Physical therapy is a mainstay of patients of all types with physical disabilities.  Studies of MS patients have shown variable results, probably due to many reasons, such as fatigue, instability of the disease, and small sample size.  The type of physical therapy also varies.  In a study from Belgium, the benefit between bilateral exercise ("in-phase") and alternating exercise ("antiphase") was evaluated at various speeds of repetition for 10 weeks.  

Exercise rates of 0.75 Hz, 1.00 Hz, 1.25 Hz, and 1.50 Hz were used. Patients had mild-to-moderate disabilities (EDSS scores from 1.5 to 6.5).  

Coordination accuracy and stability were measured at baseline and at 10 weeks. The results showed that physical intervention programs with emphasis on strength do not influence motor control of the lower limbs after a 10-week intervention period. Antiphase training is performed with the lowest accuracy at the lowest frequency but improves when frequency increases. This is a particular finding in MS patients and contrasts with the current literature in regard to healthy subjects.  This study also found that motor control and the EDSS were not correlated, probably due to the fact that EDSS is a rough picture of the distance that an MS patient can walk, whereas motor control is about stability and accuracy.

A comprehensive rehabilitation program showed improvement of MS patients with primarily pyramidal impairment and mild-to-moderate MS in both activities of daily living and mobility. In a study with 200 patients in an inpatient multidisciplinary program, patients were assessed at the beginning and end of admission with the EDSS.  Functional status was evaluated with the Barthel Index and Rivermead Mobility Index.  Sixty-five percent were women, with a mean age of 50 and mean duration of disease of 17.3 years.  All patients were enrolled in an individualized, goal-oriented, multidisciplinary inpatient program on the basis of practical skills of daily living.

Results of rehabilitation were assessed in the whole sample as well as by comparing 3 subgroups: a mild group (EDSS 2-5.5), moderate group (EDSS 6-65), and severe group (EDSS 7-8.5). The results of the program showed greater improvement in patients in the mild and moderate groups, although the severe group did show some improvement.  Pyramidal (a multipolar neuron located in the hippocampus and cerebral cortex pyramid in shape)impairment was the greatest predictor of mobility and activities of daily living.

In another rehabilitation study, patients were randomized to 3 treatment groups: outpatient, inpatient, and day hospital. There were 9 patients in each group for a total of 27 patients.  

Outcome measures were Berg Scale, Barthel Index, and Hauser Ambulation Scale.  The program lasted 5 weeks.

The results showed that all patients improved in outcome measures except for ambulation, but there was no difference among the groups.

The conclusion was that outpatient rehabilitation is equally effective as inpatient or day hospital therapy, and outpatient rehabilitation saves time and economic resources.

Supported by an independent educational grant from Genentech