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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 a progressive 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 50 years and is uncommon in children. Only 3% to 5% of all individuals with MS have symptoms begin before the age of 16, although cases as young as 2 years have been reported.3 The onset of symptoms after the age of 50 occurs in approximately 9% of individuals with MS.4 The disease is more common in women than in men by a ratio of 2:1 to 3:1, but men display a more progressive disease course and more rapid disability.5 Interestingly, when symptoms occur after age 50, the prevalence is approximately equal for men and women, and approximately half of all individuals experience the progressive form of the disease.5 Although the incidence and prevalence of MS overall have increased over the past five decades, this increase appears to be mostly related to an increased prevalence in women.6 There are also ethnic differences. MS affects predominantly white populations. African Americans demonstrate approximately half the risk of acquiring the disease. However, African Americans tend to experience a more progressive disease course, have more frequent relapses with less recovery, are more likely to have optic nerve and spinal cord involvement, and are more likely to develop greater disability over the same time period than their Caucasian counterparts.7,8 Low rates of MS are also reported in Asians and Native Americans.8
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Epidemiological studies have established ...