Multiple sclerosis treatment

Question 1

Right Lower Limb Weakness and Coordination Difficulties

Answer 1

*Relevant Symptoms: Difficulty mobilising indoors with a stick; relies on pram outdoors; trunk sway when walking.
*Physiotherapy Plan:
>Gait re-education:
- Practice indoor walking with a frame or stick to optimise safety.
- Introduce stepping drills, heel-to-toe walking, and stepping over objects to promote symmetry and coordination.
>Balance and proprioception training:
- Lateral weight transfers, step-ups, and reaching out of base of support.
- Closed-chain leg exercises (mini squats, step taps) to activate stabilising muscles.
>Strengthening exercises:
- Focus on gluteal, quadriceps, and calf strength using sit-to-stand, resisted knee extension, and bridging.
- Consider orthotic referral if foot drop or instability persists.

Question 2

Right Upper Limb Weakness and Reduced Dexterity

Answer 2

*Relevant Symptoms: Difficulty lifting baby; impaired hand coordination.
*Physiotherapy Plan:
>Fine motor coordination exercises:
- Pegboard tasks, stacking cups, picking up small objects, or using therapy putty.
- Practice with real-life tasks like holding baby bottles or buttoning.
Resisted and closed-chain >strengthening:
- Wall push-ups, resisted rows with a band, bicep/tricep curls.
>Functional retraining:
- Practice safe techniques to lift/carry baby from cot using both hands or adapted strategies.
- Introduce bilateral tasks to encourage activation and coordination of both limbs.

Question 3

Sensory Disturbances (Numbness and Burning Sensation)

Answer 3

*Relevant Symptoms: Burning/numbness in torso and thigh.
*Physiotherapy Plan:
>Sensory retraining:
- Textured materials (e.g., soft cloths, sponges) over affected areas.
- Desensitisation with massage or tapping.
>Compensatory strategies:
- Use mirrors or vision to reinforce correct limb positioning.
- Encourage visual-tactile feedback during mobility tasks.
>Safety education:
- Fall prevention strategies when proprioception is reduced.
- Reinforce safe foot placement with visual cues (e.g., contrast floor tape).

Question 4

Postural Instability and Poor Sitting Balance

Answer 4

*Relevant Symptoms: Leans to right; avoids unsupported sitting.
*Physiotherapy Plan:
>Core stability training:
- Seated pelvic tilts, bridging, static holds, and reaching from a supported position.
- Practice trunk rotations and weight shifts in sitting.
>Supported sitting tasks:
- Begin on therapy ball or chair with backrest.
- Progress to unsupported sitting with balance challenges (e.g., reaching, catching).
>Infant handling training:
- Simulated baby care while seated with support to promote safety and confidence.

Question 5

Fatigue

Answer 5

*Relevant Symptoms: Daytime sleeping, limits activity, struggles with mobility.
*Physiotherapy Plan:
>Energy conservation education:
- Teach pacing, prioritising, and planning activities throughout the day.
- Use of Fatigue Management Diaries to identify patterns.
>Aerobic conditioning:
- Low-impact seated cycling or walking with rests to improve cardiovascular fitness.
- Begin with interval training (short bursts with breaks).
>Home exercise programs:
Short, manageable sets to avoid fatigue worsening (e.g., 10 mins, 2x/day).

Question 6

Dizziness and Unsteadiness on Standing

Answer 6

*Relevant Symptoms: Dizziness when rising, needs support to stand.
*Physiotherapy Plan:
>Postural transition training:
- Practice bed to sit and sit to stand slowly using cueing and support.
- Teach head and trunk movement control strategies (e.g., pause before standing).
>Balance drills in standing:
- Standing sway, tandem stance, stepping strategies with support.
>Referral considerations:
- Discuss with MDT (neurology/GP) if autonomic symptoms persist.
- Check blood pressure if symptoms suggest orthostatic hypotension.