Physiotherapy of motor disorders in multiple sclerosis patients: critical overview of the literature

Multiple Sclerosis (MS) is a disabling chronic neurological disorder with m ultiple motor impairments and its progressive course leads to severe disabi lity. The question of the value of exercises program and physiotherapy to r educe these motor disorders and their consequences was raised. This literat ure overview is based on data from common database: Medline, Embase, Cochra ne Library. Were selected articles corresponding to open studies and especi ally clinical controlled randomised trials. To be analysed, each article sh ould correspond with inclusion criteria: confirmed diagnosis according to P oser's criteria, secondary or primary progressive form of MS without relaps e for the study period, randomisation according to severity assessed by the Expanded Disability Status Scale (EDSS), no change in symptomatic drugs al ong the study period, and a simple blind assessor. Impairment, disabilities , handicap and quality of life had to be measured. Five clinical controlled randomised trials were consistent with these criteria. They demonstrated t he effectiveness of comprehensive programs on motor function in the less se vere forms of MS, but also their inability to change the course of the most severely affected forms. However, the effects on disability, handicap and quality of life were significant in comparison with control patients. These trials emphasised the value of multidisciplinary programs including physio therapy and occupational therapy, carried out daily or 3 times a week by sp ecialised staffs. The effects lasted only few weeks or months, requiring to propose them again after this period. Other controlled randomised studies also stressed the value of specific programs: temporary alleviation of spas ticity and fatigue with cooling techniques; aerobic endurance training for less severely affected patients to prevent disuse consequences and improve fitness and quality of life; expiratory training to enhance coughing capaci ty and prevent pulmonary infections in very disabled patients, From this ov erview study, it seems that multidisciplinary comprehensive programs clearl y provide benefits to those patients and contribute to reduce disability an d improve quality of life at each stage of MS.