Physiotherapy approach in multiple sclerosis

Abstract

Multipla skleroza (MS) je kronična, upalna, autoimuna i demijelinizacijska bolest središnjeg živčanog sustava koja prvenstveno pogađa mlađe osobe, češće žene nego muškarce. Bolest je karakterizirana propadanjem mijelinske ovojnice neurona te ima dvije faze, a to su faza relapsa i faza remisije. Faza relapsa označava period pogoršanja bolesti, dok faza remisije označava mirovanje bolesti. Karakterizirana je i pojavom različitih kliničkih manifestacija kao što su poremećaji koordinacije, slabost mišića, problemi s hodom, umor, spastičnost i smetnje govora i vida. Multipla skleroza bolest je nepredvidivog tijeka i različitih oblika (relapsno-remitentni, primarno-progresivni, sekundarno-progresivni i progresivno-relapsni) te zahtijeva individualiziran, multidiscipliniran i holistički terapijski pristup. Jedan od temeljnih elemenata fizioterapijskog pristupa je individualna procjena funkcionalnog statusa pacijenta. Fizioterapijska procjena uključuje primjenu kliničkih testova za procjenu hoda, snage mišića, spastičnosti, ravnoteže i onesposobljenosti. Na temelju procjene izrađuje se plan terapije koji u obzir uzima specifične simptome, fazu bolesti, stupanj onesposobljenosti i opće zdravstveno stanje pacijenta. Fizioterapijske intervencije uključuju primjenu fizikalnih čimbenika, Bobath terapije, hipoterapije te primjenu i edukaciju o terapijskim vježbama. Terapijsko vježbanje ima ključnu ulogu u rehabilitaciji osoba s multiplom sklerozom. Provode se vježbe disanja, aerobne vježbe, vježbe istezanja, snage, ravnoteže, Frenkelove vježbe i vježbe za mišiće dna zdjelice. Cilj rehabilitacije osoba s multiplom sklerozom je očuvanje i poboljšanje funkcionalnih sposobnosti, povećanje samostalnosti i kvalitete života kao i usporavanje progresije simptoma.Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune and demyelinating disease of the central nervous system that primarily affects younger people, more often women than men. The disease is characterized by the deterioration of the myelin sheath of neurons and has two phases, namely the relapse phase and the remission phase. The relapse phase indicates a period of worsening of the disease, while the remission phase indicates a period of quiescence of the disease. It is also characterized by the appearance of various clinical manifestations such as coordination disorders, muscle weakness, gait problems, fatigue, spasticity and speech and vision disorders. Multiple sclerosis is a disease with an unpredictable course and different forms (relapsing-remitting, primary-progressive, secondary-progressive and progressive-relapsing) and requires an individualized, multidisciplinary and holistic therapeutic approach. One of the fundamental elements of the physiotherapy approach is the individual assessment of the patient's functional status. Physiotherapy assessment includes the use of clinical tests to assess gait, muscle strength, spasticity, balance and disability. Based on the assessment, a treatment plan is developed that takes into account the specific symptoms, stage of the disease, degree of disability and the patient's general health. Physiotherapy interventions include the application of electrotherapy, Bobath therapy, hippotherapy, and education of therapeutic exercises. Therapeutic exercise plays a key role in the rehabilitation of people with multiple sclerosis. Breathing exercises, aerobic exercises, stretching, strength, balance, Frenkel exercises and pelvic floor exercises are performed. The goal of rehabilitation of people with multiple sclerosis is to preserve and improve functional abilities, increase independence and quality of life, as well as slow down the progression of symptoms