Terré-Boliart R, Orient-López F
Unidad de Daño Cerebral, Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Barcelona, España.
Rev Neurol. 2007;44(7):426-31.
To review the rehabilitation therapy and rating scales used in multiple sclerosis (MS), as well as the clinical studies conducted to evaluate the effectiveness of rehabilitation therapy and the most common symptoms.
MS has a number of very specific features that will have to be taken into account when undertaking rehabilitation therapy. It is a disease that progresses in a fluctuating and unpredictable manner and, to date, there is no treatment to cure it. There is a possibility of spontaneous recovery, especially in the early stages of the disease. Evaluation of the effectiveness of rehabilitation in MS must be performed on different levels that take into account both particular aspects of rehabilitation and an overall assessment of the treatment being provided. Most studies report improvements in disability and quality of life, while deficit remains unchanged. Any improvements that are achieved tend to decline over time, which makes it necessary to perform a follow-up after rehabilitation therapy ends. Certain symptoms such as fatigue, spasticity, ataxia and sphincteric disorders will benefit from suitable pharmacological treatment applied together with the rehabilitation therapy.
The value of rehabilitation therapy for MS patients lies in its ability to improve disability and the quality of life; since its effects decline over time, regular check-ups will be essential. Proving the effectiveness of rehabilitation in a heterogeneous pathology that develops progressively, such as MS, is a complex matter and further research with better designs and rating scales needs to be conducted.
回顾用于多发性硬化症(MS)的康复治疗及评定量表,以及为评估康复治疗效果和最常见症状而开展的临床研究。
在进行康复治疗时,必须考虑到MS的一些非常特殊的特征。这是一种以波动且不可预测的方式进展的疾病,迄今为止,尚无治愈方法。存在自发恢复的可能性,尤其是在疾病的早期阶段。对MS康复效果的评估必须在不同层面进行,既要考虑康复的具体方面,也要对所提供的治疗进行全面评估。大多数研究报告称残疾和生活质量有所改善,但功能缺损保持不变。所取得的任何改善往往会随着时间推移而下降,这使得在康复治疗结束后进行随访很有必要。某些症状,如疲劳、痉挛、共济失调和括约肌功能障碍,将受益于与康复治疗同时应用的适当药物治疗。
康复治疗对MS患者的价值在于其改善残疾和生活质量的能力;由于其效果会随着时间推移而下降,定期检查至关重要。在诸如MS这种逐渐发展的异质性病理中证明康复的有效性是一件复杂的事情,需要进行设计更好、评定量表更完善的进一步研究。