Abstract

Background: There is limited research on effective physical therapy interventions for a person with multiple sclerosis (MS) directly following an exacerbation of the condition. The purpose of this case report is to describe a short-term physical therapy plan of care (POC) using the patient's symptoms to guide intensity of interventions aimed at improving walking distance, functional mobility, and lower extremity (LE) strength for a patient following an acute MS exacerbation in an inpatient setting.

Case presentation: The patient, a 30-year-old woman with a two-month history of MS, experienced an exacerbation resulting in bilateral LE weakness, inability to ambulate, and increased fatigue. The patient received physical therapy three weeks after the onset of her exacerbation. The primary interventions used throughout the POC were gait training and LE strengthening. Onset of the patient's symptoms of perceived exertion, shortness of breath, numbness and tingling in extremities, pain, dizziness, and onset of blurring vision were used to dose her exercise threshold.

Discussion: The patient was seen for one and a half to two hours per day. She demonstrated increased ambulation distance by 118 feet. She demonstrated increased gait speed, LE strength and decreased perceived fatigue. No adverse effects were noted during her entire episode of care.

Conclusions: This case demonstrates how using a patient's symptoms of MS may be an appropriate method to dose the intensity of interventions to improve endurance with ambulation, LE strength, and functional mobility in a patient after an acute MS exacerbation.

Keywords: Multiple sclerosis, fatigue, exercise, exacerbation, physical therapy