ADEMTO’s view of Multiple Sclerosis | Interview with Carmen Ortiz (OT)
It is currently stated that Multiple Sclerosis is a disease induced by an abnormal response of the immune system on the Central Nervous System, which results in demyelination of its structures. Its presentation produces cognitive alterations, muscle weakness, spasticity and fatigue, among other symptoms. For this reason, physical and cognitive improvement should be the mainstay of therapy for these patients. Exercise is a tool that can provide value in this disability.
It is estimated that 1.3 million people suffer from Multiple Sclerosis (WHO 2008 data). Its prevalence has remained on the rise, with recent studies claiming that the number of affected patients exceeds 2 million people worldwide (Reich DS et al 2018). This fact can be explained by the advances in controlling its progression with new treatments, and consequently, the increase in the life expectancy of multiple sclerosis patients (Heine M et al 2015).
Demyelination process at the level of the superficial cortex. Image obtained from Reich et al. (2018). N Eng J Med
Multiple Sclerosis in Spain
In April 2019, the Medical Advisory Committee of Multiple Sclerosis Spain (EME) estimates some relevant facts about this disease:
–55,000 people in Spain have Multiple Sclerosis (prevalence of 120 cases per 100,000 inhabitants).
-The incidence is around 4 cases per 100,000 inhabitants.
-And, 3 of 4 people with Multiple Sclerosis are women.
In Spain, one of the reference units in the treatment of this condition is the Multiple Sclerosis Association of Toledo (ADEMTO). ADEMTO, in order to provide its patients with the most up-to-date and effective treatment, includes among its diagnostic and therapeutic resources, Telerehabilitation tools aimed at people diagnosed with Multiple Sclerosis and other neurological diseases.
Telerehabilitation keeps patients more involved and empowered with their treatment and facilitates personalization, offering a tailored therapeutic intervention. These two features are part of the characteristics that every therapeutic exercise program should include, which adds even more value to these tools, and specifically to ReHand.
As pioneers in the use of technologies, ADEMTO has included ReHand in its clinical practice and helps its patients to rehabilitate their hand, wrist and fingers, complementing face-to-face and home training sessions.
We interviewed Carmen Ortiz, Occupational Therapist at ADEMTO
Why is specialized treatment of the wrist-hand-finger segment so important in Multiple Sclerosis?
“Multiple Sclerosis can affect in different ways. The upper limbs in most cases are altered due to lack of sensibility, mobility, loss of strength, manipulative dexterity etc.”
Hand disorders have a severe impact on the patient’s daily life. How do you deal with the treatment of this segment? Do you have any specific strategy?
“The treatment of each patient is individualized and specialized according to their needs and affectations. The goal is to achieve maximum functional ability and independence in their daily life”.
Do you use any specific tool or questionnaire for assessments?
“I use standardized tests such as the Box and Block test that assesses gross motor skills and the Nine-Hole Peg test that assesses fine motor skills”.
“I also assess with the Quick Dash Questionnaire the ability to perform different activities with the shoulder, arm and hand”. “On the other hand, it is important to assess function with the FIM FAM scale. Finally, I perform an assessment of the sensitivity of the upper limb”.
In this field, we know that the treatment of our patients must be purely active. That is, the therapy will be based essentially on exercises. This is something difficult to achieve for many colleagues since patients usually come to us for treatment with a passive attitude.
How do you involve your patients? How do you turn that mentality around? Do you rely on technology to achieve this?
“In my case, I work on training and learning the new tools with my patients by using them during the treatment sessions at the center. In this way, they learn how to use them and see the different advantages of including them in our treatment plan. Some time later, we can use some technologies at home and complement the conventional treatment”.
ReHand allows home-based work as a complement to face-to-face therapy. This was the case of a patient who, after suffering a stroke, started manual dexterity work with ReHand on his tablet:
In the most recent literature, there is an increasing emphasis on intensive active therapy. We have more studies showing superior outcomes by increasing the therapy time of our patients. And of course, we talk about active, exercise therapy. With so many patients to treat in a day, how do you meet this challenge?
“I ask my patients to use their Tablet during the treatment session so that they can perform the exercises individually”.
ADEMTO patient working with the ReHand app in person.
Following on from the previous question, do you think that new technologies will be a key tool to offer the patient intensive therapy?
“Of course, repetitions, real-time feedback and motivation are the key to promote brain plasticity. And in this way, a daily and continuous use of these tools would be a suitable option for intensive therapy”.
Finally, questions about hand therapy in Multiple Sclerosis: Which one is the main challenge you face today?
“The main challenge would be to achieve high adherence to treatment with the use of these tools at home. Patients should be educated about the importance and the need to perform the exercises prescribed by the tool on a daily basis.
I face this challenge with the patient’s training of the tool during face-to-face treatment sessions to enhance their motivation and adherence to the use of the tool in our treatment plan. In addition, I closely work with the caregivers so that they encourage this work routine at home and provide support if needed for the preparation and use of the tool”.
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Heine M, Port I van de, Rietberg MB, Wegen EE van, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis (Review). Cochrane Libr. 2015;Sep 11(9). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009956.pub2/full/fr#CD009956-abs-0002
Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis. N Engl J Med. 2018;378(2):169-180. doi: 10.1056/NEJMra1401483
COLAEM. La epidemiologia de la esclerosis múltiple. 2018. Available from: https://www.conlaem.es/actualidad/epidemiologia-esclerosis-multiple