Rehabilitation in Multiple Sclerosis

n Impairment is a loss or abnormality of a psychologic, physiological, or anatomic structure or function. Disability is a loss or restriction of the capacity to perform an activity in terms of a frame considered as normal. Handicap is the unfavorable situation of an individual as a result of a determined impairment and disability that restricts or impedes the fulfillment of a role normal to the individual. Multiple sclerosis (MS) is one of the most common causes of neurologic disability in young adults. In the relapsing-remitting form (RR-MS), the natural course of MS is classically characterized by relapses (in 58% to 66% of patients). With time, these relapses cause impairment and, within 10 years of onset, one half of the patients are affected by the progressive form (secondary progressive MS; SP-MS). Once the patient is on a progressive course, neither recovery nor spontaneous remission occurs, although some patients may have long periods of stability. MS also may begin with a progressive form (in 18% to 34% of patients) called primary-progressive MS (PP-MS). On average, 8 years from onset of the progressive form, the patient will experience limitations in walking; by 20 years, the patient needs support to walk; and 30 years after diagnosis, the patient can only walk a few steps. Other functional systems and processes such as the visual system, the brainstem, cerebellum, cognition, bladder, bowel, sexual function, sensory system, and cerebral also are affected progressively and cause significant disabilities in patients. These facts justify neurologic rehabilitation in MS as a process to help patients to reach and maintain their maximum physical, psychological, social, and vocational abilities and achieve an acceptable quality of life. To reach and maintain optimal function is essential in this progressive disease, and neurologic rehabilitation should be considered during all phases of the disease.