• Strength & Endurance: Progressive resistance training, often using FES (Functional Electrical Stimulation) for weaker muscles (e.g., foot drop). Aerobic exercise to improve cardiovascular health, combat fatigue, and potentially support neuroprotection.
• Balance & Proprioception: Advanced drills on unstable surfaces, perturbation training, virtual reality (VR) exergames to challenge reactive balance.
• Gait Retraining: Treadmill training (with/without body-weight support), use of visual/auditory cues, obstacle courses, dual-task walking.
• Spasticity Management: Prolonged stretching, active ROM exercises, positioning,hydrotherapy,and techniques to inhibit spasticity (e.g., slow rhythmic rotation)
• Fatigue Management: Energy conservation education, activity pacing, cooling strategies (e.g., cooling vests for heat sensitivity), appropriate exercise dosing to build endurance without exacerbating fatigue.
• Dual-Task Training: Combining physical and cognitive tasks (e.g., walking while performing mental calculations) to challenge attention and processing speed, crucial for real-world function.
• Advanced Manual Therapy Techniques: While manual therapy directly “fixes” neurological lesions, it is invaluable for managing secondary complications, improving tissue extensibility, reducing pain, and facilitating better movement.
• Manual Therapy (General): Hands-on techniques to mobilize joints, soft tissues, and nerves. For demyelinating disorders, this includes:
  • Joint Mobilization: Gentle, rhythmic movements to restore normal joint play and reduce stiffness resulting from immobility, weakness, or spasticity (e.g., ankle, knee, hip joints).
  • Neural Mobilization/Nerve Glides: Gentle movements to help nerves slide freely through their pathways, reducing compression and improving nerve health, especially if there’s secondary nerve entrapment from muscle tightness or fibrotic changes.
• Myofascial Release (MFR)

A gentle, sustained pressure applied to the fascia (connective tissue surrounding muscles, bones, and organs) to release restrictions.

• • Application in Demyelinating Disorders: Addressing fascial tightness that can result from chronic spasticity, disuse, poor posture, or altered movement patterns. By releasing these restrictions, MFR can improve range of motion, reduce pain, and facilitate more efficient movement.
• Instrument-Assisted Soft Tissue Mobilization (IASTM): Uses specialized tools (e.g., stainless steel instruments like Graston, HawkGrips) to detect and treat adhesions, scar tissue, and fascial restrictions.
  • Application in Demyelinating Disorders: Particularly useful for breaking down localized areas of fibrotic tissue or adhesions that can form in muscles or fascia due to chronic spasticity, prolonged postures, or disuse. This can improve tissue extensibility, reduce localized pain, and allow for better muscle function and range of motion.
• Dry Needling (DN): Involves inserting thin, sterile needles into myofascial trigger points or taut bands of muscle to elicit a local twitch response. It aims to release muscle tension, reduce pain, and improve muscle function.
  • Application in Demyelinating Disorders: Increasingly used to manage spasticity and associated pain in individuals with conditions like MS. By “resetting” muscle tone and reducing trigger point activity, it can improve range of motion, decrease discomfort, and facilitate better motor control.
• Active Release Technique (ART): A hands-on, soft tissue treatment system that combines precisely directed tension from the therapist with specific patient movements.
• • Application ion in Demyelinating Disorders: Addresses adhesions or restrictions in muscles, tendons, ligaments, fascia, and nerves that can develop due to overuse, trauma, or sustained abnormal postures typical in neurological conditions. ART can be applied to “release” tight muscles that contribute to spasticity or limit range of motion, and can also be used to mobilize entrapped nerves (e.g., in the case of secondary nerve compression).