By Jenny Freeman, Senior Lecturer, Institute of Health, Plymouth University and Honorary Lecturer, Institute of Neurology, London, UK.

Fatigue and multiple sclerosis

Physiotherapy can benefit people with multiple sclerosis, according to a gradually accumulating body of scientific evidence. Physiotherapy has also been suggested as an important component of a comprehensive approach to helping people with MS manage symptoms such as fatigue.

However, it encompasses an enormous range of techniques and approaches and we are only just beginning to scratch the surface in terms of finding out what works best.

Evidence suggests that some aspects of physiotherapy, such as aerobic and strengthening exercises, promote proper posture and walking, which can help to reduce fatigue. But there can be considerable variation between people with MS at different stages of the disease, and this means that they may not always respond to a particular intervention in the way that studies suggest they should.

Therefore it is important that there is an active partnership between the physiotherapist, other healthcare professionals, the person with MS and their family to discover what works best for that particular individual and to help them sustain the resulting improvements over time. This requires a frank exchange of information, negotiation and co-operation, with everyone working together to establish the goals of treatment that will make the most impact on the person’s everyday life.

Specific treatment approaches vary among therapists depending on the resources available, experience of the therapist, and personal preference of both the therapist and the person with MS. Treatment can be offered in a variety of settings: as an inpatient or outpatient or within the community. This flexible approach is essential since every person is unique, and their needs ever-changing.

Short bursts of physiotherapy input alone will not enable an MS person to achieve and maintain optimal physical fitness and function. Continuous, effective self-management is a vital part of the physiotherapy approach in order to minimise the impact of symptoms such as increased tone (spasticity), fatigue, weakness and pain. This requires an understanding of the nature of the symptoms and the rationale behind the management approach, as well as the ability to apply appropriate strategies and techniques. Such knowledge not only enables the person to have better control of their symptoms but also a clearer idea of when to seek help. Education is a key role of the physiotherapist.

In line with this approach it is important that physiotherapy exercises should not dominate one’s lifestyle but should be integrated into everyday life. This can be achieved by:
• adopting postures which are comfortable and maintain good alignment of muscles and joints, for example when lying in bed or sitting in a chair
• using movement patterns which do not promote asymmetry or increase tone and spasms
• participation in aerobic forms of exercise
• correct use of equipment.

‘Carryover’ is a word that physiotherapists often use to describe whether improvements gained are sustained over time. They measure whether changes have been maintained, or have continued to improve, in areas such as the speed and efficiency of walking, level of fitness, range of movement, and level of functional independence. Where things have deteriorated they determine whether this is because of ongoing neurological deterioration or for other reasons.

Such assessment is important because restrictions in health care resources mean that long-term ongoing input is difficult to justify if positive changes are not occurring, or if the improvements made are not maintained.

Therefore, ongoing self-management in partnership with the physiotherapist is the cornerstone of any successful treatment strategy.