What is multiple sclerosis?

Multiple sclerosis (MS, encephalomyelitis disseminata) is a chronic inflammatory autoimmune disease of the central nervous system (CNS; brain and spinal cord). More than two million people worldwide are affected; the exact cause has not yet been conclusively clarified. The disease is characterized by episodic or progressive focal inflammation in the CNS, which damages and scars nerve structures. At the damaged sites, the transmission of nerve impulses is disturbed, which can lead to a variety of symptoms. Women are affected about three times as often as men. MS can occur at any age, but the most common onset is between the ages of 20 and 40.

difference between healthy nerve cell - multiple sclerosis

What are the symptoms of multiple sclerosis?

The symptoms of MS are very individual. Depending on the locations in the CNS where the inflammation occurs, there are different types of deficits in all regions of the body. Often, visual disturbances due to an inflammation of the optic nerve and sensory disturbances of the skin occur at the beginning. Other common symptoms include eye movement disorders, pronounced fatigue, numbness and skin sensations (tingling, formication), spasmodic paralysis, coordination difficulties, bladder and bowel dysfunction, sexual dysfunction, hypersensitivity to heat, and impaired concentration and memory.

What is the course of the disease?

Despite all the research, the causes of MS have not yet been conclusively clarified. What is important, however, is that the body's own immune cells apparently attack the nerve cell processes. This causes many small inflammations in the spinal cord as well as in the brain.

These small inflammations are called demyelinating lesions, which can occur throughout the central nervous system. Accordingly, the inflammations can be described as causes, but it is not yet clear why the immune cells attack the nerves in the first place.

How is multiple sclerosis treated?

A cure for MS is not yet possible. However, various drugs help to attenuate the course of the disease and delay the progression of the physical disability. In acute relapse therapy, high-dose glucocorticoids (cortisone) are used. In order to reduce the frequency of relapses and to slow down the progression of the disease, various agents are used that influence the immune system of the affected person. Complementary therapies that alleviate the symptoms and improve the quality of life also play an important role. These include, for example, antispasmodic medication, endurance training, psychotherapy, occupational and physiotherapy, and the provision of aids such as an orthosis.

What is the purpose of an orthosis?

In particular, restricted mobility, walking difficulties and fear of falling are very stressful for those affected. In addition to regular physiotherapy, orthoses are often used in everyday life. They support walking and standing and help sufferers gain more autonomy and improve their quality of life. An orthotic reduces the likelihood of falls and trips and helps improve the sense of safety for people with MS. Furthermore, a properly fitted orthosis helps prevent a faulty gait pattern and thus prevents possible postural deformities. In order for an orthosis to be worn regularly and to ensure customer satisfaction, a detailed individual consultation and a professional fitting are crucial.

How is an orthosis fitted?

At the beginning, determining the strength levels of the legs is important for fitting an orthosis. The individual muscle groups are examined more closely in a functional test. The focus is on the leg that is to be supplied and is correspondingly weaker. For each muscle group, the degree of existing paralysis is indicated on a scale from 0 to 5. With a degree of strength of 0/5, there is complete paralysis of the respective muscle group; with 5/5, the function is completely preserved. Depending on the degree, the orthosis is individually adapted.

In addition, a classic walking test (6-minute walk test) is used to identify the degree of fatigue under stress. For this purpose, functional tests of the muscles are performed before and after walking over a period of six minutes. This allows the degree of strength of the muscle groups in the fatigue state to be determined and the orthosis to be adapted precisely to individual requirements.

Conclusion: More safety in everyday life despite MS thanks to an orthosis

Multiple sclerosis presents sufferers with a variety of daily challenges. An individually fitted orthosis helps to increase safety in everyday walking and standing and thus to maintain a degree of self-determination. Factors such as the acquired degrees of strength and muscle fatigue play a decisive role in the fitting and are assessed in detailed consultations.

(Bishop and Rumrill, 2015) (Walton et al., 2020) (Baird et al., 2018) (Neuman et al., 2021) (A et al., 2020) (Stevens et al., 2013) (Swinnen et al., 2018) (Swinnen and Kerckhofs, 2015) (Swinnen et al., 2015) (Cederberg et al., 2019).

[1] A, K.H., Gh, A., M, A., M, B., Z, S., A, B., M, K., 2020. Design and Preliminary Evaluation of a New Ankle Foot Orthosis on Kinetics and Kinematics parameters for Multiple Sclerosis Patients. J Biomed Phys Eng 10, 783-792. https://doi.org/10.31661/jbpe.v0i0.2007-1136

[2] Agarwala, P., Salzman, S.H., 2020. six-minute walk test: clinical role, technique, coding, and reimbursement. Chest 157, 603-611. https://doi.org/10.1016/j.chest.2019.10.014

[3] Baird, J.F., Sandroff, B.M., Motl, R.W., 2018. therapies for mobility disability in persons with multiple sclerosis. Expert Rev Neurother 18, 493-502. https://doi.org/10.1080/14737175.2018.1478289

[4] Bishop, M., Rumrill, P.D., 2015. multiple sclerosis: etiology, symptoms, incidence and prevalence, and implications for community living and employment. Work 52, 725-734. https://doi.org/10.3233/WOR-152200

[5] Cederberg, K.L.J., Sikes, E.M., Bartolucci, A.A., Motl, R.W., 2019. walking endurance in multiple sclerosis: meta-analysis of six-minute walk test performance. Gait Posture 73, 147-153. https://doi.org/10.1016/j.gaitpost.2019.07.125

[6] Neuman, R.M., Shearin, S.M., McCain, K.J., Fey, N.P., 2021. biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis. J Neuroeng Rehabil 18, 104. https://doi.org/10.1186/s12984-021-00891-7

[7] Stevens, V., Goodman, K., Rough, K., Kraft, G.H., 2013. gait impairment and optimizing mobility in multiple sclerosis. Phys Med Rehabil Clin N Am 24, 573-592. https://doi.org/10.1016/j.pmr.2013.07.002

[8] Swinnen, E., Christiaens, S., Ceulemans, L., Kerckhofs, E., 2015. Does wearing an orthotic device of the lower limb influence the quality of life of patients? A systematic review. Journal of Basic and Applied Research International 5, 1-13.

[9] Swinnen, E., Deliens, T., Dewulf, E., Van Overstraeten, S., Lefeber, N., Van Nieuwenhoven, J., Ilsbroukx, S., Kerckhofs, E., 2018. What is the opinion of patients with multiple sclerosis and their healthcare professionals about lower limb orthoses? A qualitative study using focus group discussions. NeuroRehabilitation 42, 81-92. https://doi.org/10.3233/NRE-172222

[10] Swinnen, E., Kerckhofs, E., 2015. Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review. J Bodyw Mov Ther 19, 759-770. https://doi.org/10.1016/j.jbmt.2015.06.008

[11] Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R.A., Robertson, N., La Rocca, N., Uitdehaag, B., van der Mei, I., Wallin, M., Helme, A., Angood Napier, C., Rijke, N., Baneke, P., 2020. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 26, 1816-1821. https://doi.org/10.1177/1352458520970841

[12] Anvil - Multiple Sclerosis

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A pleasantly bright, clean, amazingly collegial and friendly store in the heart of Munich.
What impressed me deeply, however, was the know-how and motivation of the integrated workshop. Based on a recommendation, I contacted the medical supply store for a relatively complex orthopedic problem. After a very detailed anamnesis, the problem was tackled efficiently and professionally, and here, completely naturally, the accumulated knowledge of all the staff could be accessed to ensure my optimal fitting.
Advantages and disadvantages of different procedures were explained, special features were included and then implemented in a functional solution.
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