Multiple Sclerosis
Multiple Sclerosis
Multiple sclerosis (MS) is a disease that affects
central nervous system (brain and spinal cord).
It damages the myelin sheath.
 Females are more affected than males
Signs and Symptoms
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Spasticity
Weakness
Fatigue
Sensory disturbances – Numbness and Tingling
sensations
• Balance problems
• Gait disturbances
• Visual problems
• The most common type of multiple
sclerosis is relapsing – remitting type.
Diagnosis
• At least two separate areas of damage in
Central Nervous System
• The damage occurred at least one month
apart
• Rule out all other possible diagnoses
Management of Multiple Sclerosis
• Drug therapy
– Treat new attacks (exacerbations)
– Prevent the occurrence of future attacks
– Slow or prevent disease progression
– Treat the chronic symptoms of the disease
• Physical Therapy
• Psychosocial support
Physiotherapy assessment
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Range of motion
Strength
Tone
Sensory impairment
Balance
Coordination
Cardiovascular and respiratory status
Bed mobility and transfer
Bowel and bladder impairment
Activities of daily living
Outcome measure -Kurtzke scale
Physical Therapy Intervention
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Range of motion exercises
Strengthening exercises
Coordination exercises
Balance training
Gait rehabilitation – Light weight Walking aid, Ankle
foot orthosis (AFO) and Functional electrical
stimulation
• Safe Transfers techniques
• Energy conservation techniques – For management
of fatigue.
Guillain Barre Syndrome
Guillain Barre Syndrome
• Acute Post-infectious ascending demyelinating
polyneuropathic paralysis
• Affects the peripheral nervous system
• Commonest cause of rapid-onset flaccid paralysis
Clinical Manifestations
• Usually develop 1 to 3 weeks after Upper Respiratory
tract infection (URTI) or Digestive infections
• Weakness of lower extremities (symmetrically)
• Parathesia (numbness and tingling), followed by paralysis
• Hypotonia and areflexia (absence of reflexes)
• Pain in the form of muscles cramps
• Involvement of lower brainstem leads to facial and
eye weakness
Complication
 The most serious complication is respiratory failure
Tests
• EMG and nerve conduction studies will be
abnormal
• Cerebro spinal fluid (CSF)- elevated protein
Criteria for Diagnosis
• Symmetric weakness of two or more limbs
• Decreased reflexes
• Short course (less than 4 weeks of weakness)
• No fever
• Cranial nerves Involvement - (eye
movements, double vision, swallowing;
respiratory involvement)
Outcome Measures
Hughes scale
0 – Healthy, no signs of GBS
1 – Minor symptoms or signs; able to run
2 – Able to walk > 5 meters without assistance but
unable to run
3 – Able to walk > 5 meters with assistance (human
or crutch)
4 – Bed or chair bound; unable to walk
5 – Requiring assist with ventilation for at least part
of the day or night
Physical Therapy Intervention in acute
stage
• ROM exercises
• Positioning.
• Respiratory management - In severe cases, ventilator support
is needed. In other cases – Breathing exercises and airway
clearance techniques.
• To prevent deep vein thrombosis – compressive stockings.
• Pain control – TENS can be used.
Post – acute Physical Therapy
Intervention
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ROM exercises
Strengthening exercises.
Balance training
Gait rehabilitation - Ankle foot orthosis (AFO) may be used.
Functional training