Search

In recent years, enormous strides have been made in increasing the range and efficacy of disease-modifying drugs available for the treatment of multiple sclerosis (MS) in its early and remitting stages, and more continue to emerge. Another equally important concept of successful treatment of MS is neurorehabilitation, which must be pursued alongside these medications. Key factors that contribute to the impact of neurorehabilitation include resilience and neuroplasticity. In the former, components such as nutrition, self-belief and physical activity provide a stronger response to the disease and improved responses to treatment. Neuroplasticity is the capacity of the brain to establish new neuronal networks after lesion damage has occurred and distant brain regions assume control of lost functions. In MS, it is vital that each patient is treated by a coordinated multidisciplinary team. This enables all aspects of the disease including problems with mobility, gait, bladder/bowel disturbances, fatigue and depression to be effectively treated. It is also important that the treating team adopts current best practice and provides internationally agreed standards of care. A further vital aspect of MS management is patient engagement, in which individuals are fully involved and are encouraged to strive and put effort into meeting treatment goals. In this approach, healthcare providers become motivators and patients need less intervention and consume fewer resources. Numerous interventions that promote neurorehabilitation are available, though evidence to support their use is limited by a lack of data from large randomised controlled trials. Combining interventions that promote neurorehabilitation with newer, more effective treatments creates a promising potential to substantially improve the outlook for patients at all stages of MS.

Neuroplasticity is the continuous adaptation of synaptic networks to the requirements from internal external environment. It is the basis of learning. Neurorehabilitation is its clinical application.

Limitations in activities of daily living are important to an individual's life, and the progressive nature of multiple sclerosis (MS) can have a significant impact on the patient's quality of life (QoL). Monitoring low-level limitations of activities during the early stages of MS should be encouraged, as it can indicate advancing neurological damage. Clinical data and survey evidence from numerous research groups suggest that impaired mobility is a large contributory factor to diminished QoL. Although these studies have demonstrated the negative effect of reduced mobility, there remains a substantial need for greater recognition of the presence and effects of disabilities, including reduced mobility, fatigue, pain, depression and spasticity, and the need for targeted treatments for specific impairments. In this review, literature describing the impact on the lives of patient is presented; because of the variability in speed of progression and prognosis with early mobility loss, the need for early, continuous and consistent assessment is suggested.

Walking ability is a vital component of validated test procedures to assess mobility impairment in multiple sclerosis (MS). The methods used to assess walking ability vary widely between treatment centres, and the accuracy of the methods used and numbers of parameters determined to analyse specific aspects of walking and gait are often limited. The questionnaire- and task-based methods used to assess walking in MS can be divided into different categories. First, there are the general-purpose tests such as the Expanded Disability Status Scale (EDSS), the Multiple Sclerosis Functional Composite (MSFC), the Family Assessment of Multiple Sclerosis Trial Outcome Index (FAMS-TOI) and the Short Form-36 (SF-36). These, particularly EDSS, are widely used in MS to assess limitations of all activities and social participation, of which walking is only a part. Others, such as SF-36, assess health-related quality of life (HRQoL). Second, there are methods designed to specifically assess walking or gait, including the timed 25-foot walk (T25FW), the Dynamic Gait Index (DGI), the 12-Item MS Walking Scale (MSWS-12) and the Timed Up and Go Test (TUGT). These test methods require minimal equipment to perform such as a stopwatch, a hallway or a chair, and can be completed at a medical centre in a few minutes. Most of these tests provide reliable and valid data but some lack accurate assessment of gait and some require clinician training. Third, there are tests that specifically measure balance, such as the Berg Balance Test, in which the patient completes a series of balance exercises while being observed. A recent development is the use of accelerometers to monitor MS patients over extended periods; these can provide more accurate data than patient self-report tools. In future, it is likely that more specific tests of walking ability will be more widely used as an important part of MS diagnosis and to more precisely monitor disease progression and assess patient needs.