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Neuromuscular Practice II > 2 MS Pathophysiology > Flashcards

2 MS Pathophysiology Flashcards

1
Q

What is MS?

A

Immue-related response in which antibodies induce demyelination by antibody dependent cell mediated cytotoxicity

Cytokines attack myelin, macrophages to help uptake myeline = oligodendrocyte apoptosis leads in increase demylination, increased axonal injury and scerlosed

Inflammatory

Demyelinating

CNS - white matter damage in SC, brainstem, cerebral hemispheres

Plaques

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2
Q

What are the risk factors for MS?

A

Enviromental: Vitamin D defficiency, Smoking, Infection

Genetic: First degree relative risk

Female > Male

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3
Q

MS: Clinically Isolated Syndrome

A

First episode of neurlogic symptoms last at least 24 hours

usually no associated fever or infection and is followed by a complete or partial recovery

Monofocal episode

Multifocal episode

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4
Q

Multifocal episode?

A

More than one sign/symptom - lesions in more than one place

ex: attack of optic neuritis accomplanied by numbness or tingling in legs

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5
Q

Monofocal episode

A

Single neurologic sign or symotom

Single lesion

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6
Q

MS: Relapsing Remitting

A

Most common disease course

Clearly defined attacks of new or increasing neurologic symotoms

worsesning, not worsening, stable

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7
Q

MS: Primary Progressive

A

Worsening neurologic function from onset of symptoms without early relapses or remissions

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8
Q

MS: Secondary Progressive

A

Follows an initial relapsing remitting course

Most who are diagnose with RRMS will transition to secondary

  • progressive worsening
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9
Q

Disease modifiers

A

Active/not active

Relapses or new increasing neurologic dysfunction, followed by full or patial recovery

Progressive/not progressive

steadily increasing neurologic dysfunction without recovery

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10
Q

How is MS diagnosed? (3 critieria)

A
  • Evidence of damage in at least 2 areas of CNS
  • Evidence that damange occured at 2 distinct points in time (at least one month apart)
  • Other possible causes are ruled out
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11
Q

What other test is used to diagnose MS?

A

CSF specfic oligoclonal bands

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12
Q

Clinical features of MS

A

Optic neuritis

brainstem/cerebellar dysfunction

pyramidal symptoms

spinal cord invovlement

fatigue

Heat intolerance

Cognitive dysfunction

depression

sexual dysfunction

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13
Q

Optic neuritis

A

Visual loss

pain with eye movement

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14
Q

brainstem cerebellar dysfunction

A

Ataxia, dysarthria, intention treamor, nystagmus

balance dysfunction

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15
Q

Pyramidal symptoms

A

Paresthesia

Spasticity/Spams

Loss of dexterity

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16
Q

Spinal cord Involvement

A

Spasticity/flaccidity

Sensory loss

Motor loss

Loss of bowel and bladder control

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17
Q

What is considered good prognosis?

A

few attacks, good recovery from attacks

Relapsing remitting

early medical management

<35 years

women better prognosis men

longer duration between exacerbations

1 impairment during year

remission of initial impairments

18
Q

What is considered poor prognosis?

A

multiple attacks

poor recovery

primary progressive

pyramidal

brainstem signs

cerebellar signs

Spincter impairments

19
Q

What are the most common problems with MS?

A
  • Fatigue
  • Walking/balance
  • Bowel/bladder
  • Pain/abnormal sensation
  • visual disurbance
  • Cognitive dysfunction
  • Ataxia
20
Q

What is the difference between acute and chronic fatigue?

A

Acute: Fatigue that has been present on > 50% of days

  • Significant development or increase in fatigue in the past 6 weeks
  • Fatigue that limits ADLS and QoL

Chronic: last longer than 6 weeks

21
Q

What questionnaire is used to measure fatigue?

A
  • MFIS for fatigue in people with MS

21 items

  • past 4 weeks
22
Q

What questionaire for MS Gait?

A
  • Expanded disability status scale (EDSS)

0 - .4 walk with out assistance

4 - 7.5 primarily walking distance and assistance levels

6 = cane

7.5 - 9.5 determinants are ability to transfer from WC to bed and self care

10 = Death

23
Q

Balance objective measures for MS

A

Acitivities specific balance confidence scale

Berg balance

Functional Reach

24
Q

MS pain findings

A
  • headache
  • neuropathic extremity pain
  • LBP
  • Lhermittes sign
  • Trigeminal Neurlgia

From Dysesthesia (burning, tingling, aching, throbbing, banding)

25
Q

Describe sensory loss in the spine and brain in MS

A

Spinal = dermatomal

Brain = homunculus distribution

26
Q

What is weakness in MS?

A

Axonal damange

Reduced force production

peripheral fiber changes

Disuse atrophy

TEST: MMT, Dynamometry

27
Q

How would you test for MS spasticity?

A
  • Modified Ashworth, Tardieu
  • ROM: Flexibility
  • goniometry
28
Q

What are signs of Cerebellar involvement?

A
  • Ataxia
    • Dysdiadokinesia - timing of agonist/antagoninst
    • Rebound - delayed response
    • Dysmetria - amplitude
    • Dyssenerggia - sequencing
  • Intention tremor
  • Hypotonia
  • Vestibular inputs to cerebellum
29
Q

How do you test for disdiadokinesia?

A

Rapid alternating pronation/supination

walk fast (makes gait impairment more pronounced)

30
Q

What is testing for rebound?

A

Resist flexion of joint and let go

31
Q

Test for dysmetria?

A

Figer to nose, heel to shin

Peg test

circle trace

32
Q

Dyssnergia testing

A

touch heel to opposite knee, hand to opposite elbow in supine

Duela task

33
Q

What is testing for intention tremor?

A

pt moves finger forward or foot toward finger or target

34
Q

Test for hypotonia

A

passive lumb mobement

muscle palpation

DTRs

Hold object while conversing

35
Q

What are the 3 predictors of participation limitations?

A

Fatigue

Physical function

Psycholigical variables

36
Q

What are the goals of PT?

A

functional independance

Safety

Qol

Provide resources: equipment needs, community support, programs education

37
Q

What is the goal of PT after a relapse attack?

A

Return to baseline function

may wait after a couple weeks onset to resume therapy

38
Q

What is the PT goal after progressive disease?

A
  • Avoid deconditioning
  • maximize independent function
  • assesing for mobility aids
39
Q

What is the goal of PT with advanced disease?

A

Seated trunk postioning/control

transfers

upper limb and function

respiratory function

Equipment needs

40
Q

What is the general guideline for exercising with MS?

A

mild to mod disability

30 min moderate intensity aerobic activity

2 x week

Neuromuscular Practice II (4 decks)

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