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NMR II > Clinical Management of MS > Flashcards

Clinical Management of MS Flashcards

1
Q

Name some Clinical Manifestations of MS

A
  • Fatigue
  • Sensory Disturbances
  • Motor Impairments
  • Bowel & bladder
  • Sexual dysfunction
  • Cognitive Impairments
  • Depression
  • Heat intolerance
  • Visual Disturbances
  • Communication Limitations
  • Various Secondary Limitation
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2
Q

Name some functional observations that should be made during an examination of a patient with MS

A
  • Bed mobility
  • Transitions
  • Transfers
    -Ambulation/Stairs/Ramps/Curbs
  • Wheeled Mobility
  • ADLs/IADL’s
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3
Q

What are some ways to examine strength & muscular endurance in patients with MS

A
  • MMT
  • Functional Strength Assessment
  • Repeated Movement Testing
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4
Q

What testing will give you the most information about fatiguability?

A

Repeated Movement Testing

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5
Q

What are some SOMs to examine postural control/balance?

A
  • ABC
  • BERG*
  • Mini Best
  • DGI
  • Functional Reach Test
  • Rivermead Mobility Index
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6
Q

Name some things that you should examine when looking at a patient sensiormotor impairments

A
  • Superficial
  • Deep
  • Cortical
  • Pain
  • Vision
  • Cranial Nerves
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7
Q

When examining pain in a patient with MS what might you be on the look out for?

A
  • Provoking stimuli
  • Headache
  • Hyperpathia
  • Dysesthesias
  • Trigeminal Neuralgia
  • Lhermitte’s Sign
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8
Q

What is the MFIS used for?

A
  • Modified Fatigue Impact Scale
  • Self report: measuring physical, cognitive, psychosocial function
  • Examines past 4 weeks
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9
Q

Name some test & measures to examine gait

A
  • 12 Item MS Walking Scale*
  • Timed 25’ Walk Test*(T25FW)
  • FGA
  • TUG
  • 6MWT, 2MWT
  • SWOC
  • Stair/curb negotiation
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10
Q

What does the RIvermead Mobility Index examine? Does higher score indicate higher or lower function)

A
  • Balance
  • Higher score = higher function
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11
Q

If a patient scores a 6 on the EDSS what does this indicate?

A
  • Require walking device
  • Any score below not using AD
  • Any score above they are
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12
Q

What SOM is used for Disease Specific Measures for MS? (Gold standard for disability)

A

Expanded Disability Status Scale (EDSS)

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13
Q

What score on the EDSS indicates highest risk of falling?

A

Scores of 4-6

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14
Q

Name some key things that are included in the EDSS?

A
  • Able to walk w/o aid or rest for 500 m
  • Essentially restricted to w/c
  • Restricted to bed much of day
  • Has some effective use of arms
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15
Q

Name some additional disease specific measures for MS

A
  • Multiple Sclerosis Quality of Life - 54 (MSQOL-54)
  • MS Quality of Life Inventory (MSQLI)
  • Multiple Sclerosis Impact Scale (MSIS-29)
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16
Q

How is the diagnosis of MS made?

A
  • McDonald Criteria (medical)
  • Motor sx use lables that identify “impact of condition on function at the level of the system)
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17
Q

Why is the prognosis of MS greatly variable?

A

Rate of progression affected by multiple intrinsic & extrinsic factors

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18
Q

Name some unfavorable thing that affect the PT prognosis

A
  • Male after 40 yr of age
  • Initial sx involving cerebellum, mental function, urinary control affecting multiple regions
  • Frequent or short time b/w exacerbation w/ incomplete remissions
  • Obesity
  • Smoking
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19
Q

Name some favorable things that affect the PT prognosis

A
  • Female before 40 yrs of age
  • Initial sx sensory only
  • Involvement of only on CNS region
  • Full recovery
  • Absence/ late onset cerebellar sx
  • BMI WNL; No smoking
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20
Q

What is usually the COD in patients with MS?

A
  • Pneumonia
  • Infections
  • Falls/fear of falling
  • Suicide
  • Heart disease due to inactivity
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21
Q

T/F: Physical activity & exercises is now considered to be disease modifying (considered neuroprotective)

A

True
- Reduced relapse rate
- Decreased mobility disability & progression
- Decreased lesion volume & load

22
Q

What are the most common clinical presentation of MS?

A
  • Fatigue
  • Walking Difficulty
  • Numbness, tingling
  • Pain
  • Muscle Spasms
23
Q

What of the musculoskeletal system should be examined in pts with MS?

A
  • AROM/PROM
  • Strength & Muscular Endurance
  • Posture
24
Q

What types of postures should be examined in patients with MS?

A

Functional positions for that specific patients

25
Q

What of the neuromuscular system should be examined in patients with MS?

A
  • Tone
  • DTRs & Reflexes
  • Cerebellar signs
  • Postural Control
  • Vestibular
  • Dual Task/Motor Planning
26
Q

What of the cardiopulmonary system should be examined in patients with MS?

A
  • Vitals (HR, BP, RR)
  • Response to Exercise (links to body temp)
  • Perceived exertion (RPE, Dyspnea Scale)
  • Respiratory strength (max inspiratory & expiratory pressure)
27
Q

When examining of the cognition/Affect of a patient with MS what should be examined?

A
  • Memory & attention (DUAL TASK)
  • Reasoning & Problem Solving
  • Stress/anxiety/coping strategies
  • Sleep disorders
  • Safety awareness
28
Q

What questionnaire can be used to examine cognition/affect of a patient with MS?

A
  • Mini Mental Status Exam
  • Minimal Examination of Condition Function in MS
  • Beck Depression Inventory
29
Q

When examining Fatigue & Fatiguability in patients with MS what should be examined?

A
  • Frequency
  • Duration & Severity
  • Precipitating & Relieving Factors (examine in both fatigued and fresh states)
  • Activity levels & efficacy of rest attempts
30
Q

What scales can be used to measure fatigue & fatiguability in patients with MS?

A
  • Modified Fatigue Impact Scale
  • VAS for Fatigue
  • Fatigue Scale for Motor & Cognitive Functions
31
Q

When examining skin integrity in patients with MS what should be examined?

A
  • Areas of insensitivities
  • Bruising or breakdown
  • Cotinence
  • Positioning
  • Pressure relieving strategies
  • Safety awareness
32
Q

When examining orthoses & AD in patients with MS, what should be examined?

A
  • Alignment & fit
  • Practicality & Ease of use
  • Energy Conversation vs Expenditure
  • Safety
  • Functional performance
33
Q

What are some ways to examine balance in patients with MS?

A
  • Static & Dynamic Balance Exam
  • Riverbed Mobility Index (RMI)
34
Q

Environmental examination for patients with MS include?

A
  • Barriers & Facilitators
  • Safety
  • Access
35
Q

Fine Motor Skills examination of patients with MS include?

A
  • Grip strength
  • Manual Dexterity
  • Impact on ADLs
  • 9 Hole Peg Test
36
Q

What specific test used to examine fine motor skills?

A

9-Hole Peg Test

37
Q

What are the general considerations in treatment of patients with MS?

A
  • Minimize relapse risk & disability progression, & sx management to improve function & QOL
  • Sub max intensity w/ more reps & scheduled rest which address multiple needs of patient
  • Intermittent training will allow more reps = plasticity
  • Avoid overheating & fatigue
  • Schedule & self-monitoring
38
Q

Why can heat intolerance lead to “pseudo exacerbation”?

A

Increase temps = decrease nerve conduction in demyelinated nerves

39
Q

How should treatment sessions be structured to take care of fatigue in patients with MS?

A
  • Address multiple impairments simultaneously
  • Energy conservation & activity pacing
  • Scheduling considerations
40
Q

What are some intervention strategies to address visual deficits?

A
  • Tinted glasses
  • Prism glasses
  • vision clinic
  • Environmental
  • Lighting
41
Q

What are some intervention strategies to address proprioceptive deficits?

A
  • WB
  • Compression
  • Approximation
  • Resistance
  • Tapping
  • Verbal cues
  • Biofeedback
42
Q

What a is a general way to address sensory deficits?

A

Sensory diets & programs

43
Q

What are some interventions to maintain skin integrity?

A
  • Pressure relieving strategies & equipment
  • Inspection
  • Cleaning
44
Q

What are some intervention strategies to address spasticity & ROM?

A
  • NDT/PNF techniques/ MRP (active < passive when possible stretching/ROM)
  • Stretching/ ROM exercise
  • Modalities
  • Positioning
  • Yoga, Tai Chi
45
Q

What are some interventions strategies to address strength & conditioning?

A
  • “progressive” resistance training
  • Functional approach
  • Functional Electrical Stimulation Device
  • Complementary approaches (Yoga demonstrating improved LE strength)
  • Group exercise
  • Gait training & cycling
  • Whole body vibration platform training
  • Respiratory strengthening
  • Bowel & Bladder strengthening
46
Q

What are some intervention strategies to address balance/ postural control & coordination?

A
  • Vestibular, strength, sensorimotor, spasticity, alignment
  • Static/dynamic postural control activities
  • Coordination activities
  • Gait training under dual task & altered sensory conditions
  • Aquatic therapy
  • Video game
47
Q

What are some intervention strategies to address gait training?

A
  • Address underlying impairments
  • Speed intensive training intervals
  • BWSTT
  • Robotic assisted gait training
48
Q

What are is the key to pain management in patients with MS?

A

Address underlying cause

49
Q

What are some intervention strategies for cognitive training in patients with MS?

A
  • Dual task activities
  • Mental rehearsal
  • Memory aides
  • Timing device
  • Environmental strategies
  • Feedback strategies
50
Q

What are some intervention strategies to address psychosocial management?

A
  • Continual readjustment to uncertainty
  • Enhance self- efficacy
  • Referrals
51
Q

What should be included in education for patients with MS?

A
  • Disease process, energy conservation, activity pacing
  • Negotiation of health care system
  • Health & wellness
  • Community resources
  • Referral

NMR II (14 decks)

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