Neurorehabilitation Algorithm in Multiple Sclerosis: Traditions and Challenges

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, usually beginning between 20 and 40 years (predominantly in females). Motor weakness, spasticity, balance and coordination dysfunctions provoke severe difficulty in everyday activities of MS patients. MS is a socially important disease, with a high level of acquired disability in a relatively young population. Our purpose is to emphasize the potential of some contemporary physical modalities for MS-neurorehabilitation, based on practice and research. Principal clinical and instrumental assessment and treatment methods are stated: electrical stimulations (with low and middle frequency electric currents); low frequency low intensity magnetic field; proprioceptive neuro-muscular facilitation (PNF) methods; analytic exercises, device-assisted mechano-therapy (passive, active or combined), robotic rehabilitation, etc. We insist on the importance of technical aids (wheelchair, canes, or walking sticks). Authors propose a structured Neurorehabilitation algorithm for MS-patients, with elements of physiotherapy, cryotherapy, electrotherapy, magnetotherapy, ergotherapy, diet, patient’s education. We present the application of this algorithm on a typical MS-patient, treated with cryophysiotherapy, ergotherapy, electrostimulations, Locomat-rehabilitation.

Keywords: Neurorehabilitation; Multiple sclerosis; Spasticity; Expanded disability status scale; Algorithm; Functional assessment; Physical medicine; Rehabilitation

Abbreviations: ADL: Activities of Daily Life; EDSS: Expanded Disability Status scale; ES: Electrical stimulations/Electrostimulations; ET: Ergotherapy; ICD: International Classification of Diseases; ICF: International Classification of Functioning; MS: Multiple sclerosis; NR: Neurorehabilitation; PNF: Proprioceptive Neuro-muscular Facilitation; PRM: Physical and Rehabilitation medicine; PT: Physiotherapy; UEMS: Union Europeenne des Medecins Specialistes; WHO: World Health Organization