Savonia Article: Physiotherapy in Multiple Sclerosis
In 20 – 25. 2 . 2023, Blended Intensive program in Neurological rehabilitation ran. More than 30 physiotherapy students and teachers from three universities (Savonia University of Applied Sciences, Finland, Third Faculty of Medicine, Charles University, Czech Republic and University of Thessaly, Greece) actively participated. Students worked together and wrote articles devoted to on the following themes: stroke and rehabilitation, multiple sclerosis and rehabilitation, Parkinson’s disease and rehabilitation, children with neurological disorders and rehabilitation, spinal cord injury and rehabilitation and virtual reality and exergames in rehabilitation of neurological patients. We are going to present their great work here. (Äijö et al 2022.)
Multiple sclerosis (MS) is the most common progressive, inflammatory, demyelinating disease usually diagnosed between 20-40 years of age, in which the myelin sheath of nerve cells in the brain and spinal cord is damaged. This damage decreases the transmitting ability of neurons, resulting in a wide range of symptoms including physical, mental and cognitive problems. MS takes different forms based on the way that the symptoms may occur. If symptoms occur in isolated attacks, it is relapse-remitting form of MS. Otherwise symptoms are building up over time and those are called progressive forms of MS. The most common symptoms between patients tend to be: vision problems, muscle weakness, fatigue and spasticity, balance and gate issues and also cognitive-mental fatigue and depression signs. Females are affected more frequently than males. Possible explanation of the pathogenesis of MS include: genetic susceptibility, infectious factors and environmental factors. Diagnosis is confirmed by clinical estimation, Magnetic Resonance Imaging, lumbar puncture and evoked potential test. (Kargarfard etal. 2018; Multiple Sclerosis ad.)
There is a variety of treatments that can control the relapses and delay the long-term functional disability and progression of the disease. The patients are following medical guidelines – they are being treated by medication, physical therapy, psychological therapy and more. Physical therapy can consist of several environments such as water, indoor or outdoor spaces. There are hands-on methods like Neurodevelopmental treatment (Bobath concept) or Proprioceptive Neuromuscular Facilitation. Another possibility is using innovative technologies and devices.
In the Czech Republic, the physiotherapy of multiple sclerosis is based mainly on two pillars. The first and very important group is neurodevelopmental techniques. These methods are inspired by typical positions from the child motor development during the first year of life. These methods are supposed to stimulate the central nervous system to activate different inborn motor programmes. By this we are trying the boost neuroplasticity and change the pathological posture or movement stereotypes. The ones that are used the most in the Czech Republic are for example the Proprioceptive Neuromuscular Facilitation (Kabat method), the Reflex locomotion by Vojta, Dynamic Neuromuscular Stabilization by Kolář, Bobath concept, Sensorimotor stimulation or Motor Programmes Activating Therapy by Řasová. As opposed to physiotherapy in Greece, in our country the Vojta method is used in adults as much as in children.
The second biggest part of physiotherapy in multiple sclerosis is muscle re-education. This involves strengthening exercises (with emphasis on engaging the whole muscle chains) and/including aerobic exercises. During these techniques a lot of therapeutical equipment is used (e.g., RedCord, resistance bands, gymnastic balls, bossu and other unstable platforms etc.). Of course, stretching and soft tissue techniques are also part of the therapy, usually used in the beginning of each session.
In Greece, many methods and techniques are used during the management of multiple sclerosis. Stretching and resistance exercise are used to manage the rigidity, stiffness and weakness of the muscles. Aquatic therapy, virtual reality, mHealth apps, equine therapy and green exercise are used as alternative methods because of the motivation they give to the patients. Activities like swimming help people increase vascular and lung capacity, muscle strengthening, postural control and postural and dynamic balance. Water decreases physical and mental fatigue and pain in patients with MS. The motivation that the aquatic environment gives, can also help with enhancing self-esteem. Neurodevelopmental techniques are also used as additional, functional therapy in Greece. Proprioceptive Neuromuscular Facilitation, Dynamic Neuromuscular Stabilization and Neurodevelopmental treatment (Bobath concept) are very important because of the functional and task-oriented activities are included. Physiological and dietary factors should be taken in account as well.
From what we saw here during our stay in Finland, a lot of physiotherapists are using modern rehabilitation technologies. Examples are grounded exoskeletons like Lokomat, treadmill exercises or virtual reality. Another possibility that we saw is NeuroDance, where you also have the opportunity to socialize and express yourself. We suppose that the hands-on methods are probably not so widely used.
In conclusion, we feel like the biggest similarity between the Czech Republic and Greece is that we use a lot of hands-on techniques. In comparison with Finland where they primarily use a broad spectrum of technologies that are available here. A minor difference between Czech Republic and Greece is that in Czech Republic is more prioritized the neurodevelopmental methods. Also, there is slightly different use of each physiotherapy method. And in general, in Greece they place bigger emphasis on aquatic therapy and green therapy.
Petra Chmelíková, physiotherapy student, Charles University, Third Faculty of Medicine, Czech Republic
Athanasia Kanellopoulou, physiotherapy student, University of Thessaly, Greece
Michaela Raková, physiotherapy student, Charles University, Third Faculty of Medicine, Czech Republic
Dr. Marja Äijö, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland
Dr. Kamila Řasová, Ph.D., Associative professor of Physiotherapy, Third Faculty of Medicine, Charles University, Czech Republic
Dr. Thomas Besios, Assistant Professor, Department School of Health Sciences, University of Thessaly, Greece
Kargarfard M, Shariat A, Ingle L, Cleland JA & Kargarfard M. 2018. Randomized Controlled Trial to Examine the Impact of Aquatic Exercise Training on Functional Capacity, Balance, and Perceptions of Fatigue in Female Patients With Multiple Sclerosis. Arch Phys Med Rehabil. 99(2):234-241. doi: 10.1016/j.apmr.2017.06.015. Epub 2017 Jul 20. PMID: 28735720.
Multiple Sclerosis. ad. Read: 23.2.2023. In available: https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis
Äijö M, Řasová K & Besios T. 2022. Neurological rehabilitation, Blended Intensive program has started. Savonia Article, Savonia-ammattikorkeakoulu. In available: https://www.savonia.fi/en/articles/savonia-article-neurological-rehabilitation-blended-intensive-program-has-started/