Next Steps

Instead of turning into her friend’s Tucson apartment complex, Allensworth drove her white Ford F150 onto Interstate 10. They had made it 45 minutes out of town when Allensworth presumably passed out and hit a construction sign. The impact jolted her awake. She jerked the wheel hard to the left. The truck slammed into the center divider. It flipped and continued to roll down the highway. The two friends, who weren’t wearing seatbelts, flew out of the truck. The F150 landed on top of Allensworth’s friend.Next Steps “At rehab, they want to put you in a wheelchair and push you out the door after a week. I had to fight tooth and nail to stay an extra three weeks,” she said. Allensworth was scared. With her neck and back in a clamshell brace, she couldn’t look down, handle her bowel care or perform simple daily activities without the help of nurses. She felt she wasn’t ready to go home. The nonprofit fitness facility, located on Redondo Beach Boulevard across from the South Bay Galleria, brings the latest in fitness and health to those living with paralysis and other physical disabilities. NextStep was one of the first community-based facilities to utilize equipment and programs previously found exclusively in a handful of hospitals nationwide. Kouri was playing beach volleyball in Manhattan Beach in August 2006 when he decided to take a dip in the ocean to cool off. As he had countless times before, he dove into a wave. This time, he hit a sandbar and was instantly paralyzed from his neck down. Floating on his back in the water, unable to move, Kouri just hoped someone would see him. An off-duty EMT spotted him and pulled him onto shore. Doctors told the 31-year-old, who had once been an All-American football player for Georgetown University, that he would never walk again. At the facility, Kouri participated in the locomotor training program, which at the time could be found only in seven of the best spinal cord facilities in the country. In locomotor training, patients are lifted up on a weight-bearing harness, with trainers straightlining their hips and moving their arms and legs for them on a treadmill system to simulate walking. The program reminds your nervous system what it’s like to walk again and benefits blood pressure, circulation, bone density and muscle mass, Kouri said. Christopher Reeve was one of the first to participate in the clinical trial for the training.

Physical Therapy Role in Multiple Sclerosis Rehabilitation ...

 

Physical Therapy Role in Multiple Sclerosis Rehabilitation

Unlike most other neurological disorders, including spinal cord injury, traumatic brain injury, and stroke, there is no “fixed deficit” in MS; symptom profile, lesion burden on MRI, and disease course vary over time. Therapists must be prepared to treat each MS patient individually, and with flexibility, over the long term. In Multiple Sclerosis Rehabilitation, there are no protocols or time limits—just a unique opportunity to employ numerous problem-solving skills, interventions, and resources. And because MS affects not just an individual, but a whole family, it is a disease that benefits from a team approach as in Multiple Sclerosis Rehabilitation— making coordination and communication with other health care providers extremely important.  

Interventions throughout the Disease Course by Multiple Sclerosis Rehabilitation

At the Time of Diagnosis

Patients newly diagnosed with MS benefit from education, support and a baseline evaluation by an experienced PT. At this time, misunderstandings about the disease and its management, the importance of appropriate exercise/activity, fatigue issues, and any subtle gait or balance impairments can be addressed. Follow up should be on an “as needed” basis by Multiple Sclerosis Rehabilitation.

Following Acute Exacerbations

Physical therapy following an acute exacerbation (also called a relapse or attack) should have the goal of carefully helping the person return to baseline functioning. It is customary to wait two weeks after the attack before starting or resuming outpatient PT, because of weakness, lack of sleep from IV steroids, or other factors.

Progressive Disease

Patients with primary-progressive MS do not have remissions; their functioning declines gradually, but steadily, over time. Patients who transition from relapsing-remitting MS to secondary-progressive MS are not able to return to baseline (due to progression of the disease that occurs between exacerbations) and demonstrate a slow decline in function. Because both groups have a huge emotional burden in addition to their physical challenges, physicians are encouraged to refer a person proactively to PT rather than waiting until he or she is struggling. Focus should be on support, resourcing, avoiding de-conditioning, maintaining safety, and maximizing health and independent function. Assessment of the need for mobility aids now and in the future is essential for these patients, and it is especially beneficial for the PT to assist the physician in assuring that the appropriate detailed prescription or letter of medical necessity (LOMN) is provided.

The wheelchair evaluation, a clinician's guide

EXERCISE 1. Body shape changes with weight bearing and movement. ... ( Unfortunately, this is how many pa- tients sit in wheelchairs.) c. ...

Practical exercise therapy

Wheelchair Some patients may require exercise while in a wheelchair for temporary disablement, eg amputation until weight-bearing with confidence and ...

Spinal cord medicine, principles and practice

Late complications of the weight- bearing upper extremity in the ... Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. ...

Exercise physiology in special populations

The main advantage of wheelchair exercise is its specificity for SCI wheelchair ... more severe because they use their upper extremities for weight-bearing, ...

Exercise programming for older adults

Increasing Weight Bearing and Weight Shifting Increased weight bearing and ... Scooting is an excellent activity that is especially useful when getting the ...