Determination of Multiple Sclerosis - Literature review Example

Literature review of Multiple Sclerosis Multiple Sclerosis (MS) involves an immune-mediated Process in which an abnormal responseof the body’s immune system is directed against the central nervous system (CNS). The exact target that the immune cells are sanitized to attack are still unknown, which made the scientists to name the disease as “immune-medicated” disease rather that an “autoimmune” disease (National Multiple Sclerosis Society, 2014). The disease process starts within the CNS when the immune system attacks the nerves and the myelin, which is the fatty substance that surrounds the nerve fibres. The damaged myelin will then forms a tissue scar (sclerosis) which then will prevent the transfer of the nerve impulses to the cells and it will consequently cause the various symptoms of the disease. Symptoms can vary from mild to severe and the disease can limit the patient quality of life tremendously (National Multiple Sclerosis Society, 2014). This paper seeks to review available evidence in form of literary sources, on exercise therapy or physical rehabilitation for MS patients, with the primary purpose of providing insight into how exercise can aid in prevention of disease progression and improvement of patients’ quality of life. Prior to delving into literature available on exercise therapy in MS, it is imperative to understand the disease in question. According to Kantarci (2008), multiple sclerosis represents one of the most pathologically and clinically intricate heterogeneous diseases, whose aetiology is not fully known. As a result, this author highlights the need for exploration of biologically feasible MS therapies, while pointing out research gaps that scholars should strive to fill, in the effort to develop proper preventative and rehabilitative therapies. The incidence of MS is best explained by Ragonese et al. (2008), who note that MS is a progressive disorder but a percentage greater than 80 of all affected patients suffer from the disease for a period of over 35 years. By addressing these aspects, this research article justifies the need for instantaneous intervention, particularly due to the fact that MS renders individuals inactive and physically incapacitated in the long run. McAuley et al (2010) support the latter proposition, by outlining evidence suggesting that people with MS have lower activity than people without any form of neurologic disease. These aspects clearly accentuate the importance of physical rehabilitation for MS patients. However, the article’s evidential strength on the importance of physical exercise is limited by the fact that, it focuses on social cognitive theories affecting patients’ exercise capacity, which in turn lack validated measurement models. In addition to reduced activity hence physical immobility of MS patients addressed in the preceding paragraph, Dalgas et al. (2008) show that, lack of physical activity among MS patients can result in and secondary problems like osteoporosis, obesity, and even cardiovascular damage. The latter problems can further pose a threat to MS patients, since they heighten the risk of additional complications such as pulmonary embolisms, thrombosis, urinary tract and upper respiratory tract infections, as well as, acute ulcers. DasGupta & Fowler (2003) further build on the knowledge of negative effects of physical inactivity among MS patients. These scholars indicate that, based on the characteristics and localization of morphological changes within both the gray and white brain matter, varying symptoms may be evident. For example, inactive MS patients may suffer from sexual, bowel, and bladder dysfunction, spasticity or jerky movement, paresis or partial paralysis, inability to coordinate voluntary muscle movements also known as ataxia, among the aforementioned problems of visual, coordination, and sensory impairment. In emphasizing the significance of physical rehabilitation or exercise to MS patients, Dalgas et al. (2008) state that, if exercise is properly handled by the affected, it is capable of inducing improvements pertinent to both their mental and physical functioning. However, Dalgas et al.’s (2008) study, just like DasGupta & Fowler’s (2003) research does not make the modalities of training or physical exercise clear enough for the reader. Aspects like volume, intensity, mode, and frequency of physical exercise are not addressed in these studies. Sutherland & Andersen (2001) build on previous findings not only by acknowledging the chronic and weakening nature of MS, but also by pointing out the importance of physical rehabilitation in ensuring that patients maintain an autonomous lifestyle and enjoy improved life quality. This is an assertion supported by White and Castellano (2008), authors who suggest that exercise wields the potential to slow down disease progression, in addition to preventing secondary ailments resulting from the sedentary lifestyle characteristic of many MS patients. According to Compston & Coles (2008), cognitive and emotional changes, which are common in management of MS symptoms, can best be managed through a multidisciplinary approach. The latter encompasses social and psychological interventions, as well as, physical therapies. Even though these authors primarily focus on the pharmacological treatment of MS, it is evident that they also acknowledge the importance of other crucial rehabilitative therapies. Their proposal is backed by Chiaravalloti & DeLuca (2008), who advocate for an intense and comprehensive inpatient therapy. This article also indicates that a treatment approach which encompasses physical therapy bolsters patients’ abilities to effectively manage their symptoms, while leading to improved functional capacity, hence enhanced physical activity and quality of life. The only problem with these studies is that they focus on analyzing prior research, without building on experiential evidence. In addition to examining the importance of physical exercise, it is important to understand some of the forms of exercise suitable for MS patients. A study that exemplifies this is that conducted by Petajan et al. (1996). The research, which drew comparison between the control and exercise groups, showed significant improvement of MS patients’ outcomes after participation in aerobic training, involving aerobics exercise and body stretching. The individuals in the exercise group portrayed significant reduction in thickness of skin folds and enhanced strength. Even though the results depict credibility, the latter is diminished by lack of blinding, excessive focus on exercise group, and self-reporting hence possibility of bias. Some participants also failed to get involved in the follow up phase, limiting the conclusiveness of results. Rectification of these weaknesses in future research would play a crucial role in ensuring that patients derive optimal benefit from aerobic training. The efficacy of physical exercise is supported by Romberg et al. (2004). In their research, the scholars show the potential of strength training and aerobic exercise over an incremental six month period. Strength training involved circuit resistance training comprising of four exercises for upper and lower extremities, coupled with two exercises for the torso. The aerobic exercise in the study involved aquatic training. Participating MS patients’ walking speed increased confirming that strength training and aerobic exercise is safe and beneficial for MS individuals. However, the study had several limitations including possibility of bias due to insufficient blinding of researchers and self-reporting on the part of participants. This calls for further research on these exercise modalities for conclusive findings. Further, Gutierrez et al.’s (2005) study, which sought to examine the effects of lower body resilience training programme on MS patients’ walking mechanics, showed that it is an efficient intervention tactic for enhancing functioning and walking ability in people with moderate disability. The benefits of physical exercise for MS patients are further emphasized by Oken et al. (2004), whose research on subjects engaging in a six month yoga or basic exercise class, showed immense development in regard to measures of mobility and fatigue in comparison to a control group made up of individuals in the waiting list. However, like the preceding studies, this research relied on self-reporting, lacked blinding, and did not provide adequate follow up findings. Accounting for these limitations in future would bolster findings on importance of yoga to both the physical and socio-cognitive outcomes of MS patients. Rampello et al.’s (2007) put additional emphasis on the essence of physical exercise, by examining the effect of aerobic training on MS subjects’ walking ability and exercise tolerance. Just like in the rest of the studies, the researchers found positive correlation between physical exercise and improved physical ability on the part of the MS patients. Motl & Pilutti (2012) bolster findings from other studies by showing how exercise training improves individuals’ gait, muscle strength, walking performance, balance, aerobic ability, and overall life quality. Tarakci et al.’s (2013) study is specific to the efficacy of supervised group exercise and how it enhances MS patients’ state in regard to coordination and balance, fatigue, spasticity, and functional status, while preventing condition deterioration. The research, however, had limitations like insufficient blinding hence potential for bias, and it focused on participants from one centre prompting one to question its generalizability to mainstream MS population. Further investigative research on effectiveness of supervised group exercise on MS patients, eliminating mentioned limitations, would be necessary add knowledge to the PR strategy. While most of the analysed studies focus on the benefits of physical exercise, all of them fail to take into account the challenges associated with rehabilitative efforts aimed at improving the quality of life for MS patients. The only exception in this case is Brown & Kraft’s (2005) study, which highlights the fact that the combination of cognitive and physical impairments, coupled with social and emotional issues in an ailment without a fully comprehensible aetiological course, makes rehabilitation efforts in MS rather difficult. The authors also take note of the fact that, even though inpatient rehabilitation enhances MS patients’ functional autonomy, it has only restricted success in rectifying or ameliorating the neurological impairment caused by MS. Other success constraints include varying personal preferences for exercise modalities, level of physical impairment, patient motivation level, time available for exercise, and sources of funds, among other vital considerations. After gaining insight into the importance of physical exercise in management of MS symptoms, the types of exercise, and the challenges associated with physical rehabilitation or exercise, the next crucial aspect that cannot be overlooked is the outcome measure for improvement after patients have undergone physical rehabilitation. Key among the examined outcome measures for rehabilitation of individuals with MS is Goal Attainment Scaling (GAS), suggested by Khan et al. (2008). The latter is a useful and responsive outcome measure, which examines the success of MS patients’ physical rehabilitation on the basis of their motivation and ability to achieve preset goals. Even though this measurement tool could serve a complementary role in evaluation of rehabilitation effects, this study involved a limited number of participants, meaning that the findings may not necessarily be conclusive. In addition, the clinicians involved in administration of physical exercise could have been biased since they participated in both the formulation of goals and evaluation of the eventual participants’ response to outlined objectives. The other potent mode of physical outcome measurement for MS patients is outlined by Morrison et al. (2008). This model of determining MS patients’ progress after exercising is founded upon comparison of ratings of perceived exertion (RPEs) between exercise group and control group participants. During the study, participants underwent controlled aerobics exercise by cycling on a stationary one-wheeled cycle, fitted with an ergometer. Automated monitoring of MS patients means that researchers got real time results on how they responded to the exercise; rendering the conclusion that, aerobic exercise does not accentuate fatigue and exertion in MS patients valid. However, strength of such research could be improved in the future by selecting a broader and more representative sample, while accounting for other physiological aspects pertinent to research outcomes like sensitivity to heat. Based on research findings by Barr, et al. (2014) fatigue and walking inability are usually reported as some of the most incapacitating MS symptoms. The said motor fatigue is capable of contributing to diminished mobility and deterioration of neuromuscular function. Researchers indicate that basic selective walking reaction time (RT) measures wield the potential to identify variations in motor injury caused by walking. The scholars found out that, basic reaction times are slower after MS patients walked for about six times. The findings are indicative of fatigue induced by walking exercise, providing a basis for determination of the most appropriate exercise period. Even though the study findings appear credible, there is need for further investigative research, in order to gain additional insight into the pertinence of RT measures to therapeutic and risk interventions. Further analysis of these elements would aid in improved management of MS patients’ fatigue and mobility during physical exercise. All the research articles provide in depth knowledge on the importance of physical exercise in the management of MS, while providing an information framework for development of a more comprehensive physical rehabilitation (PR) programme in the future. References Barr, C. et al. (2014). Walking for six minutes increases both simple reaction time and stepping reaction time in moderately disabled people. Multiple Sclerosis and Related Disorders. Retrieved from http://dx.doi.org/10.1016/j.msard.2014.01.002 Brown, T., & Kraft, G. (2005). Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehabil Clin N Am. 16(2), 513-555. Chiaravalloti, D., & DeLuca, J. (2008). Cognitive impairment in multiple sclerosis. Lancet Neurology, 7(12), 1139-1151. Compston A., & Coles, A. (2008). Multiple sclerosis. The Lancet 2008, 372(9648):1502-1517. Dalgas U., Stenager E., Ingemann-Hansen T. (2008). Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. Multiple Sclerosis, 14, 35–53. DasGupta R, Fowler C. (2003). Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies. Drugs, 63(2), 153-166. Gutierrez, G., Chow, J., Tillman, M., Mc- Coy, S., Castellano, V., & White, L. (2005). Resistance training improves gait kinematics in persons with multiple sclerosis. Arch Phys Med Rehabil, 86, 1824-1829. Kantarci O.H. (2008). Genetics and natural history of multiple sclerosis. Semin Neurology 28: 7–16. Khan, F., Pallant, J., & Turner-Stokes, L. (2008). Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis. Arch Phys Med Rehabil, 89, 652-659. McAuley, E, Motl, R., White, S., & Wójcicki, T. (2010). Validation of the Multidimensional Outcome Expectations for Exercise Scale in ambulatory, symptom-free persons with multiple sclerosis. Arch Phys Med Rehabil, 91, 100-105. Morrison, E., Cooper, D., White, J., Larson, J., Leu S., Zaldivar, F., & Ng’, A. (2008). Ratings of perceived exertion during aerobic exercise in multiple sclerosis. Arch Phys Med Rehabil, 89, 1570-1574. Motl, R. W. & Pilutti, L. (2012). The benefits of exercise training in multiple sclerosis Nat. Rev. Neurol. advance online publication doi:10.1038/nrneurol.2012.136 National Multiple Sclerosis Society. (2014). Definition of MS. Retrieved from http://www.nationalmssociety.org/What-is-MS/Definition-of-MS Oken, S., Kishiyama, S., Zajdel, D., Bourdette, D., Carlsen, J., Haas, M., Hugos, C., Kraemer, D., Lawrence, J., & Mass, M. (2004). Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology, 62:2058–2064. Petajan, J., Gappmaier, E., White, A., Spencer, M., Mino, L., & Hicks, R. (1996). Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology, 39, 432-441. Ragonese P., Aridon P., Salemi G., D’Amelio M., & Savettieri G. (2008). Mortality in multiple sclerosis: a review. European Journal Neurology, 15, 123–127. Rampello, A., Franceschini, M., Piepoli, M. (2007). Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients with Multiple Sclerosis: A Randomized Crossover Controlled Study. Physical Therapy, 87, 545-555. Romberg, P., Virtanen, M., Ruutiainen, M, .Aunola, S., Karppi, S., & Vaara, M… (2004). Effects of a 6-month exercise program on patients with multiple sclerosis: A randomized study. Neurology, 63, 2034-2038. Sutherland, G., & Andersen, M. (2001). Exercise and multiple sclerosis: physiological, psychological, and quality of life issues. J Sports Med Phys Fitness, 41, 421–432 Tarakci, E., Yeldan, I., Huseyinsinoglu, B., Zenginler, Y., & Eraksoy, M. (2013).Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clinical Rehabilitation, 27(9) 813–822. White L., & Castellano, V. (2008). Exercise and brain health–implications for multiple sclerosis: part II - immune factors and stress hormones. Sports Medicine, 38, 179–186. Read More