Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, i.e. the brain and spinal cord. Here, the nerve processes (also called axons) are attacked and damaged by the body’s own immune cells. The exact cause of this misguided immune response still remains unclear. The resulting inflammation primarily damages the myelin sheath of the nerve. This is the insulating layer that promotes rapid conduction of impulses in the nervous system.
In multiple sclerosis, there are essentially a relapsing-remitting and a progressive course form. In the relapsing-remitting variant, acute neurological symptoms occur, which are treated with cortisone and may completely regress. This form is by far the most common. Underlying here are the inflammatory processes described above.
The progressive course is characterized by continuous deterioration of the neurological state. Ongoing degeneration of the nerve tissue sets in. The inflammation fades into the background, even though additional episodes can occur. A relapsing-remitting MS often changes into a progressive form over time.
The neurological symptoms depend on the location of the damage in the central nervous system. Especially in the beginning, there are often visual or emotional disturbances. However, there are also paralysis and gait disturbances, as well as problems with micturition or sexual function, possible. Particularly common in the course of the disease is the so-called fatigue, a form of chronic exhaustion. Depression is also relevant, and problems of higher cognitive functions, such as the ability to concentrate, can significantly impair quality of life.
Drug therapy, especially of relapsing-remitting MS, has improved significantly in recent years. MS is a relatively common disease in Austria, with about 12,500 people suffering from it, and apart from that, it affects mainly young people. For this very reason, rehabilitation also occupies a significant place in the treatment.
The rehabilitative therapy is individually adapted to the neurological restrictions and personal needs of the patients. The aim is to preserve the functions required for daily living and often also the ability to work, and thus increase the quality of life.
At the Rehabilitation Clinic Wien Baumgarten, the medical field is covered by four specialists in neurology and one general practitioner. Permanent care by medical specialists is ensured, and the additional neurological diagnostics by means of electrophysiology (ENG/EMG/EEG) and ultrasound (cervical vessels, peripheral nerves) can be performed on-site if required.
It is important that the therapy is personalized. The goal of rehabilitation is to improve independence in daily living and increase quality of life. Therefore, the therapy concept is coordinated in agreement with all professional groups involved (medicine, therapy, nursing). This concept includes individual and group therapies, training and lectures.
In the field of neurology, close interdisciplinary cooperation between the individual professional groups involved is very important. Thus, there are regular team meetings in which each patients’ health status and agreed therapies are discussed. The aim is to develop a concept for promoting strengths and reducing weaknesses that is supported by all professional groups. The following therapeutic options are available at the rehabilitation clinic:
The basis of the therapy is a daily strength and endurance training. This therapy is carried out on state-of-the-art devices for individual strength building. The endurance training is done among other things using ergometer and Motomed®. Here differentiated work only on the upper or the lower limbs can be performed. This creates the foundation for the further therapeutic procedure.
In the individual therapy, both traditional work in the therapeutic one-to-one setting, and training on the treadmill or the SilverFit® are done. By increasing the movement repetitions on the treadmill, the training effect can be improved. In the context of the treadmill therapy, a gait analysis is performed, if necessary. The analysis allows the gait to be objectively analyzed, and pathological behavior to be changed. The training on the SilverFit® allows a dual-task training. The dual-task training (combination of two functions such as walking and solving of computational tasks) is an important part of the therapy, as it has a high relevance to everyday life. The SilverFit® can be adapted to the patient’s mobility, regardless of the degree of disability.
In addition to the individual therapy, the patients are also worked with in various group therapies. The so-called “Forced Use Group” intensively trains to increase a residual function. The coordination and balance group works to improve these skills. Furthermore, there are walking training groups, which are held taking into account the participants’ capacities. Due to the location, it is possible to offer outdoor training and Nordic walking outdoors as well. For underwater therapy, two basins are available for single as well as for group therapy.
The aim of occupational therapy in the field of neurorehabilitation is to help patients achieve the greatest possible independence through individualized therapy. Situations of daily living such as body care, shifting, cooking and household activities, communication, work, and leisure are to be relearned, improved, and permanently preserved through occupational therapy. This is done through both individual and group therapy.
Here too, in addition to the classic therapy concepts, computer-assisted therapy procedures are available. For example, robotic and computer-assisted finger-hand therapy devices such as the Amadeo® and Pablo® are used. An important area is cognition. In this area, potential neuropsychological deficits are addressed by cognitive training. As group therapies, memory, cooking, handicraft and fine motor skills groups are offered.
The focus of speech therapy includes the diagnosis and treatment of speech, voice and swallowing disorders. The goal is the best possible reactivation and maintenance of communication skills and food intake. In addition, compensation strategies for dealing with the restrictions are trained. The methods are geared to everyday life and should thus enable participation in social life.
For workup of a swallowing disorder, a video-endoscopic swallowing examination can be performed. The examination detects a possible disturbance of the swallowing act. Subsequently, the therapeutic procedure can be adapted under video control.
Clinical pictures being treated are: Aphasia, apraxia, dysphagia, dysarthria, and voice disorders. Again, this is done both in individual and in group therapies.
In patients with MS, cognitive disorders such as in the fields of attention, learning, and memory may occur. By neuropsychological testing, such possible deficiencies can be determined at the beginning of the hospitalization. The cognitive training is carried out among other things by means of PC training programs. In addition, there is the possibility of individual care in one-on-one interviews.
Nutrition is also an important issue during the rehabilitation stay. Dietary advice is regularly provided to ensure a balanced diet that is tailored to the needs of the patient and the therapy program.
The care promotes implementation in daily life of what has been learned. Thus, deficiencies that occur in everyday activities are quickly detected and remedied.
In order to comprehensively plan the therapies outlined above, regular therapy meetings are held. In these, the goals defined with the patient are mapped to the training program by all participating professional groups. At the same time, the program can be adapted even more individually to the medical needs thanks to the information from a variety of disciplines. It is important to implement the skills learned in therapy in daily life. Through the mutual interaction of all professional groups, there is the opportunity of not only recalling in the training situation what has been learned, but to use it in everyday life as well.
The neurological department of the Rehabilitation Clinic Wien Baumgarten is a highly specialized neurorehabilitation facility with 70 beds. VAMED is the leading private provider in the field of neurological rehabilitation in Austria and present in Vienna with two inpatient neurological rehabilitation clinics (Neurological Therapy Center Rosenhügel and Rehabilitation Clinic Wien Baumgarten).
Cerebral vascular diseases, movement disorders, Parkinson’s disease, polyneuropathies, status post-traumatic injury of the brain, spinal cord or peripheral nervous system, neuromuscular disorders, and degenerative spinal cord changes with neurological symptoms are among the conditions to be treated, in addition to multiple sclerosis. The concept of interdisciplinary care ensures individual therapy tailored to the patients’ Needs.
Our location in Vienna combines the amenities of a cosmopolitan city with the proximity of the Wienerwald recreation area. In addition to ultramodern equipment of the therapy rooms, there are only single rooms in our house, which are suitably equipped for disabled people. This ensures the best possible Regeneration.
The author, Prim. Dr. Christoph Stepan, is head of the Department of Neurology at the Rehabilitation Clinic Wien Baumgarten, a healthcare facility of VAMED
These articles might also interest you:
+ "MS Gait Rehabilitation" - from Prim. Dr. Hermann Moser
+ "Through proper diet the risk of multiple sclerosis can be reduced" - from Prim. Dr. Matthias König
+ "Neurorehabilitation in Multiple Sclerosis" - from Prim. Dr. Hermann Moser
+ "Neurorehabilitation in Vienna" - from Prim. Dr. Christoph Stepan