Multiple Sclerosis
Multiple sclerosis (MS) is a demyelinating disease which affected 2.3 million people in 2015 (Mortality & Causes of Death, 2016). Demyelination refers to damage to the insulting covers of nerve cells in the central nervous system, which includes the brain and spinal cord. With no insulation on nerve cells, transduction of signals along nerves may be disrupted. This disruption leads to the common deficits seen in MS including: muscle weakness, sensation issues, coordination problems, and disrupted vision. An in depth list of symptoms can be seen here.
The destruction of myelin is not well understood, but is thought to be due to either an autoimmune reaction against myelin producing cells, or a failure of those cells that produce myelin. 4 types or patterns of progression are currently acknowledged:
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Clinically isolated syndrome or progressive relapsing MS
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Relapsing-remitting MS: Unpredictable relapses + months/years of remission
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Primary progressive MS - progression with no remission after onset
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Secondary progressive MS - Relapsing-remitting with progressive neurological decline and no definite periods of remittance
Treatment for MS is only able to modify symptoms and depends upon the type of MS. Medication is a common intervention both during attacks and to slow progression. However, some medications are expensive or not well tolerated, therefore other interventions are vital in the management of MS. Physical therapy is a very common addition to the care of MS patients as it can help to strengthen muscles, relearn gait, improve balance, improve upper limb coordination and improve overall aerobic endurance.
The disease can appear as early as a patients late 20's so in some cases it can be an exceptionally long term disease. Therefore physical therapy interventions that are effective and applicable to people of all ages are extremely valuable. Virtual reality (VR) based intervention may be an example of one such therapy as they are easily modifiable and can meet the needs and abilities of a wide range of patients. They also offer clearly defined progression in the form of high scores and difficulty levels.
VR based interventions with evidence for their use in MS are as follows:
References
(2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England), 388(10053), 1459-1544.