The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk

Abstract

Objective: The aim of the study was to evaluate the effectiveness of therapy intervention in reducing impairment and disability due to upper limb and trunk ataxia in chronic multiple sclerosis (MS).

Design: The change in performance scores of two patient groups - an inpatient group who received two weeks' therapy intervention and an outpatient 'control' group awaiting a similar admission - were compared.

Subjects: Thirty-seven (out of a total of 62) patients with clinically definite or laboratory-supported definite MS, with ataxia of the upper limbs and/or trunk, and who had stable or slowly progressive disease.

Intervention: The (inpatient) treatment group (n = 28) received eight half-hour sessions each of occupational therapy and physiotherapy over eight consecutive working days. Treatment approaches used were aimed at improving dynamic posture and appropriate adaptation of the environment. The control group (n = 9) received no intervention.

Assessments: Patients were assessed the day before therapy began and the day after it ended: the control group were assessed at the same (two-week) interval. Assessments used included the Jebsen Test of Hand Function (JTHF), the Kurtzke Functional Systems Scale (FSS) and Expanded Disability Status Scale (EDSS), the Northwick Park Index of activities of daily living (NPI), and patient and assessor visual analogue scales. Assessors were independent of patient treatment.

Results: There were no significant differences between the two groups at entry to the study with respect to age, sex and scores on the FSS (exception bowel function). The NPI scores were not significantly different except for walking and feeding, whereas the control group was slightly better (Mann-Whitney U-test; p = 0.048; p = 0.037).

No significant difference between the change scores of the two groups was found on the JTHF and FSS neurological scores. The treatment group showed significant improvement compared to controls in the NPI scores and on the self and assessor visual analogue scales.

Conclusion: The findings support the clinical impression that therapy used to improve dynamic posture and methods of performing functional tasks can result in improvement of functional ability in patients with MS where spontaneous improvement would not otherwise be expected.

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References

Manyam BV Recent advances in the treatment of cerebellar ataxias. Clin Neuropharmacol 1986; 9: 508-16.

Langton-Hewer R. , Cooper R. , Morgan MH Investigation into the value of treating intention tremor by weighting the affected limb. Brain 1972; 62: 1-30.

Morgan MH

Ataxia - its causes, measurement and management. Int

Rehabil Med 1980; 2: 126-32.

Langton-Hewer R.

Multiple sclerosis - management and rehabilitation. Int

Rehabil Med 1980; 2: 116-25.

Frankel D. Multiple sclerosis. In: Umphred DA ed. Neurological rehabilitation. Toronto: CV Mosby Co., 1985: 398-415.

Samra K. , Waltz JM , Riklan M. , Koslow M. , Cooper IS Relief of intention tremor by thalamic surgery. J Neurol Neurosurg Psychiatry 1970; 33: 7-15.

Knott M. , Voss DE Proprioceptive neuromuscular facilitations: patterns and techniques. New York: Horber Medical Division, Harper & Row , 1956.

Rood M. Use of sensory receptor to activate, facilitate and inhibit motor response, automatic and somatic in development sequence. In: Sattely C ed. Approaches to treatment of patients with neuromuscular dysfunction. Duburque, IA: WC Brown Book Co., 1962.

Ayres AJ Occupational therapy directed toward neuromuscular integration. In: Willard HS , Spackman C eds. Occupational therapy, third edition. Philadelphia, PA: JB Lippincott , 1963: 413-39.

10.

Voss DE Proprioceptive neuromuscular facilitation: the PNF method. In: Pearson PH , Williams CE eds. Physical therapy services in the developmental disabilities. Springfield, IL: Charles C Thomas, 1972.

11.

Bobath K. , Bobath B. Neurodevelopmental approach to treatment. In: Pearson PH , Williams CE eds. Physical therapy services in the developmental disabilities. Springfield, IL: Charles C Thomas, 1972.

12.

Howison M. , Perella JA , Gordon D. In: Hopkins H , Smith H eds. Willard and Spackman's occupational therapy . Philadelphia: JB Lippincott, 1978.

13.

Graham J. MS - a self-help guide to its management. Wellingborough : Thorsons, 1982: 523.

14.

Sutherland J. Occupational therapist in the rehabilitation team. In: Capildeo R , Maxwell A eds. Progress in rehabilitation. Multiple sclerosis. London: Macmillan , 1982: 45-58.

15.

Chase RA , Cullen Jr JK , Sullivan SA , Ommaya AK Modification of intention tremor in man. Nature 1965; 206: 485-87.

16.

Barlow JS , Schwab RS Mutual limb stabilisation in relation to tremor characteristics in Parkinsons and essential or heredofamilial tremor. Neurology 1971; 21: 78-90.

17.

Matthews B. MS the facts. Oxford: Oxford University Press, 1978.

18.

Hasler D. The use of the gymnastic ball. Therapy 1981 ; 27 August.

19.

McDonald WI , Halliday AD Diagnosis and classification of multiple sclerosis . Br Med Bull 1977; 33: 4-6.

20.

International Federation of Multiple Sclerosis Societies. Minimal record of disability. Acta Neurol Scand 1984; 70(suppl 101): 191-217.

21.

Jones L. The evaluation of the Jebsen Test: reliability, validity and usefulness as a measure of hand function in neurological patients [Thesis]. London: British College of Occupational Therapists , 1986.

22.

Jebsen RH , Trieschmann R. , Trotter N. , Howard LA An objective and standardised test of hand function. Arch Phys Med Rehabil 1969; 50: 311-19.

23.

Agnew P. , Maas F. An interim Australian version of the Jebsen Test of Hand Function. Aust J Physiother 1982; 28(2): 23-29.

24.

Sheikh K. , Smith DS , Meade TW , Goldenberg E. , Brennan PJ , Kinsella G. Repeatability and validity of a modified activities of daily living (ADL) index in studies of chronic disability. Int Rehabil Med 1(2): 51-58.