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LEARNING OBJECTIVES
Describe the etiology, epidemiology, pathophysiology, signs and symptoms, diagnosis, and course of multiple sclerosis (MS).
Describe elements of the medical management of patients with MS.
Identify and describe the examination procedures used to inform the evaluation of patients with MS to establish the physical therapy diagnosis, prognosis, and plan of care.
Describe the role of the physical therapist in the management of patients with MS in terms of direct interventions and patient/client-related instruction to maximize function and quality of life.
Describe appropriate elements of the exercise prescription for patients with MS.
Review current research findings concerning the rehabilitation of patients with MS.
Identify the psychosocial impact of MS and describe appropriate interventions.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
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Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation, selective demyelination, and gliosis. It causes both acute and chronic symptoms and can result in significant disability and impaired quality of life. MS affects approximately 400,000 persons in the United States; worldwide MS affects approximately 2.1 million people.1 It was first defined by Dr. Jean Charcot in 1868 by its clinical and pathological characteristics: paralysis and the cardinal symptoms of intention tremor, scanning speech, and nystagmus, later termed Charcot's triad. Using autopsy studies he identified areas of hardened plaques and termed the disease sclerosis in plaques.2
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The onset of MS typically occurs between ages 20 and 40 years. MS is rare in children, as is the onset of symptoms in adults older than age 50 years. The disease is more common in woman than in men by a ratio of 2:1 to 3:1. Although the incidence and prevalence of MS overall have increased over the last 5 decades, this increase appears to be mostly related to an increased prevalence in women.3 There are also ethnic differences. MS affects predominantly white populations; African Americans demonstrate approximately half the risk of acquiring the disease. Low rates are also reported in Asians and Native Americans.1
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Epidemiological studies have established a geographical pattern of MS prevalence with areas of high, medium, and low frequency. High-frequency areas include the temperate zones of the northern United States, the Scandinavian countries, northern Europe, southern Canada, New Zealand, and southern Australia. Areas of medium frequency closer to the equator include the southern United States and Europe and the rest of Australia, and low-frequency tropical areas include Asia, Africa, and South America. Migration studies indicate that the geographical risk associated with an individual's birthplace is retained if emigration occurs after age 15 years. Individuals migrating before this age assume the risk of their new location.4,5
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The risk of MS is increased in persons with an affected family member. The risk is 3.0% for a sibling, 5.0% for a ...