నైరూప్య

Balance and gait Neurorehabilitation in multiple sclerosis with significant fatigue and spasticity

Koleva IB

Multiple sclerosis (MS) is a socially important disease, with a high level of acquired disability in a relatively young population. Motor weakness, spasticity, balance and coordination dysfunctions provoke severe difficulty in everyday activities of MS patients. Neurorehabilitation (NR) is an interdisciplinary thematic field between Neurology, Neurosurgery, Physical and rehabilitation medicine (PRM). According the White Book of PRM, Rehabilitation (including NR) is a functional therapy, based on a detailed functional assessment. Balance and Gait recovery are important goal in NR-clinical practice, essential for the independence of patients in activities in daily living. We present the case of a 33-years old female, with definitive MS, cerebro-spinal form, relapsingremitting evolution with secondary progression; admitted to our PRM-Department for NR 15 days after a relapse. Ad the entry, the patient had spastic inferior paraplegia, cerebellar ataxia; significant spasticity, and important fatigue. EDSS-score = 6,5. We applied a complex NR-programme, combination of traditional and modern methods, oriented to diagnosis (functional tests and scales, stabilometry and gait assessment; International Classification of Functioning) and therapy (proprioceptive neuromuscular facilitation - PNF; electrical stimulations; cryotherapy; balance and gait training; transcranial and transmedullar magnetic field, ergotherapy, LOCOMAT (Hocoma). Because of the significant spasticity, appearance of clonus and important fatigue, we divided the physiotherapy and robotic procedures in periods of 30 minutes. Complex NR-programme is effective for stimulation of activity-dependent neuroplasticity. We emphasize the impact of NR for functional recovery, amelioration of autonomy and quality of life of MS-patients. In case of fatigue and spasticity, we recommend fractionation of the NR-procedures.