**2. Role of physiotherapy in the treatment of multiple sclerosis**

The most effective non-pharmacological treatment for patients diagnosed with multiple sclerosis include physiotherapy, symptomatic therapy and psychotherapy [4]. The key of the effectiveness of the therapy lays in its all-encompassing character, that is, the cooperation between a doctor, physiotherapist, nurse, social worker, occupational therapist as well as psychologist. In case of some patients, it is not necessary to involve all the specialists listed above. Starting from the diagnosis of the disease and through its development, the patient's situation should be analyzed on an ongoing basis and based on that, they should be under observation of particular specialists. Close cooperation between the physician and the physiotherapist seems to be indispensable in every case of multiple sclerosis [5]. Regular physiotherapy allows patients to maintain independence for longer. The positive effects of the physiotherapy are possible due to the neuroplasticity of the brain. Neuroimaging and electrophysiological examinations show spontaneous and physiotherapy induced changes in the nervous system [6]. Correlation between physical exercise and recovery of motor and cognitive functions in patients is being studied. The studies largely focus on the role of cytokines and neurotrophic factors in these processes, in particular brain-derived neurotrophic factor (BDNF). Increased BDNF levels are observed after regular physical exercise. Brain-derived neurotrophic factor (BDNF) is one of the nerve growth factors. It enhances neuronal regeneration, promotes the survival or nerve cells and influences Schwann cells. Data obtained in several studies show relations between the increased levels of neurotrophins observed after regular physical activity and the induction of neuroplasticity, as well as the recovery of motor and cognitive functions. According to some sources, the plasma cytokine and neurotrophins concentration depends mainly on the type of exercise (light/intense) and not on engaging in a physical activity itself [7, 8]. It is emphasized that patients with multiple sclerosis can tolerate longer training sessions of high and rapidly increasing intensity, which allows them to make a more noticeable progress in less time. In patients with multiple sclerosis, endurance physical activity, in particular short and intense series of exercises, significantly increases cardiorespiratory fitness and leads to an increase in the secretion of brainderived neurotrophic factor (BDNF) and nerve growth factor (NGF). Sensory symptoms worsening may be observed after kinesiotherapy. However, this is a temporary effect that resolves within half an hour after the exercise session [7].

It is difficult to identify a clear cause of disability in patients with multiple sclerosis. It seems that the patient's fitness is reduced not only as a result of the progression of the disease. It may also be a consequence of reduced physical activity in MS patients compared to healthy people. Patients with multiple sclerosis, due to lack of regularity in undertaking physical activity, show a reduction in both the maximum aerobic capacity (maximal oxygen consumption) and muscle strength, which additionally translates into impaired functional capacity and reduced quality of life. The physiological profile of these patients may be a consequence of the irreversible effects of the disease as well as of the inactive lifestyle [4, 9]. The effectiveness of the treatment depends on the stage of the disease and the effects of secondary lack of physical activity. It is not clear to what extent the individual impairments can be reversed, as well as to what extent physiotherapy can boost the remyelination of the nervous system. However, kinesiotherapy carried out on a regular basis can certainly contribute to the improvement of the patient's general condition by reducing

### *Role of Physiotherapy and Practice of Judo as an Alternative Method of Treatment in Multiple… DOI: http://dx.doi.org/10.5772/intechopen.95501*

the effects of lack of any physical activity. Therefore, rehabilitation in MS remains the main non-pharmacological strategy that allows to reduce disability and maintain patient's functionality [9].

According to the National Multiple Sclerosis Society based in the US, rehabilitation in MS helps patients to achieve and maintain their maximum physical, psychological, social and professional potential, as well as quality of life in relation to the disease, environment and their life goals. Achieving and maintaining an optimal condition is necessary to accept a life with a chronic illness [9]. Exercising particular functions, improving muscular strength and working on proprioception facilitates the patients' everyday life. In case of patients diagnosed with MS, mental attitude is of an extreme importance. When preparing a rehabilitation and physiotherapy program, attention should be paid to the patients' mental state, as well as to their level of motivation to exercise on a regular basis. The aim of physiotherapy, in addition to the physical aspects, is to improve patient's mental condition. A properly selected program will allow the patient to achieve the intended results. Thanks to such an approach and action, patients gain confidence in themselves and their movements and it is easier for them to accept the disease together with its consequences, while finding their place in the society [1, 4, 7]. The rehabilitation should focus on restoring the functions lost by the patient or properly controlling the compensation processes in order to use the patient's adaptive abilities in the most effective way [5].

Generally speaking, in the case of MS patients, rehabilitation should begin with educating the patients and their relatives. It is important to explain the need for regular rehabilitation and its correlation with the pharmacological treatment. It should be noted that the physiotherapist together with the patient sets rehabilitation goals at each stage of the disease. Education is more effective at the early stages of the disease, because the patient shows lower degree of disability and can be taught the correct pattern of performing particular movements in an effective way, which may be useful in the later stages of MS [10, 11]. Then, the so-called symptomatic and task rehabilitation is introduced. It consists of teaching the patients specific functions that may facilitate their everyday life [4]. The detailed plan of the physiotherapy depends on the dysfunctions presented by the patient, the course of the disease and the patients' needs (including their attitude). Structured therapy should also include the patient's individual work at home [10].

Each patient may show different symptoms, which may hinder their everyday life to a varying degree. Physiotherapy aims at choosing a method that can treat several ailments at the same time [11]. Depending on the patient's needs, the emphasis is put on different types of exercise: exercises that increase muscle strength, improve proprioception and coordination or the aerobic exercises. A combination of various types of training is used in order to obtain better results. For instance, a combination of endurance and resistance training improves mobility, balance and coordination [4, 12]. Due to the early age of the diagnosis, the progressive nature of the disease, symptoms that hinder normal functioning and are often embarrassing and may contribute to depression, alternative forms of physical rehabilitation are increasingly being considered. Many types of physical activity can be adapted for therapeutic purposes. Therapy derived from a specific type of sport has a positive effect on the level of motivation to undertake the effort as well as the patient's well-being and self-esteem. This approach allows patients to feel that their goal is not limited to preventing the effects of the disease − the dysfunctions they present−− but it is an opportunity to learn new skills, develop new interests or maintain the previous ones. In particular, at the initial stages of MS, it is beneficial to introduce unconventional forms of rehabilitation, which have therapeutic effects, but at the same time may become an alternative way of spending free time. It may support the process of accepting progressing disability. A person who

#### *Demyelination Disorders*

notices his or her limitations often tends to isolate oneself from society and shows a fear of learning something new. The use of unconventional methods of rehabilitation is aimed at: helping the patient overcome fear, building self-confidence, motivating them to spend time with other people, and encouraging them to adopt a more open attitude, thus facilitating a conversation about their disability. Different activities can be used for therapeutic purposes, including: aerobic training, cycling, judo, tai chi, kickboxing, bicycle ergometer, yoga, aqua spinning and other water exercises [4, 7, 12, 13].
