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2009 | 9 | 2 | 140-146
Article title

Aktualne kierunki rehabilitacji w stwardnieniu rozsianym

Title variants
Contemporary trends of rehabilitation in multiple sclerosis
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The number of reports describing the effectiveness of comprehensive rehabilitation in multiple sclerosis (MS) is systematically growing. The latest scientific data reported the essential difference in health state between those patients who underwent rehabilitation and those who didn’t. The advantage of inpatient rehabilitation against outpatient has been proved. The correlation between disability and quality of life has been also noticed, as well as influence on burden of patient’s caregivers. Multiple sclerosis is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Goals of rehabilitation are: to give the management of symptoms and to improve general fitness due to aerobic exercise. First goal can be achieved using facilitation – impairment- based approach, while the second one by use of a new strategy: task- oriented – disability- focused approach. First is the treatment of the main symptoms of MS: fatigue, bladder and bowel disturbances, sexual dysfunction, cognitive and affective disorders, and spasticity. Even though these symptomatic therapies have benefits, their use is limited by possible side effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, rehabilitation has been shown to ease the burden of these symptoms by improving self- performance and independence.
For these aims the comprehensive multidisciplinary rehabilitation is necessary. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Since 1890, when Wilhelm Uhthoff for the first time described that increased body temperature from physical exertion may lead to transient impairment of vision in patients with MS, the Uhthoff phenomenon has been defined the strategy of rehabilitation procedures in MS. Heat therapy and physical exercises were restricted because of fear against flare up of disease, aquatic exercises were limited till 30°C of water temperature. Last years something has been changed. Few reports on randomised controlled trials about progressive exercise program, mainly consisting of resistance training for few months has been published. Findings from those studies suggest overall disability and mobility improvement with the aerobic training. All types of rehabilitation should be tailored to fit patient specific needs. Based on the Uhthoff phenomenon, therapeutic trials with cooling vests are investigated and developed. In this review report of the contemporary trends in comprehensive rehabilitation in MS has been presented.
Physical description
  • Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach, ul. Mikołowska 72 B, 40- 065 Katowice
  • Centrum Medyczne w Szczytnie
  • Szpital Specjalistyczny św. Łukasza w Końskich
  • 1. Brown T.R., Kraft G.H.: Exercise and rehabilitation for indi -viduals with multiple sclerosis. Phys. Med. Rehabil. Clin. N. Am. 2005; 16: 513-555.
  • 2. Khan F., Turner-Stokes L., Ng L., Kilpatrick T.: Multidisci -plinary rehabilitation for adults with multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 2008; 79: 114.
  • 3. Mauritz K.H.: Nowe elementy w rehabilitacji chorych na stwardnienie rozsiane. Farmakoter. Psych. Neurol. 2005; 3: 249-251.
  • 4. Solari A., Filippini G., Gasco P. i wsp.: Physical rehabilitation has a positive effect on disability in multiple sclerosis patients. Neurology 1999; 52: 57-62.
  • 5. Wiles C.M., Newcombe R.G., Fuller K.J. i wsp.: Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 2001; 70: 174-179.
  • 6. Finlayson M., Cho C.: A descriptive profile of caregivers of older adults with MS and the assistance they provide. Disabil. Rehabil. 2008; 30: 1848-1857.
  • 7. Kozubski W, Liberski P. (red.): Choroby układu nerwowego. Wyd. II, PZWL, Warszawa 2008: 569-570.
  • 8. Di Fabio R.P, Soderberg J., Choi T i wsp.: Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. Arch. Phys. Med. Rehabil. 1998; 79: 141-146.
  • 9. Grochmal S., Zielińska-Charszewska S. (red.): Rehabilitacja w chorobach układu nerwowego. PZWL, Warszawa 1986: 235 237.
  • 10. Kesselring J., Beer S.: Symptomatic therapy and neurorehabilitation in multiple sclerosis. Lancet Neurol. 2005; 4: 643-652.
  • 11. Opara J.: Kompleksowa rehabilitacja chorych ze stwardnieniem rozsianym. Neurol. Neurochir. Pol. 1998; 32: 623-632.
  • 12. Barnes M.P., Kent R.M., Semlyen J.K., McMullen K.M.: Spasticity in multiple sclerosis. Neurorehabil. Neural Repair 2003; 17: 66 70.
  • 13. Haselkorn J.K., Balsdon Richer C., Fry Welch D. i wsp.; Multiple Sclerosis Council for Clinical Practice Guidelines: Overview of spasticity management in multiple sclerosis. Evidence based management strategies for spasticity treat ment in multiple sclerosis. J. Spinal Cord Med. 2005; 28: 167 199.
  • 14. Uhthoff W: Untersuchungen uber die bei der multiplen Herdsklerose vorkommenden Augenstorungen. Arch. Psychiatr. Nervenkrankh. 1890; 21: 305 410.
  • 15. Schuhfried O., Mittermaier C., Jovanovic T. i wsp.: Effects of whole body vibration in patients with multiple sclerosis: a pilot study. Clin. Rehabil. 2005; 19: 834-842.
  • 16. Centonze D., Koch G., Versace V i wsp.: Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis. Neurology 2007; 68: 1045-1050.
  • 17. Nielsen J.F., Sinkjaer T., Jakobsen J.: Treatment of spasticity with repetitive magnetic stimulation; a double blind placebo - controlled study. Mult. Scler. 1996; 2: 227-232.
  • 18. Stutzer P., Kesselring J.: Wilhelm Uhthoff: a phenomenon 1853 to 1927. Int. MS J. 2008; 15: 90-93.
  • 19. Opara J., Szwejkowski W., Pidsudko Z.: Czy opisanie zjawiska Uhthoffa utrudniło rehabilitację w stwardnieniu rozsianym? Rehabil. Med. w druku.
  • 20. Nelson D.A., McDowell F.: The effects of induced hyperthermia on patients with multiple sclerosis. J. Neurol. Neu rosurg. Psychiatry 1959; 22: 113 -116.
  • 21. Lepore F.E.: Uhthoff’s symptom in disorders of the anterior visual pathways. Neurology 1994; 44: 1036 1038.
  • 22. Kohlmeier R.E., DiMaio VJ.M., Kagan-Hallet K.: Fatal hyperthermia in hot baths in individuals with multiple scle rosis. Am. J. Forensic Med. Pathol. 2000; 21: 201 203.
  • 23. Dworzańska E., Mitosek-Szewczyk K., Stelmasiak Z.: Zespół zmęczenia w stwardnieniu rozsianym. Neurol. Neurochir. Pol. 2009; 43: 71 76.
  • 24. Opara J.A., Szwejkowski W, BrolaW: Jakość życia w zaburzeniach widzenia w stwardnieniu rozsianym. Wiad. Lek. 2008; 61: 62 66.
  • 25. Fisk J.D., Pontefract A., Ritvo P.G. i wsp.: The impact of fatigue on patients with multiple sclerosis. Can. J. Neurol. Sci. 1994; 21: 9 14.
  • 26. Janardhan V, Bakshi R.: Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J. Neu rol. Sci. 2002; 205: 51 58.
  • 27. Kos D., Kerckhofs E., Nagels G. i wsp.: Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil. Neural Repair 2008; 22: 91-100.
  • 28. Merkelbach S., Sittinger H., Koenig J.: Is there a differential impact of fatigue and physical disability on quality of life in multiple sclerosis? J. Nerv. Ment. Dis. 2002; 190: 388 393.
  • 29. Potemkowski A.: Zapalenie nerwu wzrokowego jako początkowy objaw stwardnienia rozsianego. Klin. Oczna 2000; 102: 95-98.
  • 30. Selmaj K.: Stwardnienie rozsiane - kryteria diagnostyczne i naturalny przebieg choroby. Polski Przegląd Neurologiczny 2005; 1: 99-105.
  • 31. Humm A.M., Beer S., Kool J. i wsp.: Quantification of Uhthoff’s phenomenon in multiple sclerosis: a magnetic stimulation study. Clin. Neurophysiol. 2004; 115: 2493-2501.
  • 32. Peterson C.: Exercise in 94°F water for a patient with multiple sclerosis. Phys. Ther. 2001; 81: 1049-1058.
  • 33. Tataru N., Vidal C., Decavel P i wsp.: Limited impact of the summer heat wave in France (2003) on hospital admissions and relapses for multiple sclerosis. Neuroepidemiology 2006; 27: 28-32.
  • 34. van der Mei I.A., Ponsonby A.L., Dwyer T. i wsp.: Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case -control study. BMJ 2003; 327: 316-321.
  • 35. Morris E.S., Sharrack B., Dalley C.D., Snowden J.A.: The Uhthoff phenomenon: a potential post transplant com plication in advanced progressive multiple sclerosis. Bone Marrow Transplant. 2007; 40: 1003 1004.
  • 36. Davis S.L., Frohman T.C., Crandall C.G. i wsp.: Modeling Uhthoff’s phenomenon in MS patients with internuclear ophthalmoparesis. Neurology 2008; 70: 1098-1106.
  • 37. Albrecht H., Schwecht M., Pollmann W i wsp.: Lokale Eis -applikation in der Therapie der gliedkinetischen Ataxie. Kli nischer Nachweis positiver Behandlungseffekte bei Patienten mit multipler Sklerose. Nervenarzt 1998; 69: 1066 1073.
  • 38. Beenakker E.A., Oparina T.I., Hartgring A. i wsp.: Cooling garment treatment in MS: clinical improvement and decrease in leukocyte NO production. Neurology 2001; 57: 892-894.
  • 39. Schwid S.R., Petrie M.D., Murray R. i wsp.; NASA/MS Cooling Study Group: A randomized controlled study of the acute and chronic effects of cooling therapy for MS. Neurology 2003; 60: 1955-1960.
  • 40. Edlich R.F., Buschbacher R.M., Cox M.J. i wsp.: Strategies to reduce hyperthermia in ambulatory multiple sclerosis patients. J. Long Term Eff. Med. Implants 2004; 14: 467-479.
  • 41. Meyer-Heim A., Rothmaier M., Weder M. i wsp.: Advanced lightweight cooling - garment technology: functional improvements in thermosensitive patients with multiple sclerosis. Mult. Scler. 2007; 13: 232-237.
  • 42. Opara J., Szwejkowski W, Brola W., Pidsudko Z.: Stymulacja magnetyczna w stwardnieniu rozsianym. Fizjoterapia (Wrocław) w druku.
  • 43. Brola W, Węgrzyn W, Czernicki J.: Wpływ zmiennego pola magnetycznego na niewydolność ruchową i jakość życia chorych ze stwardnieniem rozsianym. Wiad. Lek. 2002; 55: 136 143.
  • 44. Richards T.L., Lappin M.S., Acosta-Urquidi J. i wsp.: Double blind study of pulsing magnetic field effects on multiple sclerosis. J. Altern. Complement. Med. 1997; 3: 21 29.
  • 45. Lappin M.S., Lawrie F.W., Richards T.L., Kramer E.D.: Effects of a pulsed electromagnetic therapy on multiple sclerosis fatigue and quality of life: a double blind, placebo con trolled trial. Altern. Ther. Health Med. 2003; 9: 38 48.
  • 46. Benedetti M.G., Gasparroni V, Stecchi S. i wsp.: Treadmill exercise in early multiple sclerosis: a case series study. Eur. J. Phys. Rehabil. Med. 2009; 45: 53-59.
  • 47. Dalgas U., Ingemann - Hansen T., Stenager E.: Physical exercise and MS recommendations. Int. MS J. 2009; 16: 5-11.
  • 48. Kileff J., Ashburn A.: A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis. Clin. Rehabil. 2005; 19: 165 169.
  • 49. Lord S.E., Wade D.T., Halligan P.W: A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study. Clin. Rehabil. 1998; 12: 477 486.
  • 50. Pariser G., Madras D., Weiss E.: Outcomes of an aquatic exercise program including aerobic capacity, lactate thresh old, and fatigue in two individuals with multiple sclerosis. J. Neurol. Phys. Ther. 2006; 30: 82-90.
  • 51. Petajan J.H., Gappmaier E., White A.T. i wsp.: Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann. Neurol. 1996; 39: 432-441.
  • 52. Rietberg M.B., Brooks D., Uitdehaag B.M., Kwakkel G.: Exercise therapy for multiple sclerosis. Cochrane Database Syst. Rev. 2005; (1): CD003980.
  • 53. Romberg A., Virtanen A., Ruutiainen J.: Long term exercise improves functional impairment but not quality of life in multiple sclerosis. J. Neurol. 2005; 252: 839-845.
  • 54. Snook E.M., Motl R.W: Effect of exercise training on walking mobility in multiple sclerosis: a meta analysis. Neurore habil. Neural Repair 2009; 23: 108-116.
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