Scribd
Upload
23 views4 pages

? Fatigue Management in Multiple Sclerosis

Fatigue in Multiple Sclerosis (MS) is a prevalent and debilitating symptom affecting up to 80% of patients, characterized by a lack of energy that is not relieved by rest. Management strategies include personalized physiotherapy approaches such as aerobic exercise, energy conservation techniques, and cognitive support, alongside pharmacological options like amantadine. Recent advances in technology, such as virtual reality rehab and AI-based monitoring, further enhance fatigue management for individuals with MS.

Uploaded by

Ajas Km
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
23 views4 pages

? Fatigue Management in Multiple Sclerosis

Fatigue in Multiple Sclerosis (MS) is a prevalent and debilitating symptom affecting up to 80% of patients, characterized by a lack of energy that is not relieved by rest. Management strategies include personalized physiotherapy approaches such as aerobic exercise, energy conservation techniques, and cognitive support, alongside pharmacological options like amantadine. Recent advances in technology, such as virtual reality rehab and AI-based monitoring, further enhance fatigue management for individuals with MS.

Uploaded by

Ajas Km
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

🧠 Fatigue Management in Multiple Sclerosis (MS)

🔹 1. What is Fatigue in MS?

Fatigue in MS is one of the most common and disabling symptoms, reported by up to 80%
of patients. It is described as a subjective lack of physical and/or mental energy,
interfering with usual activities.

It can be disproportionate to exertion and not relieved by rest.

🔹 2. Types of Fatigue in MS

Type Description
Direct result of MS due to demyelination and inefficient nerve
Primary fatigue
conduction.
Due to other MS-related factors like sleep disturbance, depression,
Secondary fatigue
infection.
Physical fatigue Muscle weakness, heaviness after minor effort.
Cognitive fatigue Trouble with concentration, memory, or mental processing.
Heat-sensitive
Worsened by increased body temperature (Uhthoff’s phenomenon).
fatigue

🔹 3. Pathophysiology of Fatigue in MS

 Central origin: Demyelination → inefficient synaptic transmission → increased


energy demand → brain fatigue.
 Neurochemical imbalances: Altered serotonin, dopamine, and noradrenaline levels.
 Cortical excitability changes: fMRI shows reduced activation in attention and motor
areas.
 Inflammation: Proinflammatory cytokines (e.g., TNF-alpha, IL-6) may increase
fatigue.

🔹 4. Factors Contributing to Fatigue

Factor Examples
Sleep disorders Insomnia, restless leg syndrome, sleep apnea
Medications Antispastics, antidepressants
Depression/anxiety Low motivation, emotional exhaustion
Poor physical conditioning Sedentary lifestyle
Factor Examples
Heat sensitivity Hot weather, exercise-induced heat
Infections or relapses Active inflammation

🔹 5. Assessment of Fatigue

Tool Purpose
Fatigue Severity Scale (FSS) Measures impact of fatigue on daily function
Modified Fatigue Impact Scale (MFIS) Assesses physical, cognitive, psychosocial fatigue
Borg’s Rate of Perceived Exertion Monitors exercise intensity and fatigue response
Visual Analogue Scale (VAS) Rates subjective fatigue level

🧘‍♂️6. Physiotherapy-Based Fatigue Management


A multimodal, energy-conserving approach is ideal:

🔸 a. Aerobic Exercise Training

 Low to moderate intensity improves fatigue and fitness without worsening


symptoms.
 Mode: Walking, cycling, aquatic therapy.
 Frequency: 2–3 times/week, 30 mins/session.
 Evidence: Cochrane Review (2015) supports aerobic exercise to reduce fatigue in
MS.

🔸 b. Energy Conservation Techniques

 Pacing: Break tasks into manageable segments.


 Planning: Prioritize and schedule energy-demanding activities.
 Posture: Use ergonomic tools (e.g., shower chairs, kitchen stools).
 Positioning: Sit when possible to reduce muscle energy consumption.
 Delegation: Encourage patients to ask for help with heavy tasks.

🔸 c. Cooling Therapy (for heat-sensitive fatigue)

 Use:
o Cooling vests
o Fans during activity
o Air conditioning or cold showers
 Helps prevent fatigue worsening during or after physical activity.
🔸 d. Strength and Resistance Training

 Builds endurance of postural muscles → supports mobility.


 Avoid overtraining—individualize program based on fatigue level.

🔸 e. Yoga and Mind-Body Therapies

 Combines gentle stretching, breathing, and relaxation.


 Improves mental fatigue, stress, and body awareness.
 Studies show reduction in fatigue scores with regular practice.

🔸 f. Cognitive Fatigue Management

 Cognitive pacing: Frequent mental breaks during work/study.


 Use of planners/reminders: Reduces mental overload.
 Cognitive training apps: Target memory and attention deficits.

🔸 g. Sleep Hygiene Education

 Regular bedtime routine


 Avoid screen use before bed
 Comfortable sleeping environment

🔸 h. Education and Self-Management

 Empower patients to recognize and manage early fatigue signs.


 Use diaries or apps to track fatigue triggers and patterns.

🧪 7. Pharmacological Adjuncts (to be prescribed by


physicians)
 Amantadine: Most commonly prescribed for MS fatigue.
 Modafinil: Useful for cognitive fatigue (off-label).
 L-carnitine: Some evidence in secondary fatigue.
⚠️Physiotherapists should coordinate with neurologists regarding drug side effects that may
impact physical therapy.

📈 8. Recent Advances in Fatigue Management


Technology Benefit
Virtual Reality Rehab Increases engagement in aerobic/cognitive training
Wearable Activity Monitors Track fatigue levels and promote pacing
AI-based fatigue monitoring Predict fatigue flare-ups using behavior and movement
Tele-rehabilitation platforms Guide patients through home-based fatigue management

✅ Summary
Fatigue in MS is multifactorial and requires personalized physiotherapy strategies. An
effective program should include:

 Aerobic and resistance exercise


 Energy conservation
 Environmental adjustments
 Cognitive support
 Cooling measures
 Mind-body approaches

The goal is to help the individual optimize energy, enhance independence, and improve
quality of life.

📚 References

 Cochrane Review (2015). "Exercise for fatigue in multiple sclerosis."


 Heine M et al. (2015). "Exercise therapy for fatigue in multiple sclerosis." J Neurol
Sci.
 Bakshi R. (2003). "Fatigue associated with multiple sclerosis." Neurology.
 Multiple Sclerosis Journal (2020). "Cooling therapy and fatigue: a systematic review."
 National MS Society Guidelines (2023)

Would you like this information formatted as a clinical handbook, PDF for patients, or
PowerPoint for teaching purposes?

You might also like