Pulmonary Dysfunction, Assessment, and Treatment in Multiple Sclerosis

Abstract

Pulmonary muscle weakness is a symptom of multiple sclerosis (MS) that begins early in the disease process, although it is often not recognized by health-care providers until later stages. Standard pulmonary function tests are not effective in detecting this reduction in pulmonary muscle strength. Maximal inspiratory and expiratory pressures are indirect measures of pulmonary muscle strength that are effective in detecting early changes. Once detected, pulmonary muscle weakness is effectively treated with pressure threshold load inspiratory and expiratory muscle exercises that can be implemented using inexpensive handheld pressure threshold load muscle training devices. These exercises require little time and are effective in patients with any level of disability. Int J MS Care. 2010;12:97-104. Multiple sclerosis (MS) is a disease of the central nervous system. Signs and symptoms and the accumulation of disability are due to demyelination and axonal injury.1 Multiple sclerosis affects not only muscles of the limbs and trunk but also muscles of respiration. Muscle weakness, changes in muscle tone, motor incoordination, and postural abnormalities all reduce pulmonary function. In the majority of patients with mild-to-moderate disability associated with MS, central motor conduction to the diaphragm muscle is abnormal.2 Respiratory impairment in neurologic or neuromuscular injuries or disorders such as MS includes 1) difficulty in ventilation due to inspiratory muscle weakness; 2) difficulty in coughing due to weakness of the expiratory muscles, upper-airway (glottic) muscle, and inspiratory muscles; and 3) risk of aspiration of fluids due to upper-airway muscle weakness. ; however, due to the prevalence of MS in the United States (approximately 400,000) and worldwide (2.5 million), a significant number of individuals may be at risk.5 Very few studies address differences in respiratory impairment relative to type of MS, although Grasso et al. 6 reported greater respiratory abnormalities in patients with cerebellar involvement.Patients with MS rarely complain of pulmonary dysfunction, although upon testing pulmonary dysfunction is commonly found.7 Pulmonary muscle strength is often reduced even in patients with mild disease. [8][9][10][11][12] Pulmonary compromise affects as many as 52% of recently diagnosed individuals with MS.13,14 Pulmonary muscle involvement occurring early in the course of the disease is due largely to reversible neuromuscular failure.10 Indirect measures of pulmonary muscle strength (maximal inspiratory pressure [MIP]

Physical therapy in multiple sclerosis: A new strategy of treatment

“…During the relapse, the patient usually remains in bed; therefore, breathing exercises often become the only form of activation. Breathing exercises are also used in patients with impaired speech in the form of speech therapy [29] . In patients with multiple sclerosis, impaired gait is a consequence of neurological deficits such as balance and coordination disorders, spasticity, visual disturbances, paraparesis and hemiparesis.…”

Rehabilitation in multiple sclerosis.

“…Breathing exercises are also used in patients with impaired speech in the form of speech therapy. 29 In patients with multiple sclerosis, impaired gait is a consequence of neurological deficits such as balance and coordination disorders, spasticity, visual disturbances, paraparesis and hemiparesis. Deteriorated locomotion or movement in the form of pathological gait significantly reduces the quality of life of patients with MS and makes them dependent on family or friends.…”

Pulmonary muscle function response to inspiraory muscle training in multiple sclerosis patients

“…8The rationale for selecting an inspiratory muscle trainer (IMT) is that weakened inspiration predisposes the respiratory muscles to fatigue and contributes to perceived dyspnea. Inspiratory muscle training also increases Maximum Inspiratory Pressure (MIP) and reduces dyspnea (rest and exercise) (9).The purpose of this study was to investigate the efficacy of Inspiratory muscle training (IMT) on pulmonary functions in Egyptian multiple sclerosis patients.…”