The Central Nervous System

The Central Nervous System is composed of the brain and the spinal cord and one of it’s primary functions is to send out messsages to the rest of the body. One chronic illness that affects the Central Nervous System is Multiple Sclerosis. Roughly 2 million people througout the world have been faced with this disease, and “in the United States, it is estimated that 450,000 people are affected, with 10,000 new cases per year” (Goodman & Fuller 772). This disabiling condition has been found more prevelant in the Caucasion race and there is a higher ratio of women diagnosed with MS then men. Multiple Sclerosis is an autoimmune disorder that can be categorized in four different subtypes: relapsing-remitting MS, secondary progressive MS, primary
progessive MS, progressive-relapsing MS. This disease consists of demyelnation of the axons in the CNS, “the myelin coating in various sites throughout the brain and spinal cord becomes inflamed due to an immune response and is eventually destroyed, leaving hard scars, called scleroses, that block the underlying neurons from transmitting messages” (Shier, Butler, and Lewis 366). MS is considered a progressive degenerative disease and the most common subtype is relapsing-remitting MS and the least common is the progressive-relapsing MS. The lesions that become present on the brain and spinal cord become a barrier between the CNS and the rest of the body. As the hard plaque lesions start forming, the body starts to see negative changes and dysfunctions anywhere from blurred vision, decline in muscle coordination, bladder irregularities, to psychological imbalances. The onset of this disease is typically found in, but not limited to, young adults ranging from 20 to 40 years of age and the exact cause is still unknown. The fact that this disease can provide several symptoms depending on it’s severity makes it hard to initially diagnose and is almost impossible to diagnose withought MRI scans. One of the most common ailments found in individuals with MS is fatigue.
Fatigue not only causes physical distress on the body but also mental distress on the mind. "Fatigue significantly impairs a patient's quality of life, bearing negative effects on performance at work and on the patient's social and private life" (Hanken, Eling, and Hildebrandt 1). Since MS is a highly variable disease, the severity of fatigue is highly dependent on the severity of the MS in the individual. MS is considered a progessive disease with no cure so the ultimate treatment is how to best treat the symptoms. There is current research being done to better find the cause of fatigue in MS patients and "several lines of evidence suggest that immune factors play a major role in MS-realted fatigue" (Hanken, Eling, and Hildebrandt 3). Since fatigue is such a disabiling condition the patient is advised to take necessary steps in daily activities in and away from the home to help make the physical stresses of life easier. With taking preventative measures the hope is to postpone the need for assisted devices until hopefully much later in life or not even at
all.
Depression is another manifestation that seems to occur with the onset of MS.
Since depression originates from abnormal chemistry in the brain and MS produces lesions on the brain the two seem to go hand in hand. Studies show that there tends be a “correlation between the lesion load/location of MS and the severity of depression” (Khodarahimi & Rasti 92). Not only can fatigue and depression be experienced from MS but also atrophy of the spinal cord can be prevelant. There have been studies to prove that “SC atrophy occurs at an early clincal stage in MS patients” (Plantone 1). MS attacks the spinal cord through grey-matter demyelantion and axonal loss. Axonal loss is a subsequent result from the harmful effects of the brain and spinal cord lesions formed by MS. Defficiency in muscles, brain activity, and just daily endurance are just the tip of the iceberg when it comes to discussing the side-effects the body endures from the chronic plague of
MS. As mentioned above, MS is an utterly terrifying disease that can affect several different functions of the human body. There are several treatment options to best manage life with MS, with one of those options being physical therapy interventions. In decades past it was thought that since fatigue and muscle weakness were very common in patients with MS, that it would be beneficial to stay clear of physical exercise due to fear of increasing fatigue. Well a recent study has shown that a specifcally tailored rehabalition program formed especially for patients with certain types of MS can be beneficial to their quality of life and overall independence. The study took 17 patients with MS that had the same level of mild disabillity from MS. The study was composed of 10 sessions of treatment over the span of 2 weeks. Each sesssion had a component of gait training, stretching, 2 task oriented circuits, muscle strenthening, and a rest period in between the 2 task oriented circuits. These sessions lasted for 2 hours at a time and were specifically designed for these patients. After patients completed this tailored circuit physical therapy intervention the results indicated that “exercise is well tolerated and induces reelveant improvements in both physical and mental functioning of persons with MS” (Chisari et al. 511-512). Although this was a small study, the results had a positive outcome and could be a break through for therapy interventions in the MS community. The only downside is the time commitment and lack of patient education on this rehab technique. It is important that patients with MS understand that not just any exercise will be beneficial to them. The severity of their MS and their level of physical function plays an important role in determing the physical therapy intervention best for them. In conclusion, MS is an autoimmune degenerative disorder that originates in the CNS that can result in several dysfunctions of the body. MS has been categorized to have 4 different subtypes with highly variable affects on each individual diagnosed. Numerous research has been done on this disorder to try and find the root of the actual cause but no definitive results have been obtained thus far. Living with MS is all about finding the best way to manage the disease because it does not just go away due to it’s progressive nature. Luckily “there is now good evidence that exercise can improve fitness and function for those with mild MS and helps to maintain function for those with moderate to severe disability” (Goodman & Fuller 781). With that being said, we could see an increase in demand for physical therapy as being one of the preferred methods of treatment for patients with MS.