Controlling Spasticity in MS 3 of 4
III. PRESSURE SORES
About pressure sores
Pressure sores, sometimes called bed sores, or pressure ulcers, occur in people who spend much of their day sitting or lying down. The term, "bed sore," is misleading. One does not need to be in bed all the time to be at risk for a pressure sore. MS reduces the thousands of small movements people ordinarily make both in sleep and while sitting down. MS can dull sensation in the buttocks or legs, eliminating the usual sensory cues for shifting position.
Spasticity contributes to pressure sores by making normal movement more difficult and by causing posture changes that create pressure points. Another cause of pressure sores is “shearing,” which occurs when the person is receiving positioning assistance from someone, and the movement is more sliding or dragging than lifting.
Pressure sores begin innocently enough, as small reddened areas. The spot may not even feel painful or tender. However, there may already be significant damage to the soft tissues underneath reddened areas of skin. If pressure on the area is not relieved, the skin will break down, forming a sore. These sores can deepen quickly. They are prone to infection, and they can eventually destroy large areas of underlying tissue and even bone. Your nurse or doctor can provide instruction in prevention and early detection. Controlling spasticity is part of good pressure sore prevention. Complicated infected pressure sores are contributing factors in some MS-related deaths.
IV. REHABILITATION Physical therapy A physical therapist (PT) recommends and teaches specific exercises and movements that can increase flexibility and relieve spasticity. First, you will have several tests that measure muscle tone, resistance, strength, and coordination. You'll also be asked about your general functioning in routine daily activities. In addition to stretching exercises you do yourself, PTs also relieve spasticity with specific exercises (done with the help of another person) to stretch and relax shortened muscle fibers, increase joint movement, extend contracted muscles, and improve circulation. Some of these techniques may be taught to a family member or helper so that they can be performed on a routine basis at home. Strengthening exercise prescribed by the PTs is also important because a muscle that is spastic is not necessarily strong. Physical therapy can help maintain range of motion to prevent contractures. Strengthening the spastic muscles, and those that oppose the spastic ones, may be particularly beneficial. This is like making sure that both the “push” and the “pull” are in good condition. PTs may also recommend hydrotherapy (therapy using water) and local application of cold packs. Hydrotherapy is a very effective way to temporarily relax spastic limbs, especially when used in combination with gentle stretching. For those who are unable to stand independently, a standing frame allows for stretching of leg muscles, as well as pressure on the leg bones, which helps limit bone mineral loss (osteoporosis). Orthotic devices Orthotic devices (such as braces and splints) maintain the extremity in a better position, which makes it easier to move around or get into a more comfortable position. They should be fitted by a professional. A common example is the ankle-foot orthosis (AFO—which places the ankle in a better alignment). Although many drugstores and catalogs offer them over-the-counter, ill-fitting devices can aggravate spasticity and cause pressure sores or pain. Trained PTs can direct you to the best options and teach you how to use them. Occupational therapy Occupational therapists (OTs) are experts in modifications to make daily life with spasticity more comfortable and enhance independence. That might include replacing small drawer pulls with large knobs, spraying drawer tracks with silicone to make the drawers glide, or lowering the clothes bar in your closets. OTs will recommend devices and let you try out samples. You may be amazed at the ingenuity of the available devices. Here is a small sample: For people who use wheelchairs, OTs may also recommend positioning changes that minimize spasticity. Sometimes simple adjustments in the height of a footrest or the width of a seat can make a world of difference. OTs can also develop exercise programs for your hands and arms, and may recommend splints that position the hands for best functional use.