[Locomotor reeducation and multiple sclerosis. A critical analysis of the literature]

Multiple Sclerosis (MS) is a disabling chronic neurological disorder with multiple motor impairments and its progressive course leads to severe disability. The question of the value of exercises program and physiotherapy to reduce these motor disorders and their consequences was raised. This literature overview is based on data from common database: Medline, Embase, Cochrane Library. Were selected articles corresponding to open studies and especially clinical controlled randomised trials. To be analysed, each article should correspond with inclusion criteria: confirmed diagnosis according to Poser's criteria, secondary or primary progressive form of MS without relapse for the study period, randomisation according to severity assessed by the Expanded Disability Status Scale (EDSS), no change in symptomatic drugs along the study period, and a simple blind assessor. Impairment, disabilities, handicap and quality of life had to be measured. Five clinical controlled randomised trials were consistent with these criteria. They demonstrated the effectiveness of comprehensive programs on motor function in the less severe forms of MS, but also their inability to change the course of the most severely affected forms. However, the effects on disability, handicap and quality of life were significant in comparison with control patients. These trials emphasised the value of multidisciplinary programs including physiotherapy and occupational therapy, carried out daily or 3 times a week by specialised staffs. The effects lasted only few weeks or months, requiring to propose them again after this period. Other controlled randomised studies also stressed the value of specific programs: temporary alleviation of spasticity and fatigue with cooling techniques; aerobic endurance training for less severely affected patients to prevent disuse consequences and improve fitness and quality of life; expiratory training to enhance coughing capacity and prevent pulmonary infections in very disabled patients. From this overview study, it seems that multidisciplinary comprehensive programs clearly provide benefits to those patients and contribute to reduce disability and improve quality of life at each stage of MS.