How to recover from an MS relapse

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A relapse is one scary experience. The tendency of traditional medicine in the past was to advocate bed rest and the patient to adopt a ‘sick role’. The lack of research in this area meant that doctors were left to adopt beliefs that were outdated by modern standards; they truly believed that bed rest during an MS relapse helped with the recovery process.

This would make sense if in fact you’re dealing with a broken leg or following a heart attack, but not when it’s the brain. The brain or the nervous system is built on a feedback system – whether it be negative (no activity/stimulus) or positive (activity/stimulation). We in the neuroscience community call this ‘neuroplasticity’.

Neuroplasticity – the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury [Oxford English Dictionary].

One of the biggest fears related to exercise immediately following an MS relapse was whether it detrimentally affected recovery or even delayed it. I used to come across this and similar discussion points as a Research Fellow during my stint at Queens Square – no one really had the evidence back then. I hope by now patients as well as doctors know this to be false.

This then leaves the type of exercise to be used. The conventional treatment for a long-time was in-patient physiotherapy, which in many places was done by therapists using standardised exercises targeting gait, upper and lower extremities, balance/core stability. These tend to be very stereotyped exercises that are at times functional based i.e. getting up stairs for instance. But, over the last decade or so as Artificial Intelligence technology has expanded so has its use in rehabilitation programmes. I’m not talking about the fancy exoskeleton technologies that make you walk, but simple things like X-box Kinect and Nintendo Brain training that are available to the mass market at a fraction of the cost.

Exergaming – Fitness game, exergaming or exer-gaming (a portmanteau of “exercise” and “gaming”), or gamercising is a term used for video games that are also a form of exercise. Exergaming relies on technology that tracks body movement or reaction [Wikepedia].

EA Sports Boxing

In this study published below, looking at conventional physiotherapy vs. Exergaming using X-box Kinect, the investigators found improvements in upper limb extremity function, cognition, balance, health-related quality of life and walking when commenced during a relapse for both types of therapies. However, only conventional physiotherapy was superior to exergaming in improving upper limb function (this may be secondary to the unilateral nature of the games that use sporting activities as their basis). Exergaming, on the other hand was able to improve fatigue unlike conventional physiotherapy.

I hope soon both of these are available to MS patients during their in-patient admissions or out in the community.

Abstract

Mult Scler Relat Disord 2022 Apr 25;63:103823. doi: 10.1016/j.msard.2022.103823. Online ahead of print.

Effects and safety of exergaming in persons with multiple sclerosis during corticosteroid treatment: a pilot study

Asiye Tuba Ozdogar Cavid Baba Turhan Kahraman Ozge SagiciSeda DastanOzge ErtekinSerkan Ozakbas 

Background: There is no information about the effects and usability of rehabilitation during corticosteroid treatment. This randomized clinical trial was conducted to evaluate and compare the effects and safety of exergaming and conventional rehabilitation (CR) on persons with multiple sclerosis (MS, pwMS) during corticosteroid treatment.

Methods: The participants were randomly divided into two groups: Exergaming (n=15) and CR (n=15). Rehabilitation was applied by a physiotherapist who has expertise in MS. Measurements were done at baseline (T1), immediately after discharge (T2), and 1 month after discharge (T3). The outcome measures included upper extremity functions, walking, balance, cognitive functions, quality of life, depression, and fatigue.

Results: The Nine Hole Peg Test, California Verbal Learning Test, Symbol Digit Modalities Test, MS Walking Scale-12, Six Spot Step Test showed a significant difference between T1 to T2 and T1 to T3 in the exergaming and CR groups (p < 0.05). The Timed 25 Foot Walk and Multiple Sclerosis International Quality of Life Questionnaire were significantly different between T1 to T3 in the exergaming and CR groups (p < 0.05). Brief Visuospatial Memory Test-Revised was significantly different between T1 to T3 and T2 to T3 in the exergaming and CR groups (p < 0.05). The MFIS showed a significant difference between T1 to T2 and T1 to T3 in the exergaming group (p < 0.05).

Conclusions: This study suggests that exergaming and CR are effective and safe methods for improving upper extremity, cognitive functions, fatigue, quality of life, balance, and walking ability in pwMS during the hospitalization period.

About the author

Neuro Doc Gnanapavan

9 comments

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  • So the two key words are brain and injury

    Let look at stroke

    The researchers found:

    Survivors in both the high-intensity, variable training and high-intensity, forward walking groups walked faster and farther than the low-intensity, variable training group.
    For all walking outcomes, 57% to 80% of participants in the high-intensity groups had important clinical gains, while only 9% to 31% of participants did so following low-intensity training.
    High-intensity variable training also resulted in improved dynamic balance while walking and improved balance confidence.

    Rehabilitation that allows walking practice without challenging the nervous system doesn’t do enough to make a statistical or clinically significant difference in a patient’s recovery after a stroke,” Hornby said. “We found that when stroke patients are pushed harder, they see greater changes in less time, which translates into more efficient rehabilitation services and improved mobility.”

    Whatch the movie

    High-intensity step training boosts stroke survivors’ walking skills

    https://medicalxpress.com/news/2019-08-high-intensity-boosts-survivors-skills.html

    Nice post

  • I had five relapses before I was diagnosed and perhaps because I wasn’t diagnosed I was never given any advice on exercise, except for one doctor who didn’t believe I don’t get any symptoms when I run. I’d actually go even further and say running made me feel better. Between the start and end of a run my symptoms would go away – only to return the next morning after I’d been still overnight.

    Now it appears there is something wrong with my heart and I’ve been advised not to run or cycle… Up until yesterday this was fine as I wasn’t feeling anywhere near well enough but now I’m feeling a bit better my life is about to get very frustrating.

  • is it reasonable to think exercising/learning early after a relapse could lead to better recovery?

  • Before I found the long-term exercise solution I used wii fit quite successfully and I think you are missing the really big advantage in this approach. IMO the physio route is all but impossible to sustain in the longer term. It’s one thing to be on a targeted programme knowing that at the next face-to-face appt with the physio she’ll be expecting to see the results of your efforts. Not the same at all as being told that ‘you must stretch’, ‘go up stairs’ etc. three times a day for evermore. The grind of mind-numbing DIY daily exercises can play tricks with your mind, added to which is the guilt you carry as and when you default – another thing to remind you of the burden of living with a long-term condition. By introducing a gaming element, you are de-medicalising the situation and it’s better to be concentrating on cartoons and silly music than wondering if you’re heading for a relapse. If your head is not in the right place, everything about the MS is worse.

    • I’m seeing a physical therapist for electro muscular therapy (NMES), and like the last therapist who I saw only once, even though that’s what the prescription was given for in writing, they wanted to do exercises. It just reminds me of being a kid and having trumpet lessons once a week, in house- the teacher would come over but I hardly ever practiced like I was supposed to.

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