exam 3: MS Flashcards
approximately 80% of pts. with MS experience _________ symptoms.
approximately 70% of patients experience _________ impairments.
visual
cognitive
Patients with MS often deal with fatigue as a barrier so as a PT you should perform examination with _________ position changes and use few but appropriate ________
minimal; outcome measures
Screening tests sensitive for MS:
Phonation test (ahhh 20 secs.)
Kinesthesia test (deep sensation, joint in space)
what are two functional mobility outcome measures for MS?
9-hole peg test
four square step test
what are two postural stability outcome measures for MS?
berg balance scale
dizziness handicap inventory (outpatient only)
what are three gait examination outcome measures for MS?
timed 25 foot walk test
12-item MS walking scale
TUG with dual task challenges
what are two endurance and fatigue outcome measures for MS?
6MWT
modified fatigue impact scale
what is a benefit of using the 12 item MS walking scale outcome measure?
a walking outcome measure that does not require activity which could be fatiguing to the patient, however, still gives therapist a sense of areas or situations that are most difficult or dangerous for patient
MSWS-12 scoring:
12-100
greater number = greater disability
what does the MS impact scale measure?
QOL questionnaire which measures the physical and psychological impact of MS on daily life
- self report
MSIS:
- # of questions
- subcategories
- benefit of this vs MSQOL
- scoring
- 29
- physical and psychological impact
- shorter
- 1 = no impact 5 = extreme impact
higher scores = greater impact of disease on QOL
what is the dizziness handicap inventory (DHI)?
self-assessment questionnaire that quantifies the impact of dizziness on daily life by measuring self-perceived handicap
DIH:
- population?
- setting?
- three domains:
- scoring:
- non specific, general population
- outpatient only
- functional (9), emotional (9), physical (7)
- 0=no, 2=sometimes, 4=yes
0-100 –> 100 = worse score
higher score = greater perceived impact of dizziness on mobility or emotional impact
what is the MS quality of life?
multidimensional health related quality of life measure that combines generic and MS specific items into a single measure with 12 subscales
MS QOL:
- scoring
- benefit?
- covers?
- low scoring preferred –> high score = MS has high impact on QOL
- easy to administer (10-15 min)
- broad range of domains of health related QOL
what is the medical outcomes study short form 36? (SF-36)
generic patient reported outcome measure that quantifies health status and measures health related quality of life
SF-36:
- ___ subscales and ____ domains
- scoring
- 8; 2
- 0 = negative health 100= positive health
each subscale can be used independently
what is the modified fatigue impact scale?
self report assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning
MFIS:
- population
- full length has ___ items, short has ___
- why is it not highly recommended?
- subscales
- scoring
- MS specific
- 21; 5
- not free
- physical, cognitive, psychosocial
- 0 = never, 4 = almost always fatigued
total score = 0-84 ; shortened = 0-20
higher numbers indicate greater fatigue
multiple sclerosis functional composite:
- addresses:
- population:
- setting:
- limitations of prior existing functional status outcomes
- MS specific
- outpatient only
MSFC:
- what are the 3 component parts?
- scoring:
- timed 25-foot walk test, 9-hole peg test, 3 second version of paced auditory serial addition test * audio tape
- Z-scores –> SD in positive indicates worse than the mean, SD in negative means better than avg person with MS
what is the most commonly used standardized test of walking performance in MS that measures mobility and LE function?
timed 25 foot walk test
scoring for T25FWT?
average of 2 timed trials for walking a distance of 25 feet
no cut off scores
what is the four square step test?
test of dynamic balance and coordination that clinically assesses the participant’s ability to step over objects forward, sideways and backwards
physical therapy interventions for MS focus on:
–> primary goal for therapy is to ______
improving strength, mobility, aerobic capacity, QOL
–> prevent inactivity as disease progresses
for chronic, progressive MS therapy interventions are mainly focused on what type?
compensatory
rehabilitation for MS should be initiated ____-
EARLY - at diagnosis
what are some neuroplastic interventions for MS patients?
salient
sufficient repetition
intensity in dosing and challenge
benefits of stretching for MS patients:
pain management
correction of faulty movie patterns
spasticity reduction
prevent loss of ROM
Therapeutic pain management for MS:
lukewarm water pool therapy
pressure stockings and gloves for dysesthesias
DO NOT USE TENS
what interventions can you do for somatosensory loss for MS?
barefoot interventions
resensitization exercises for finger dexterity
what interventions can you do for vision loss for MS?
- restoration
- compensation
- eye patching strategies, low light
- promote safety, house well lit
what type of exercise is recommended for fatigue management?
intermittent (longer rest breaks for recovery) but can perform a greater volume of exercise if exercising intermittently (massed)
true or false. neurogenic fatigue equals perceived CV fatigue
false - does not
what is Uhthoff’s phenomenon?
increases or presence of neurological symptoms in response to heating or becoming overwhelmed by increased body temp
what are interventions strategies during exercise to manage heat sensitivity?
cooling garments
drink cold fluids
what can you do for bladder control interventions?
pelvic floor interventions
timed voiding schedule
walking interventions for MS:
- outcome measures:
- use ____ to test in fatigued and nonfatigued state
- common impairments with MS
- DGI/FGA/community balance and mobility scale
- 6MWT
- foot drop, diminished hip ext in terminal stance, decreased push off to propel into swing
what is best when building a gait endurance program for MS patients?
intermittent exercise –> instead of walking for 20 minutes without a break, walk 5 minutes with short recoveries
** walk for 5 min, rest, walk for 2 min
what is the most common AD for MS? what about in late stage MS?
canes
wheelchair/powerchair
what are benefits for aquatic therapy for MS?
improves tolerance of exercise and adherence
improves fatigue
improves QOL
what is the most common symptom of MS?
fatigue
your patient is very fatigued by the end of the day and asks if there is anything they can do to conserve energy throughout the day. what are some suggestions you can make?
pace activities with rest breaks
plan ahead –> don’t do all your hard work early in the morning
sit if possible
slide objects vs lifting/carrying
use AD
