臨床表徵 Signs and Symptoms

 Sensory impaired 

 Anesthesia, paresthesias, disturbance in position sense, dysesthesias

 Visual impaired 

 optic neuritis, scotoma, nystagmus, diplopia

How is MS Treated and Managed?

 Drug therapy

 Treat new attacks (exacerbations)

 Prevent the occurrence of future attacks

 Slow or prevent disease progression

 Treat the chronic symptoms of the disease

 Physical therapy

 Psychosocial support

物理治療目標(Goals)

 To set the goal according to patient’s functional condition 

 To give problem solving and education 

 symptom-related approach

 To treat the patient as a whole 

 To maximize independence, selfdetermination, and quality of life

疲乏 Fatigue

 Sleep-deprivation fatigue 

 要改善睡眠 (減少肌肉痙攣，減少夜間喝水) 

 Deconditioning fatigue 

 有氧運動，增加耐力

 Neuromuscular fatigue 

 (demyelinated axons-> more energy consumption, and increase body 0.1° F can decrease nerve conduction velocity)需適度休息，室溫低，給予能量儲存技巧(energy conservation technique), 給予輔具(adaptive equipment) 

 Emotional stress induced fatigue 

 提高興趣，改善心情

肌無力 Weakness

 肌力訓練(strengthening exercise)

 受損肌肉阻力漸進運動， 例: ( 1~2磅) x (8~10下) 漸增

 訓練殘存的正常肌肉，給最大運動阻力

 避免疲乏：  給間歇運動，中間休息1~5分鐘，使neurotransmission恢復

 避免廢用(avoid disuse)

 鼓勵運動，給assistive exercise，PNF等

痙攣 Spasticity

 Passive ROM 

 Prolonged stretching:≧20 sec. 

 Cold therapy 

 Inhibitory relaxation: hold-relax (PNF)：   slow-rocking, slow stroking 

 Reflex-inhibiting movement patterns: asymmetrical tonic neck reflex 

 Functional skills and weight bearing exercise

感覺異常 Sensory Dysfunction

 Cold applications: for burning or tightsensations

 Sensory reeducation: brush－＞soft hair

 Training visual compensation and safetytechniques

 Routine skin inspection 

 Mattresses or cushions provided

構音困難與吞嚥困難Dysarthria and Dysphagia

 Dysarthria

 using pauses to improve slurred, rapid speech 

 oral exercises to increase strength of oral 

 Dysphasia

 positioning to prevent aspiration pneumonia

 Think swallow  (conscious swallow)

 food and liquid selection (semiliquid->water)

平衡與協調Balance and Coordination

 Cerebellar signs are common: ataxia,dysmetria, incoordination, resting tremor 

 Management: 

 from wide to narrow base of support 

 from low to high center of gravity 

 visual cues and biofeedback to improve balance and tremor 

 use low weighted cuff to reduce ataxia, or tremor

步行與活動Ambulation and Mobility

 Train trunk control and balance first 

 Normalizing muscle tone 

 Maximizing flexibility and ROM 

 Strengthening muscles 

 Gradual sitting and standing programs: sitting tolerance, tilting table standing 

 Visual and tactile cues 

 Functioning training with or without assistive devices

認知異常Cognitive Dysfunction

 Due to demyelination in the cerebral tracts 

 Understanding the nature and extent of illness 

 Give compensatory strategy: memory book 

 Use clear, written, sequenced steps for exercises 

 Adapted methods of performing ADL

體適能 General Conditioning and Fitness

 Aerobic exercise: swimming (low temp), walking, stationary bikes 

 Start from low intensity as tolerated.

http://www.pt.ntu.edu.tw/mhh/course/neuro/BS/jjluh_MS%20and%20ALS/%E9%81%8B%E5%8B%95%E7%A5%9E%E7%B6%93%E5%85%83%E7%96%BE%E7%97%85%E3%80%81%E8%82%8C%E8%82%89%E8%90%8E%E7%B8%AE%E6%80%A7%E5%81%B4.pdf