Multiple sclerosis: confirms that rehabilitation is as important as pharmacological treatment



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In the third Latin American CHARCOT 2019, which combines the reference in the multiple sclerosis of the entire region and is developing in our country, experts stressed that physical and cognitive rehabilitation of patients with multiple sclerosis is one of the pillars. It is fundamental to the treatment of this disease, which is basically focused on restoring functionality that is lost due to potentially disrupted outbreaks caused by this condition.

"Rehabilitation and physical activity of patients with multiple sclerosis are aspects that do not have all the importance they deserve but are essential in the treatment. The patient must undergo rehabilitation when attempting to recover the so-called functionality, there are some skills that may not be recoverable and others with appropriate strategies can continue their normal lives, "said Edgardo Cristiano, neurologist, director of the Multiple Sclerosis Center in Buenos Aires (CEMBA) of the Italian hospital.

For this, the concept of plasticity is key, as it has already been observed for some time that the implementation of body and brain neurons in those areas that have been damaged by the disease are replaced in their functions by others who stay healthy.

According to Liliane Patrucco, a neurologist and head of the demyelinization department at the Italiano de Buenos Aires Hospital, "on the one hand, physical rehabilitation of the patient is essential, which can be achieved through exercises that can be performed. On the other hand, cognitive rehabilitation helps the person is adapted to everyday life. "

"Getting to know is crucial: for example, occupational therapy can significantly affect the quality of life of patients," he added.

Multiple sclerosis is a chronic and disabling immunological disease, a product of harm that occurs in myelin, that is, in a layer that covers the nervous system of the central nervous system. According to experts, the prevalence of this condition, which is usually the first symptom between 18 and 40, is 30 per 100 thousand inhabitants, which is estimated to be between 14,000 and 18,000 in Argentina. .

Affected more women than men in the ratio of 3 hospitals per male. Today, it is known that the most common type of MS is recurrent-remitent, also called "recidivism and remission", in which patients have periods of well-being and occasionally have episodes of recurrence.

"Physical and cognitive rehabilitation can be done not only personally, but also virtual, using a technology known as telereurorehabilitation, with software that is specially designed so that the patient can reach certain goals from the home, the moment, doing exercises as many times as The day you want is always accompanied by a specialist who can be a physical rehabilitator, working therapist or neuropsychologist who is responsible for the cognitive aspects of the patient, "said Patrucco.

In order to be able to perform teleuroregulation, it is necessary that the patient has a personal computer or tablet in his home. It is a complete virtual reality program based on the realization of exercises captured by the sensor and reflected on the screen, which allows them to express themselves in a playful way. For example: a fetus is displayed on the screen, which should be stored in the appropriate shelf. Realizing the real moves, the screen reflects what the patient is doing. This allows working with fine movements of precision and coordination, but there are also exercises that suggest a person's hike.

"This is a growing trend, especially because it allows for shortening distances, given that not all people can go physically to places where rehabilitation is being done, either because they do not have a family member who would accept them because they live too far, because transport by a rescue vehicle is complicated or delayed, among other things, and this technique is a way to break these barriers, "said Cristiano.

"It has been proven that those who have access to some form of rehabilitation have better functionality than those who do not have this option," said the specialist.

The flexibility of our neurons

Due to the progression of the disease, some connections between the neurons of certain areas of the brain have been damaged, and the person loses the functionality associated with these neurons, especially in any outbreak of the disease. transient – or not – as loss of sensitivity in the hand or arm, vision in one or both eyes, ability for normal movement, among others.

Fortunately, with proper rehabilitation, the activity of these neurons can often be taken by others from undamaged areas, thus restoring lost functionality.

"This is very clearly visible with magnetic resonances, where it is possible to visualize that some areas of the brain are activated for new functions that they did not previously cooperate with," Cristiano said.

"Recent research has shown that it is possible to restore the functionality of damaged neurons, which would contribute to improving the patient's recovery, but gives us guidelines for everything we need to know about the functioning of the brain," concluded Patrucco. .

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