Neurorehabilitation in Multiple Sclerosis

Multiple sclerosis is the most common neurological disease in young adulthood. Contrary to the previously held belief that physical activity is harmful in MS, by now it has been understood that training therapies for patients are effective and safe.

About two-thirds of all MS patients report mobility impairments. In everyday life, such impairments manifest, among other things, as gait disorders, paralysis, and general fatigue. Moreover, the resulting weakening of the muscular system also has a negative impact on the patient's well-being, quality of life, and interaction with the social environment. In the therapy of MS patients, rehabilitation of walking therefore forms an important part of the treatment strategy. The central objective of therapy is to maintain or re-establish an active lifestyle.

Neurorehabilitation can be positively influenced by various individualized sports physiotherapy measures. Through physical activity, MS patients acquire more strength and endurance, thereby improving their quality of life. Low-stress strength and endurance training or a combination of both types of exercise is well tolerated by MS patients, and it improves both the physical and the emotional condition.

Endurance training:

To increase endurance, 2–3 training units per week are sufficient. Each unit should take 10 to 40 minutes. To achieve a noticeable effect, patients should be trained for at least eight weeks. An exercise intensity of 60 – 80 % of the maximum heart rate (number of heartbeats per minute that a person can reach upon maximum effort) has proven to be ideal. Walking speed, extension of the walking distance, but also climbing of stairs and the frequently occurring fatigue can be positively influenced. Regular endurance training also has a positive effect on the brain. The ability of the nerve cells to adapt to new requirements and to expand their function is improved.

Strength training:

The muscle strength of MS patients can likewise be treated with specific strength exercises. The guiding principle is full-body training with 4–8 workouts in 2–3 training sessions per week. Initially, 1–3 sets with around 15–20 repetitions are performed per workout. Later, the training can be increased until the desired workout number is reached. To prevent overheating, small breaks of 2–4 minutes have proven to be effective. However, this form of training is suitable only for patients capable of walking.

Hippotherapy:

In many cases, therapeutic horseback riding has a positive impact on trunk stability, balance, and ability to walk. Here the three-dimensional oscillation pulses originating from the horse are transmitted to the patient. Hippotherapy, is, however, available only to a limited extent and always requires a doctor’s prescription. For settlement with the insurance company, timely inquiry regarding approval and funding of the therapy is important.

Medical aids and appliances:

The need for a medical appliance is determined by a therapist in the context of outpatient or inpatient care. For so-called tariffed appliances, a prescription must be issued by a doctor. Only then may the cost be absorbed by the health insurance provider. If a patient requires a wheelchair, an explanatory statement and a dimensional drawing are additionally required for approval and preparation. An approval by the medical superintendent at the public health insurance provider may still be required. In contrast, non-tariffed appliances must be privately funded.

As a special form of a medical appliance, functional electrical stimulation is to be mentioned here. If patients are affected by muscle paralysis on the forefoot, this form of therapy can improve their walking ability by stimulating the affected muscles.