1. Physiotherapy in the Early Stage
of Multiple Sclerosis
Paul Van Asch
Secretary of RIMS
Head of Physiotherapy Dept.
National Multiple Sclerosis Centre
Melsbroek - Belgium
International MS Conference
September 2003
DMSG Berlin

2. National Multiple Sclerosis Centre
Melsbroek, Belgium
In-patient department: 134 beds
Out-patient department: 80 PwMS / day

3. Objectives of Symptomatic Management and Rehabilitation in MS
The goal of every treatment approach should be to encourage
self management and to provide the PwMS a sense of control
over their disease.
Thus a sensible management strategy for the majority of
symptoms should include: - Education
- Therapy input
- Drug treatment
Due to the progressive condition periodic reassessement is needed.
( A. Thompson, J Neuro Neurosurg Psychiatry
2001; 71(suppl II):ii22-ii27)

4. 4 Primary aims of Physiotherapy in MS
+ Maintain and increase of ROM
+ Stimulate postural stability
+ Prevention of contractures
+ Support weight - bearing
L. De Souza, MS: Approaches to Management, 1990

5. Is there a role for Physiotherapy in the Early Stage of MS?
Yes
progressive nature of MS without prognosis => sensible approach
Preventative therapeutic role
1/ Providing Information
2/ Training Program
3/ Support

6. 1/ Providing Information
To Whom ? - PwMS
- Partner
- Caregivers (professional and non-professional)
How ? - MS - school
- Partner sessions
- Local MS Self Help Groups
=> In collaboration with the Belgian MS - Society

7. What ? => The occurence of Motor Symptoms and their
potential impact on Functional Activities
Potential Impact on
Functional Activities
- Walking
- Leisure activities
- Professional activities
Motor Symptoms
- Spasticity
- Paresis
- Ataxia, Tremor
- Balance Problems

8. When to start Physiotherapy ?
What is Physiotherapy ?
Physiotherapy is more than a passive
intervention of stretching and mobilization
of specific parts of the body, the PwMS
needs to be an active participant in a
functionally oriented exercise program
(Mertin, Paeth, Physiotherapy and MS:application of
the Bobath concept. MS Management 1:10-13)
When to start Physiotherapy ?
Individual
Not continuous

9. 2/ Setting up a Training Program
Why ? => Prevention and management of problems
in the locomotor system

10. = Adapted to the needs and possibilities
INDIVIDUAL PROGRAMS
= Adapted to the needs and possibilities
of each PwMS
1/ Evaluation : anamnesis, overall testing
2/ Training Program : variety of techniques
3/ Follow Up : 6 - monthly

11. Aerobic Training
Stretching
Energy Management
Strengthening
Pelvic Floor Exerc.
Relaxation

12. Do we have some evidence ?
Tentative evidence exists to support rehabilitation in MS
- Physiotherapy: Wiles CM et al. Controlled randomised crossover trial of
the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol
Neurosurg Psychiatry 2001;70:174-9
- Aerobic Training: Petajan JH et al. Aerobic training on fitness and
quality of life in multiple sclerosis. Ann Neurol 1996;39:432-41
Mostert S, Kesselring J. Effects of a short term exercise
training program on aerobic fitness, fatigue, health perception and activity level
of subjects with mS, Multiple Sclerosis 2002;8:
- Rehabilitation in MS: Freeman, Solari, Rodgers, Ponichtera, Petajan
- Clinical Experience

13. 3/ Support Partner family Professional home MS-society PwMS
Rehab centre

14. Conclusions Tentative evidence exists to support Rehabilitation in MS.
Within the multidisciplinary team, the physiotherapist has an important role in the prevention and management of locomotor problems in the early stage of MS.
Successful treatment cannot be measured by wether or not the PwMS improved, but rather by wether or not the best level of activity is achieved with respect to an individual’s life style at each stage of the disease. ( L. De Souza, MS Approaches to management 1990)

15. Thank You