Multiple Sclerosis

Case Presentation: Multiple Sclerosis 

A 58-year-old female with Multiple Sclerosis presents with mild spinal pain and ataxia. Her diagnosis of Multiple Sclerosis was made less than five years prior. During that time, she has had two episodes of limb paraesthesia and diplopia that was attributed to Multiple Sclerosis. Her overall health otherwise was unremarkable. She is not medicated but has been advised by a health professional to maintain a strict diet with supplementation (fish oils, Vitamin D and CoQ10). 


Treatment and Therapeutic Plan 

The findings and presentations appear consistent with a vestibular hypofunction. However, it was uncertain whether the balance disorder was a comorbidity with Multiple Sclerosis. 

A therapeutic plan was recommended and the following goals outlined. 

  1. To improve her vestibular system. 
  2. To support postural control system. 
  3. To learn and educate healthier choices with life in particular with the impact of MS 

A therapeutic plan involving a six-week rehabilitation neuro modulated rehabilitation program was advised. Eventually, the plan is to encourage neuroplasticity and fitness among her nervous system without compromise. The principal form of therapy was Vestibular Rehabilitation Therapy; involving ocular gaze stabilisation, head torsional activities and gait exercises. 


 Clinical Outcomes 

Clinical re-evaluations involving specialised balance testing and Computerised Digital Posturography (CDP) was performed regularly throughout the trial. This presentation supports Martin and colleagues (2006) findings that the motor function can decline very early with the disease progress with minimal significant hard neurological findings (Martin et al., 2006). 

The table below diagrammatically shows the composite balance scores from September 2012 to May 2013. A composite score is a collection of key balance variables with force plate analysis and compares to normal cohorts. Clearly she has demonstrated a significant shift in her balance (235.45% to 10.45%) with eyes open task over the four testing periods. 

Composite balance scores demonstrate improved balance with rehabilitation for MS 


Discussion 

Rehabilitation is an important aspect of the health care management of patients with Multiple Sclerosis (Calabresi, 2008). In Kalb (2012), stated the role of rehabilitation with Multiple Sclerosis “is a process that helps a person achieve and maintain…optimal function.”(p70) (Kalb, 2012). A challenge impacting on most therapeutic interventions for Multiple Sclerosis is weakness and fatigue. Multiple Sclerosis- related fatigue has been associated with the impaired physical activity (Filippini & Ebers, 2007), quality of life (Koch, Mostert, Heerings, Uyttenboogaart, & De Keyser, 2009) and maintenance of balance (Cattaneo, Jonsdottir, Zocchi, & Regola, 2007). 

Vestibular rehabilitation therapy (VRT) is a clinical protocol treatment for individuals with dizziness and balance related disorders. This form of rehabilitation therapy involves physical exercises of the head, ocular movement and balance training. The effectiveness of balance training on Multiple Sclerosis has been supported previously (Frzovic, Morris, & Vowels, 2000).


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