Benefits of Individualized Physiotherapeutic Intervention in a Patient with Relapsing-remitting Multiple Sclerosis: A Case Report
Akanksha Nagar *
Department of Physiotherapy, Faculty of Health and Allied Sciences, Guru Kashi University, Bathinda, Punjab, 151302, India.
Himanshu Kaushal
Department of Neurology, Guru Gobind Singh Medical College & Hospital, Faridkot, Punjab, 151203, India.
Jaspreet Vij
Institute of Physiotherapy, University Regional Centre, Sri Goindwal Sahib, Baba Farid University of Health Sciences, Punjab, 151203, India.
*Author to whom correspondence should be addressed.
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system that frequently results in progressive motor and non-motor impairments affecting function and quality of life. We report the case of a 37-year-old woman with a three-year history of relapsing-remitting MS presenting with worsening gait instability, balance impairment, fatigue, and tremors. Baseline assessment demonstrated moderate disability (Expanded Disability Status Scale [EDSS] 4.5), moderate fatigue (Modified Fatigue Impact Scale [MFIS] 42/84), impaired mobility (Timed Up and Go [TUG] 18 s), reduced physical quality of life (MSQOL-54 physical score 55/100), and moderate caregiver burden (Zarit Burden Interview [ZBI] 32/88).
The patient underwent a 12-week individualized physiotherapy programme (45 minutes/session, five sessions per week) comprising task-specific lower-limb strengthening, balance and gait training, spasticity management, aerobic conditioning, functional task practice, and a gamified virtual-reality–based balance training component to enhance engagement and motor learning. Post-intervention, EDSS improved to 3.5, indicating reduced functional limitation; MFIS decreased to 28, TUG improved to 13 s, MSQOL-54 physical score increased to 68, and caregiver burden reduced to 25. Improvements were maintained at three months but partially attenuated at six months, reflecting disease progression.
This case demonstrates that structured, individualized physiotherapy can produce clinically meaningful short-term improvements in mobility, fatigue, and functional independence in relapsing-remitting MS, while highlighting the importance of ongoing rehabilitation and maintenance strategies to sustain gains.
Keywords: Multiple sclerosis, physiotherapy, exercise rehabilitation, fatigue, quality of life, caregiver burden