Rehabilitation and functional re-education with multiple sclerosis: a team process, a daily discipline.

Consequently, this disorder may give rise to widely differing clinical pictures with deficiencies that are sometimes very fragmented, sometimes very complete.
What is more, the development of the disorder can vary substantially from one person to another. Some people experience discrete attacks followed by a more or less full recovery, while others suffer a slowly progressive development of the deficits observed. Others still display intermediary or successive forms between these two extremes.

MS can therefore cause a great many functional deficits which, when combined, can result in considerable dependency. The rehabilitation sector endeavours to provide assistance that is as effective as possible in this respect.

First of all, it is important to distinguish between care provided with a view to rehabilitation, to the extent that it seeks to recover partially or entirely the function that has been lost, and care that is described as functional re-education, as the aim is to preserve functional autonomy for a specific activity or action, possibly by means of technical aids that will help carry out the action, without necessarily recovering the basic function. The most common example of this is moving around, which is initially done by walking but which can possibly be readjusted on a modified basis, if walking is no longer possible, by using a wheelchair.

Rehabilitation and functional re-education may involve a number of disciplines:

• these are mainly physiotherapy, ergotherapy, logopedics and neuropsychology.
• surgical truss makers and orthopaedic technicians supply technical aids.
• psychologists can also provide valuable support.
• another "discipline" that is all too often forgotten must also be added here: that of the patients who, informed, motivated and guided by their therapists who act as coaches, will themselves undertake certain rehabilitation activities at home (balancing or walking exercises, breathing exercises, manual work, etc.) to prolong the benefits of their medical support.

The work done by these various re-education teams is usually orchestrated by a specialist in physical medicine and re-education or by a neurologist who focuses specifically on re-education.

Before starting a re-education programme, a comprehensive evaluation is undertaken of the clinical problems and functional condition of the person to be treated. This phase includes various tests in each discipline. A detailed picture of the problems encountered can then be built up, leading to a proposal for care specifically focusing on the deficiencies of the individual patient and the development of their problems. The re-education plan will be drawn up on the basis of these results, paying particular attention to the expectations and priorities of the patient. Subsequently, these results will also make it possible to assess the effectiveness of the medication or rehabilitation programme or the impact of the progression of the illness.

Once the re-education objectives and the means to be implemented have been specified, the programme enters the practical implementation phase. This will always be more effective and pleasant if the dialogue between the patient and the team of carers is good, since it is important to try and modulate the nature and intensity of the sessions on the basis of the patient's condition day by day.  

Doctor B. MAERTENS
Head of Physical Medicine and Re-education Service,
CNRF de FRAITURE