Clinical Management of MS Flashcards
Name some Clinical Manifestations of MS
- Fatigue
- Sensory Disturbances
- Motor Impairments
- Bowel & bladder
- Sexual dysfunction
- Cognitive Impairments
- Depression
- Heat intolerance
- Visual Disturbances
- Communication Limitations
- Various Secondary Limitation
Name some functional observations that should be made during an examination of a patient with MS
- Bed mobility
- Transitions
- Transfers
-Ambulation/Stairs/Ramps/Curbs - Wheeled Mobility
- ADLs/IADL’s
What are some ways to examine strength & muscular endurance in patients with MS
- MMT
- Functional Strength Assessment
- Repeated Movement Testing
What testing will give you the most information about fatiguability?
Repeated Movement Testing
What are some SOMs to examine postural control/balance?
- ABC
- BERG*
- Mini Best
- DGI
- Functional Reach Test
- Rivermead Mobility Index
Name some things that you should examine when looking at a patient sensiormotor impairments
- Superficial
- Deep
- Cortical
- Pain
- Vision
- Cranial Nerves
When examining pain in a patient with MS what might you be on the look out for?
- Provoking stimuli
- Headache
- Hyperpathia
- Dysesthesias
- Trigeminal Neuralgia
- Lhermitte’s Sign
What is the MFIS used for?
- Modified Fatigue Impact Scale
- Self report: measuring physical, cognitive, psychosocial function
- Examines past 4 weeks
Name some test & measures to examine gait
- 12 Item MS Walking Scale*
- Timed 25’ Walk Test*(T25FW)
- FGA
- TUG
- 6MWT, 2MWT
- SWOC
- Stair/curb negotiation
What does the RIvermead Mobility Index examine? Does higher score indicate higher or lower function)
- Balance
- Higher score = higher function
If a patient scores a 6 on the EDSS what does this indicate?
- Require walking device
- Any score below not using AD
- Any score above they are
What SOM is used for Disease Specific Measures for MS? (Gold standard for disability)
Expanded Disability Status Scale (EDSS)
What score on the EDSS indicates highest risk of falling?
Scores of 4-6
Name some key things that are included in the EDSS?
- 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
Name some additional disease specific measures for MS
- Multiple Sclerosis Quality of Life - 54 (MSQOL-54)
- MS Quality of Life Inventory (MSQLI)
- Multiple Sclerosis Impact Scale (MSIS-29)
How is the diagnosis of MS made?
- McDonald Criteria (medical)
- Motor sx use lables that identify “impact of condition on function at the level of the system)
Why is the prognosis of MS greatly variable?
Rate of progression affected by multiple intrinsic & extrinsic factors
Name some unfavorable thing that affect the PT prognosis
- 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
Name some favorable things that affect the PT prognosis
- 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
What is usually the COD in patients with MS?
- Pneumonia
- Infections
- Falls/fear of falling
- Suicide
- Heart disease due to inactivity
T/F: Physical activity & exercises is now considered to be disease modifying (considered neuroprotective)
True
- Reduced relapse rate
- Decreased mobility disability & progression
- Decreased lesion volume & load
What are the most common clinical presentation of MS?
- Fatigue
- Walking Difficulty
- Numbness, tingling
- Pain
- Muscle Spasms
What of the musculoskeletal system should be examined in pts with MS?
- AROM/PROM
- Strength & Muscular Endurance
- Posture
What types of postures should be examined in patients with MS?
Functional positions for that specific patients
What of the neuromuscular system should be examined in patients with MS?
- Tone
- DTRs & Reflexes
- Cerebellar signs
- Postural Control
- Vestibular
- Dual Task/Motor Planning
What of the cardiopulmonary system should be examined in patients with MS?
- Vitals (HR, BP, RR)
- Response to Exercise (links to body temp)
- Perceived exertion (RPE, Dyspnea Scale)
- Respiratory strength (max inspiratory & expiratory pressure)
When examining of the cognition/Affect of a patient with MS what should be examined?
- Memory & attention (DUAL TASK)
- Reasoning & Problem Solving
- Stress/anxiety/coping strategies
- Sleep disorders
- Safety awareness
What questionnaire can be used to examine cognition/affect of a patient with MS?
- Mini Mental Status Exam
- Minimal Examination of Condition Function in MS
- Beck Depression Inventory
When examining Fatigue & Fatiguability in patients with MS what should be examined?
- Frequency
- Duration & Severity
- Precipitating & Relieving Factors (examine in both fatigued and fresh states)
- Activity levels & efficacy of rest attempts
What scales can be used to measure fatigue & fatiguability in patients with MS?
- Modified Fatigue Impact Scale
- VAS for Fatigue
- Fatigue Scale for Motor & Cognitive Functions
When examining skin integrity in patients with MS what should be examined?
- Areas of insensitivities
- Bruising or breakdown
- Cotinence
- Positioning
- Pressure relieving strategies
- Safety awareness
When examining orthoses & AD in patients with MS, what should be examined?
- Alignment & fit
- Practicality & Ease of use
- Energy Conversation vs Expenditure
- Safety
- Functional performance
What are some ways to examine balance in patients with MS?
- Static & Dynamic Balance Exam
- Riverbed Mobility Index (RMI)
Environmental examination for patients with MS include?
- Barriers & Facilitators
- Safety
- Access
Fine Motor Skills examination of patients with MS include?
- Grip strength
- Manual Dexterity
- Impact on ADLs
- 9 Hole Peg Test
What specific test used to examine fine motor skills?
9-Hole Peg Test
What are the general considerations in treatment of patients with MS?
- 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
Why can heat intolerance lead to “pseudo exacerbation”?
Increase temps = decrease nerve conduction in demyelinated nerves
How should treatment sessions be structured to take care of fatigue in patients with MS?
- Address multiple impairments simultaneously
- Energy conservation & activity pacing
- Scheduling considerations
What are some intervention strategies to address visual deficits?
- Tinted glasses
- Prism glasses
- vision clinic
- Environmental
- Lighting
What are some intervention strategies to address proprioceptive deficits?
- WB
- Compression
- Approximation
- Resistance
- Tapping
- Verbal cues
- Biofeedback
What a is a general way to address sensory deficits?
Sensory diets & programs
What are some interventions to maintain skin integrity?
- Pressure relieving strategies & equipment
- Inspection
- Cleaning
What are some intervention strategies to address spasticity & ROM?
- NDT/PNF techniques/ MRP (active < passive when possible stretching/ROM)
- Stretching/ ROM exercise
- Modalities
- Positioning
- Yoga, Tai Chi
What are some interventions strategies to address strength & conditioning?
- “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
What are some intervention strategies to address balance/ postural control & coordination?
- Vestibular, strength, sensorimotor, spasticity, alignment
- Static/dynamic postural control activities
- Coordination activities
- Gait training under dual task & altered sensory conditions
- Aquatic therapy
- Video game
What are some intervention strategies to address gait training?
- Address underlying impairments
- Speed intensive training intervals
- BWSTT
- Robotic assisted gait training
What are is the key to pain management in patients with MS?
Address underlying cause
What are some intervention strategies for cognitive training in patients with MS?
- Dual task activities
- Mental rehearsal
- Memory aides
- Timing device
- Environmental strategies
- Feedback strategies
What are some intervention strategies to address psychosocial management?
- Continual readjustment to uncertainty
- Enhance self- efficacy
- Referrals
What should be included in education for patients with MS?
- Disease process, energy conservation, activity pacing
- Negotiation of health care system
- Health & wellness
- Community resources
- Referral
