Multiple Sclerosis - A Practical Guide to Rehabilitation - 21

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

Pharmacologic agents may also be part of a
rehabilitation plan for persons with MS. For
example, patients with spasticity may benefit
from a combination of exercise and medication,
such as oral baclofen or tizanidine. If tolerability
to these drugs is challenging (side effects may
include lethargy and fatigue), or when spasticity
is more diffuse or generalized, intrathecal
baclofen (delivered via an implanted pump with a
catheter) may be appropriate. Injection of
botulinum toxin A into specific muscle groups is
another option when spasticity is more focal or
localized to 1 or 2 muscle groups. Dalfampridine,
an oral potassium channel blocker, has been
shown to improve walking ability in patients with
MS and mild-to-moderate walking
impairment.58,59 It is important to note that any

medication for symptom management should be
managed in consultation with the patient's
physician/neurologist.
Adaptive/Assistive Devices
In addition to strengthening exercises, stretching,
task-specific training, and pharmacologic
therapies, assistive devices are for many patients
essential to maintaining or improving mobility.
When working with patients to select such
devices, it is important to recognize current needs
and also anticipate future needs (possibly as long
as 5 years out). Most insurance companies will
not consider payment for a new product sooner,
unless the patient has demonstrated significant
permanent changes. Table 7 summarizes various
mobility devices of benefit to patients with MS.

Table 7: Mobility Aids for Individuals with MS
Device

Indications for Use

Types

Canes

* Can provide a small measure of balance
* Not meant to support a large amount of
weight
* Held in hand opposite the weak side
* Should be as tall as the hip bone or as high as
the bend of the wrist while standing tall with
arms relaxed at the sides

*
*
*
*

Crutches

* Provide greater stability when weakness and
imbalance is more significant
* Can use one or both depending on how the
patient feels
* Loftstrand crutch: cuff allows the hand to be
free and prevents dropping the crutch
* Hand piece should fit the same as a cane

* Axillary
* Forearm/Loftstrand/
Canadian
* Trekking poles

Walkers

* Give more support for weakness and balance
problems
* Hand grips should be as tall as the hip bone or
as high as the bend in the wrist when standing
tall with arms relaxed at sides

*
*
*
*

Manual
Wheelchairs

* Require good upper body strength and
endurance to propel for all mobility

* "Transport wheelchair"
(lightweight but the
individual must be pushed)
* Custom wheelchairs
(customized seating and
many optional features)

Mobility

Single point
4-point
Small-based quad
Large-based quad

Standard (no wheels)
Front wheeled
4-wheeled
4-wheeled with seat and
hand brakes

21



Multiple Sclerosis - A Practical Guide to Rehabilitation

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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
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 65
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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