and our physiotherapists are able to liaise directly with NHS staff in order to reduce the burden on families. To summarise the process involved I have detailed a typical case study of a patient with Multiple Sclerosis and how we can help.

Firstly, it will begin with an assessment at their home (usually 1hr) of the patient and their current level of strength, fitness and mobility and will look at what they wish to achieve and their goals. This initial assessment is one of the most important sessions that anyone with MS can have, as it gives them a good idea of what is possible and what they need to work on. At the end of this assessment the patient with MS will be given an exercise plan and general management plan containing things to do and work on and a discussion will take place about what is best to do in order to help them manage their Multiple Sclerosis. What happens next very much depends upon their needs: for example if they are generally doing very well and are able to independently access exercise classes etc, the physiotherapist will likely suggest a 3 – 6 monthly review session to check in and see how things are going and make any tweaks necessary to the plan. However, some patients with MS will have much higher needs for physiotherapy and will need seeing regularly at home to work on the various difficulties that they have and maximise their function. This is usually a maximum of 2 -3 sessions per week.

Okay, I hope that you have found this blog article about Multiple Sclerosis helpful. If you or anyone you know has Multiple Sclerosis then please get in touch to have a chat about how we might be able to help with exercise and physiotherapy. We can be contacted via email: enquiries@threespiresphysiotherapy.co.uk or phone: 07884281623