This was discussed last May 26 and 27 in Milan at the Conference ‘Fatigue in neurological pathologies – From clinical practice to pathophysiological bases’. Over 120 physiotherapists, speech therapists and specialist doctors took part in the two-day event to discuss the recovery, management and treatment of this symptom well known by people with neurological disabilities, but still little noticed by clinicians.
29 MAG –
Fatigue in subjects with stroke, Parkinson’s and multiple sclerosis: these are the themes around which the Conference entitled ‘Fatigue in neurological pathologies – From clinical practice to pathophysiological bases’, hosted at the Fast Congress Center. Over 120 physiotherapists, speech therapists and specialist doctors took part in the two-day event to discuss the recovery, management and treatment of this symptom well known by people with neurological disabilities, but still little noticed by clinicians.
A widespread and often misunderstood problem. Fatigue is a widespread feature in neurological diseases: it can affect up to 70-80% of patients affected by multiple sclerosis and Parkinson’s disease and up to 85% of patients with stroke outcomes. “This event- he explained Susanna Mezzarobbapresident of the GIS (Specialist Interest Group) in Neurological Physiotherapy and Neuroscience of the Italian Association of Physiotherapy (Aigi), researcher at the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (Dinogmi) of the University of Genoa and Irccs San Martino Hospital of Genoa – wanted to bring to the fore the theme of fatigue in neurological pathologies, a problem that is certainly well known, even if its neurophysiopathological mechanisms are still little known”.
“We all – he continued – know what physiological fatigue is, or that sense of fatigue and reduction in performance after a prolonged event, both physical and mental. Fatigue becomes pathological when it is pervasive, disproportionate to the activity carried out and the rest no longer gives its beneficial effects. The patient distinguishes it from normal tiredness; he feels exhausted, experiences an overwhelming sense of tiredness without this being justified by the amount of physical-mental activity he has carried out”.
Of the three pathologies at the center of the conference, ‘fatigue’ linked to multiple sclerosis is certainly the most detected and studied symptom to date, even if in the last 10 years, clinics and research have been taking important steps to detect and understand fatigue also in Parkinson’s disease and stroke.
“In all these patients, however – Mezzarobba underlined – fatigue interferes in a truly important way with work activities and is always associated with a deterioration in the person’s quality of life. In 2013, at the ‘World Parkinson Congress’, the patients defined the ‘fatigue’ problem as one of the most important on which research and the clinic are called to spend themselves. The papers presented at the conference described the ‘fatigue’ symptom as complex, still difficult to interpret and understand, and very often even to describe. And ‘ a subjective symptom that fits into the complexity of other motor and non-motor symptoms typical of the various pathological conditions and which themselves all become potential confounders for the identification of the fatigue itself”.
New hypotheses for evaluation and treatment. “Physiotherapy – specified Mezzarobba – is proving to be one of the possible and promising answers for the interpretation and management of fatigue within the therapeutic project. There are no standard goal pharmacological therapies for ‘fatigue’: certainly not in the disease Parkinson’s disease, we know more about multiple sclerosis, while it is still to be defined as regards stroke.Definitely optimizing function with different types and modalities of therapeutic exercises, both progressive loads, aerobics, and remodulating the quality of movement , is currently a rationale for response. As it is valid for other types of symptoms, fatigue can also be interpreted as a need to reorganize movement, recover and relearn new motor patterns”.
“The reports and the debate that emerged during the two days of the congress – Mezzarobba also underlined – brought out the need for a clear taxonomy of the symptom of fatigue, albeit with different levels of specificity, already partially achieved in Multiple Sclerosis, to be constructed in Parkinson’s and Stroke”. Recognizing and highlighting the symptom of fatigue is the fundamental prerequisite for being able to identify the criteria of its clinical relevance and the various domains of function (mental and physical) that it influences. Lastly, Dr. Mezzarobba recalled the importance of the debate on differential fatigue assessment strategies, assuming that only by identifying specific patient fatigue structures can we be able to build an effective therapeutic exercise. A therapeutic exercise that will be different if it has to manage a primary cognitive or physical fatigue, or a fatigue; it will be even different if you find yourself managing a secondary effort.
“Physiotherapy – he intervened Simone Cecchetto, president of Aifi- is establishing itself more and more as the science that cures movement dysfunctions and that cures other dysfunctions through movement; events like today’s make it more and more evident. Fatigue is a complex phenomenon that can be based on various factors such as neuroinflammation, physical deconditioning induced by hypomobility, alteration of the perception of the sense of fatigue, an information discrepancy that overloads cognitive and motor programming and many others of study”.
“In today’s event – continued Cecchetto – some differential evaluation strategies of the possible different determinants of fatigue potentially susceptible to different treatments in different patients were outlined, one of the keys to the personalization of physiotherapy treatment, the ‘tailored physiotherapy’, which will be the main theme of our National Congress to be held on 10 and 11 November in Bologna”.
“It was also very interesting – concluded President Cecchetto – to see the new physiotherapy strategies that are spreading to help people with neurological disabilities in whom fatigue becomes one of the factors influencing the quality of life: for example motor imagery, action observation, sensory discrimination training, graded exposure and many others”. The institutions’ attention to the development of the science of Physiotherapy was demonstrated, among other things, by the presence throughout the conference of the presidents or vice-presidents of the four recently established Orders of Physiotherapists (OFI) of Lombardy.
29 maggio 2023
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