Symptomatic therapy and neurorehabilitation in multiple sclerosis

Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317, Valens, Switzerland.
The Lancet Neurology (Impact Factor: 21.82). 11/2005; 4(10):643-52. DOI: 10.1016/S1474-4422(05)70193-9
Source: PubMed

ABSTRACT Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Symptoms that contribute to loss of independence and restrictions in social activities lead to continuing decline in quality of life. Our aim is to give an updated overview on the management of symptoms and rehabilitation measures in MS. Appropriate use of these treatment options might help to reduce long-term consequences of MS in daily life. First, we review 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, neurorehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. Second, we discuss comprehensive multidisciplinary rehabilitation and specific treatment options. 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. Treatment should be adapted depending on: the individual patient's needs, demands of their surrounding environment, type and degree of disability, and treatment goals. Improvement commonly persists for several months beyond the treatment period, mostly as a result of reconditioning and adaptation and appropriate use of medical and social support at home. These findings suggest that quality of life is determined by disability and handicap more than by functional deficits and disease progression.

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    • "No que se refere ao treinamento cognitivo (TC), o mesmo pode ser compreendido como um processo ativo de educação e capacitação, focado no manejo apropriado de déficits adquiridos. Como uma modalidade da (re)abilitação neuropsicológica, seu objetivo é obter o melhor potencial físico, mental e social do indivíduo, para que ele possa remanescer ou integrar-se em um meio social (Kesselring & Beer, 2005). Em um contexto mais amplo, a reabilitação neuropsicológica visa, então, aprimorar déficits cognitivos, comportamentais e psicossociais, sendo que o TC procura otimizar habilidades cognitivas não necessariamente deficitárias (Wilson, 2008). "
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    ABSTRACT: The present study examined the effects of a Working Memory Training (WMT) in healthy elderly. Twenty participants comprised the final sample, eleven from the experimental group (WMT) and nine from the control group (socialization). Every subject underwent a neuropsychological evaluation pre and post-intervention. The meetings were held once a week, for three months. Results indicated that subjects in the experimental group improved cognitive functions related to concentrated attention, learning, short-term and episodic memory. Subjects in the control group also demonstrated, in a smaller number of variables, improvement in concentrated attention and episodic memory. WMT seems to have generated a transfer effect, especially to episodic memory, which is directly related to the subsystem of working memory (WM), suggesting that WMT may be useful in the context of the neuropsychology of aging.
    Psicologia Reflexão e Crítica 12/2012; 26(1):122-135. DOI:10.1590/S0102-79722013000100014 · 0.09 Impact Factor
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    • "Living with multiple sclerosis (MS) can be a difficult experience , both physically and psychologically [1] [2], with common symptoms including visual problems, motor abnormalities, bowel and bladder incontinence, loss of balance and sexual dysfunction [2] [3]. Research also indicates that there is an increased prevalence of falls in people with MS (PwMS) [4] [5] and a high proportion of patients who experience debilitating symptoms of fatigue, defined as a 'a subjective lack of physical and/or mental energy that is perceived by the individual or the caregiver to interfere with usual and desired activities' [6]. "
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    ABSTRACT: Exercise is an effective intervention for improving function, mobility and health-related quality of life in people with multiple sclerosis (PwMS). Questions remain however, regarding the effectiveness of pragmatic exercise interventions for evoking tangible and sustained increases in physical activity and long-term impact on important health outcomes in PwMS. Furthermore, dose-response relationships between exercise and health outcomes have not previously been reported in PwMS. These issues, and improved knowledge of cost effectiveness, are likely to influence key decisions of health policy makers regarding the implementation of exercise therapy as part of the patient care pathway for PwMS. Hence, the primary aim of this study is to investigate whether a 12-week tapered programme of supervised exercise, incorporating cognitive-behavioural techniques to facilitate sustained behaviour change, is effective for evoking improvements in physical activity and key health outcomes in PwMS over 9months of follow-up. A total of 120 PWMS will be randomised (1:1) to either a 12 -week pragmatic exercise therapy intervention or usual care control group. Participants will be included on the basis of a clinical diagnosis of MS, with an expanded disability status score (EDSS) between 1 and 6.5. Outcome measures, to be assessed before and after the intervention and six months later, will include physical activity, clinical and functional measures and health-related quality of life. In addition, the cost effectiveness of the intervention will be evaluated and dose-response relationships between physical activity and the primary/secondary outcomes in those with mild and more severe disease will be explored.
    Contemporary clinical trials 10/2012; 34(2). DOI:10.1016/j.cct.2012.10.011 · 1.99 Impact Factor
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    • "Unauthorized reproduction of this article is prohibited. a primary concern of patients and their families after an illness or injury (King, 1996; Russell et al., 2002; Lobentanz et al., 2004; Kesselring and Beer, 2005). Thus, the fact that the A-MPAI-4 correlated with a valid and reliable tool measuring functional independence indicates that A-MPAI-4 captures a salient patient-centered aspect of functionality, namely independence, which is also a core principle in rehabilitation. "
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    ABSTRACT: The Mayo-Portland Adaptability Inventory 4 (MPAI-4) is a valid and reliable assessment tool to detect clinical impairments in patients with acquired brain injury. The tool is widely used by rehabilitation therapists worldwide, given its good psychometric properties and its availability in several languages. The purpose of this study was to translate the tool into Arabic and to examine its validity and reliability with multiple sclerosis and stroke patients. A total of 128 participants were enrolled in this study: 49 with multiple sclerosis, 17 with stroke, and 62 healthy adults. The psychometric properties of discriminative and convergent construct validity as well as test-retest reliability were tested. The translated tool, the Arabic-MPAI-4 (A-MPAI-4), significantly discriminated among the three subgroups (F=50.93, P<0.001), correlated moderately but significantly with the Arabic version of the Performance Assessment of Self-Care Skills Self-Report as a measure of functional independence in daily activities (r=-0.35, P<0.001), and showed good stability over time (r=0.73, P<0.001). The A-MPAI-4 is a valid and reliable tool for clinical use with multiple sclerosis and stroke patients who speak Arabic.
    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 05/2012; 35(3):243-7. DOI:10.1097/MRR.0b013e3283544c9f · 1.14 Impact Factor
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