Multiple Sclerosis
Characteristics and Causes
Multiple sclerosis (MS) is a progressive, chronic disease that affects the central nervous system (brain, optic nerves and spinal cord). It is characterized by an inflammatory process leading to damage to the myelin sheath that covers nerve fibers. Symptoms depend on the location of the "inflammatory foci." All regions of the central nervous system can be affected. One of the most frequent early symptoms is visual disturbance. Other symptoms may include: loss of strength, impaired balance and coordination of movements, tremors, speech disorders, swallowing difficulty, sphincter, sensory and cognitive disturbances.
Course of Disease
Multiple sclerosis is characterized by a very variable course because of the different manifestations of clinical symptoms and a large individual variability. In relapsing-remitting MS, patients will typically have acute phases with neurological deficits, alternating with periods of remission of symptoms. Typically, in the later stages of the disease, neurological disorders manifest themselves in a more continuous and progressive manner.
Objectives of Rehabilitation
The first stage of the multidisciplinary clinical approach to patient care is an initial evaluation of neurological symptoms. Involved are neurologists, physiatrists, physical therapists, nurses, neuropsychologists, speech therapists, speech-language pathologists, ophthalmologists, pulmonologists and urologists. The neurorehabilitation process strives to recover as much as possible the person's ability to perform activities of daily life, trying to minimize the deficits or developing compensation strategies in case of loss of specific skills. Rehabilitation includes, in addition to physical therapy exercises in the gym, treatments of hydrokinetic therapy, occupational therapy sessions, sports therapy, cognitive therapy, speech therapy treatments, sphincter disturbances treatments and visual therapy.
Treatment of Dysphagia
Particular attention is paid to difficulty swallowing (dysphagia), which can affect both liquid and solid food ingestion. The speech therapist who specializes in treating dysphagia works in conjunction with the Clinical Nutrition Service to develop a suitable dietary protocol and intervenes with exercises to improve the function of the muscles involved in the swallowing process. At discharge from the hospital is presented a dietary protocol that gives specific guidance on the home preparation of meals.
Social Services Support
Particular attention is paid to the ongoing concerns of patient, family members and caregivers. Proper care can dramatically improve the quality of life of patients with multiple sclerosis. Within this process falls the social and professional reintegration of the patient. The social workers, at discharge, work with patients, family and caregivers to contact employers and determine the availability of and conditions for professional reintegration.
Continuity of Care: Day Hospital
Once discharged from the hospital, patients with multiple sclerosis often follow an ongoing path of rehabilitation at the Neuromotor Day Hospital or the Phoniatric Day Hospital in case of swallowing problems. The provision of the treatment is done on an outpatient basis by the hospital ward that has been treating the patient to ensure continuity of care.