Contemporary trends of rehabilitation in multiple sclerosis
Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach, „Repty” – Górnośląskie Centrum Rehabilitacji w Tarnowskich Górach (Józef Opara) 
Centrum Medyczne w Szczytnie (Waldemar Szwejkowski) 
Szpital Specjalistyczny św. Łukasza w Końskich (Waldemar Brola) 
Correspondence to: Prof. dr hab. n. med. Józef Opara, Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach, ul. Mikołowska 72 B, 40-065 Katowice, e-mail: 
Aktualn Neurol 2009, 9 (2), p. 140-146

The number of reports describing the effectiveness of comprehensive rehabilitation in multiple sclerosis (MS) is systematically growing. The latest scientific data reported the essential difference in health state between those patients who underwent rehabilitation and those who didn’t. The advantage of inpatient rehabilitation against outpatient has been proved. The correlation between disability and quality of life has been also noticed, as well as influence on burden of patient’s caregivers. Multiple sclerosis is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Goals of rehabilitation are: to give the management of symptoms and to improve general fitness due to aerobic exercise. First goal can be achieved using facilitation – impairment-based approach, while the second one by use of a new strategy: task-oriented – disability-focused approach. First is the treatment of the main symptoms of MS: fatigue, bladder and bowel disturbances, sexual dysfunction, cognitive and affective disorders, and spasticity. Even though these symptomatic therapies have benefits, their use is limited by possible side effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, rehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. For these aims the comprehensive multidisciplinary rehabilitation is necessary. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Since 1890, when Wilhelm Uhthoff for the first time described that increased body temperature from physical exertion may lead to transient impairment of vision in patients with MS, the Uhthoff phenomenon has been defined the strategy of rehabilitation procedures in MS. Heat therapy and physical exercises were restricted because of fear against flare up of disease, aquatic exercises were limited till 30ºC of water temperature. Last years something has been changed. Few reports on randomised controlled trials about progressive exercise program, mainly consisting of resistance training for few months has been published. Findings from those studies suggest overall disability and mobility improvement with the aerobic training. All types of rehabilitation should be tailored to fit patient specific needs. Based on the Uhthoff phenomenon, therapeutic trials with cooling vests are investigated and developed. In this review report of the contemporary trends in comprehensive rehabilitation in MS has been presented. 

Keywords: physiotherapy, rehabilitation, multiple sclerosis, cooling, fatigue