Multiple Sclerosis - A Practical Guide to Rehabilitation - 13

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

conditions (in particular, vascular comorbidities)
has increased the lifespan of individuals with MS.
In addition, though unusual, individuals may be
diagnosed with MS after age 50 years (termed
late-onset MS or LOMS) and even after age 60
years (termed very late-onset MS or VLOMS).31
Management of MS in the elderly has some
unique challenges. Older individuals with MS
tend to be more physically disabled and are more
likely to have progressive disease. They have more
age-related and MS-related comorbidities than
their younger counterparts,31 and distinguishing
symptoms of MS from those of normal aging can
be tricky. In addition, in later life, the
inflammatory aspects of MS tend to recede, giving
way to neurodegenerative disease. While DMTs
have been shown effective for preventing relapses,
many are ineffective in limiting the accrual of
disability seen with progressive disease.31,32 Older
individuals also may be more sensitive to side
effects of DMTs due to decreased ability to process
metabolites.33
Symptoms often reported in older adults with MS
include diminished muscle strength, weakness,
fatigue, reduced sensation, balance issues, visual
changes, changes in bowel and bladder function,
cognitive impairment, and sleep disturbances.31
All of these overlap with symptoms of the normal
aging process. Distinguishing symptoms of aging
from those of worsening MS is critical, as is
considering the possibility of other neurological
disorders that are common with advancing age,
and may mimic MS.31
As for any other population, management of older
individuals with MS requires a multidisciplinary
approach. Given their likely physical limitations,
they may need assistance with daily activities.
They may require assistive devices, which can help
maintain mobility and independence and reduce
fall risk. Participation in educational programs
and support groups can be beneficial. Clinicians
should screen for depression and anxiety, which

are common in MS population, including those
aging with MS.31
Pregnancy and MS
MS is a disease that predominantly affects women
of childbearing age. Fortunately, for women who
wish to become pregnant, MS does not seem to
affect fertility, nor does it seem to increase
miscarriages, stillbirths, pregnancy complications,
congenital malformations, or cesarean
deliveries.34 However, vaginal delivery may be
impaired in women with greater disability,
especially when the lower body is affected.
Current standard of care is to avoid DMTs during
pregnancy and conception, although some (IFN
β, glatiramer acetate) are likely safe.35 There is
strong evidence that pregnancy has a short-term
protective effect in patients with MS, with fewer
relapses, especially during the third trimester.33
Long-term benefits of pregnancy have also been
observed, specifically in delaying wheelchair
dependence, reducing risk of disability, and
preventing disability accrual.36,37,38 However, in the
first 3-6 months post-partum, relapses tend to
increase; risk of relapse is about 20-40% higher
during this period.32 Exclusive breastfeeding and
breastfeeding-associated amenorrhea offers some
protection from relapses, but women often forgo
breastfeeding to restart DMT.39
Rehabilitation has a significant role during and
after pregnancy in patients with MS. Hormonal
changes and changing body morphology during
pregnancy can cause increased joint laxity and
pain; physical therapy and exercise can help
manage these symptoms. Assessing gait and
mobility safety is imperative, especially as the
pregnancy progresses, and assistive devices may be
required to maintain mobility and reduce fall risk.
Plans for care of the baby (including managing
mobility with the baby) and resumption of DMTs
and symptomatic therapies should be reviewed
before delivery.

Introduction

13



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
Multiple Sclerosis - A Practical Guide to Rehabilitation - 6
Multiple Sclerosis - A Practical Guide to Rehabilitation - 7
Multiple Sclerosis - A Practical Guide to Rehabilitation - 8
Multiple Sclerosis - A Practical Guide to Rehabilitation - 9
Multiple Sclerosis - A Practical Guide to Rehabilitation - 10
Multiple Sclerosis - A Practical Guide to Rehabilitation - 11
Multiple Sclerosis - A Practical Guide to Rehabilitation - 12
Multiple Sclerosis - A Practical Guide to Rehabilitation - 13
Multiple Sclerosis - A Practical Guide to Rehabilitation - 14
Multiple Sclerosis - A Practical Guide to Rehabilitation - 15
Multiple Sclerosis - A Practical Guide to Rehabilitation - 16
Multiple Sclerosis - A Practical Guide to Rehabilitation - 17
Multiple Sclerosis - A Practical Guide to Rehabilitation - 18
Multiple Sclerosis - A Practical Guide to Rehabilitation - 19
Multiple Sclerosis - A Practical Guide to Rehabilitation - 20
Multiple Sclerosis - A Practical Guide to Rehabilitation - 21
Multiple Sclerosis - A Practical Guide to Rehabilitation - 22
Multiple Sclerosis - A Practical Guide to Rehabilitation - 23
Multiple Sclerosis - A Practical Guide to Rehabilitation - 24
Multiple Sclerosis - A Practical Guide to Rehabilitation - 25
Multiple Sclerosis - A Practical Guide to Rehabilitation - 26
Multiple Sclerosis - A Practical Guide to Rehabilitation - 27
Multiple Sclerosis - A Practical Guide to Rehabilitation - 28
Multiple Sclerosis - A Practical Guide to Rehabilitation - 29
Multiple Sclerosis - A Practical Guide to Rehabilitation - 30
Multiple Sclerosis - A Practical Guide to Rehabilitation - 31
Multiple Sclerosis - A Practical Guide to Rehabilitation - 32
Multiple Sclerosis - A Practical Guide to Rehabilitation - 33
Multiple Sclerosis - A Practical Guide to Rehabilitation - 34
Multiple Sclerosis - A Practical Guide to Rehabilitation - 35
Multiple Sclerosis - A Practical Guide to Rehabilitation - 36
Multiple Sclerosis - A Practical Guide to Rehabilitation - 37
Multiple Sclerosis - A Practical Guide to Rehabilitation - 38
Multiple Sclerosis - A Practical Guide to Rehabilitation - 39
Multiple Sclerosis - A Practical Guide to Rehabilitation - 40
Multiple Sclerosis - A Practical Guide to Rehabilitation - 41
Multiple Sclerosis - A Practical Guide to Rehabilitation - 42
Multiple Sclerosis - A Practical Guide to Rehabilitation - 43
Multiple Sclerosis - A Practical Guide to Rehabilitation - 44
Multiple Sclerosis - A Practical Guide to Rehabilitation - 45
Multiple Sclerosis - A Practical Guide to Rehabilitation - 46
Multiple Sclerosis - A Practical Guide to Rehabilitation - 47
Multiple Sclerosis - A Practical Guide to Rehabilitation - 48
Multiple Sclerosis - A Practical Guide to Rehabilitation - 49
Multiple Sclerosis - A Practical Guide to Rehabilitation - 50
Multiple Sclerosis - A Practical Guide to Rehabilitation - 51
Multiple Sclerosis - A Practical Guide to Rehabilitation - 52
Multiple Sclerosis - A Practical Guide to Rehabilitation - 53
Multiple Sclerosis - A Practical Guide to Rehabilitation - 54
Multiple Sclerosis - A Practical Guide to Rehabilitation - 55
Multiple Sclerosis - A Practical Guide to Rehabilitation - 56
Multiple Sclerosis - A Practical Guide to Rehabilitation - 57
Multiple Sclerosis - A Practical Guide to Rehabilitation - 58
Multiple Sclerosis - A Practical Guide to Rehabilitation - 59
Multiple Sclerosis - A Practical Guide to Rehabilitation - 60
Multiple Sclerosis - A Practical Guide to Rehabilitation - 61
Multiple Sclerosis - A Practical Guide to Rehabilitation - 62
Multiple Sclerosis - A Practical Guide to Rehabilitation - 63
Multiple Sclerosis - A Practical Guide to Rehabilitation - 64
Multiple Sclerosis - A Practical Guide to Rehabilitation - 65
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
https://www.nxtbookmedia.com