Historically, work out training was discouraged for MS patients due to the possibility of overheating the organism and increasing fatigue or triggering exacerbation. Currently, neurorehabilitation programs are among the most popular therapies in reducing the disabilities and social disadvantages of MS patients [5
]. Clinical studies have shown real benefits from exercises that are very effective in improving balance and increasing walking capacity. Moreover, special programs of work out based on aerobic training are very effective in reducing fatigue, enhancing mood and improving quality of life. Despite the demonstrated benefits, attrition in exercise intervention studies is a concern, ranging from just over 18.6% to 42.4%. A high-energy cost of walking, respiratory muscle dysfunction and deconditioning are the important factors contributing to low exercise tolerance in MS patients [6
]. This situation buildup limitation of physical activity and may reduce the ability to participate in daily social and family activities [7
]. One of the main aims of rehabilitation in MS is to maintain and improve functional independence. In particular, aerobic exercise seems to be a promising rehabilitative tool for patients with MS because it could positively affect both maximum exercise
Balance and postural control problems are present in 20% of patients with MS at onset and 80% in chronic cases [5
]. Many studies show that balance disorders are the leading cause of falls for people with MS (between 52% and 63% from 2–6 months; increases with age and MS progression) [7
]. The risk of falling significantly decreases the mobility and quality of life. The National MS Society in 1985 published the Minimum Record of Disability (MRD) [10
]. This is the most widely used MS outcome measure. The MRD followed the World Health Organization (WHO) classifications for 3 types of MS dysfunctions (impairment; disability; handicap) that are the main fields of rehabilitation [11
]. Impairment refers to clinical signs and symptoms of neurologic disease; Disability refers to the personal limitations caused directly on the activities of daily living by the neurologic impairment; Handicap refers to a reduced ability to participate in social and environmental situations due to the effects of the disability
or impairment on the patient [9
] (Figure 1).
The MRD includes the special scales to measure the 3 types of dysfunction in MS patients:
1. Impairment – Expanded Disability Status Scale (EDSS)
2. Disability - Incapacity Status Scale
3. Handicap - Environmental Status Scale
The most commonly used is the EDSS originally developed by Kurtzke in 1955 as the Disability Status Scale (DSS). The EDSS rated impairment due to MS on a 1 to 10 point scale. Subsequently, the scale was expanded to include half point steps. According to the EDSS score the patients were divided into the following subgroups: low physical disability (EDSS ≤ 3.5), moderate physical disability (3.5 < EDSS ≤ 6.5) and high physical disability (EDSS > 6.5). An advantage of the EDSS is that administration of it takes only 10 to 20 minutes and includes evaluation of all major areas of the CNS as they apply to MS. However, it is more heavily weighted toward effects on ambulation and provides limited assessment of upper extremity
function, cognitive function and fatigue. Moreover, it does not detect change over a short period of time. EDSS scores are bi-modal, clustering at 3 to 4 and 6 to 7 [13
The National MS Society Clinical Outcomes Assessment Task Force reviewed multiple measures to determine which were reliable, correlated well with disease duration, changed over time and had concurrent and predictive validity based on the EDSS [9
Three measures of MS functional composite were recommended to estimate disability and impairment (Table 1).
In mature form MS represent almost all neurological symptoms connected with persistent inflammatory
state and multifocal injury of CNS. So, interdisciplinary team is essential for maximizing the patient's ability to function [4
]. There are separate roles in the rehabilitation team; each member has its own specific area where he excels in knowledge and expertise. Members communicate with each other and with the patients, prioritizing and coordinating treatment regimens and goals. One of the more significant components in managing the disease is rehabilitation, which starts as early as the beginning of the disease. Prevention, diagnosis, long-term and acute treatment - these are all parts of rehabilitation process, together with community integration, end-life management, and prevention of handicaps and hypokinesis.
Augmenting and maximizing life quality is a fundamental challenge of rehabilitation team. The team observes the significance of different understanding of quality of live among different patients, and recognizes its impact on patient function in both psychosocial and physical environments. As a result, rehabilitation team along with the patient aims to maximize and augment his or her ability to exist independently both in the community and at home, addressing patient’s concerns, as they appear, comprehensively [14
Prevention is another fundamental element in rehabilitation. It includes wide variety of challenges, such as muscle contractures, prevention of falls and decubitus ulcers
, but also includes prevention of loss of the employment and maximizing patient performance at the workplace. For best results and prolonged benefit, inpatient rehabilitation should be repeated periodically.
Therapies for some conditions, such as MS, are mostly concluded at outpatient setting or at home. One of the most frequently requested services is physical therapy, occupational therapy, which is followed by psychotherapy
and massage therapy. Some patients also request the aid of social workers, and some request services of language and speech therapists [5