Final: MS Flashcards
What are the 10 main clinical manifestations of MS?
- Fatigue
- Sensory disturbances
- Motor impairments
- Bowel and Bladder
- Sexual dysfunction
- Cognitive impairments
- Depression
- Heat intolerance
- Visual disturbances
- Communication limitations
What is another terms for heat intolerance?
Uthoff’s symptom
What are three common motor impairments associated with MS?
Ataxia, intention tremors, spasticity
What is included in functional observation for a pt with MS?
Bed mobility, transitions, transfers, ambulation, wheeled mobility, ADLs
What are some things to consider when taking a history for a pt with MS?
Process of diagnosis, course of disease, current level of function, falls, medications, driving status, environment, social support, specialist involvement, fatigue
What are examples of specific system level impairment questions to ask a pt with MS?
- Heat intolerance
- Vision
- Vertigo, dizziness
- Pain, sensory changes
- Memory or cognition
- Emotional or mood problems
- GI
- Speech or swallowing
- Stiffness and spasms
- Breathing or coughing
What are the three key musculoskeletal assessments for MS?
- AROM/PROM
- Strength and muscular endurance
- Posture
Why is it important to assess both strength and muscular endurance for MS pts?
Fatigability
What does repeated movement testing assess in MS patients?
Fatigability
What neuromuscular assessments should you perform when examining a pt with MS?
Tone, DTR, reflex, CN, cerebellar, postural control, vestibular, dual task
How do you document tone?
Modified Ashworth Scale
How should you assess the cerebellum with a pt with MS?
Metria, diadokokinesia, rebound
What balance related STOMs are indicated for a MS patient?
Berg, Mini-BEST, DGI, Functional reach, Rivermead
What is Lhermitte’s Sign?
MS sign that is the sensation of an electric shock going through the whole body
What types of pain is associated with MS?
Provoking stimuli, headache, hyperpathia, dysesthesias, trigeminal neuralgia, Lhermitte’s
What visual impairments are associated with MS?
Acuity, tracking fields, accommodations
What cardiopulmonary tests and measures should be included when assessing a pt with MS?
Vitals, response to exercise, perceived exertion, respiratory strength
What cognitive components are important to include when examining a pt with MS?
Memory and attention, reasoning and problem solving, stress, coping, sleep, safety awareness
What STOMs can be used to assess cognition in pt’s with MS?
Mini Mental Status, Minimal Examination of Cognitive Function, Beck Depression Inventory
What characteristics are important to consider when assessing fatigue and fatigability?
Frequency, duration and severity, aggravating and easing factors, activity levels and efficacy of rest attempts
What tools can be used to assess fatigue?
1.Modified Fatigue Impact Scale
2. VAS for Fatigue
3. Fatigue Scale for Motor and Cognitive Functions
What does MFIS stand for?
Modified Fatigue Impact Scale
What is the MFIS?
Self report measure of physical, cognitive, and psychosocial function
What is the cutoff on the MFIS to distinguish between fatigued and non-fatigues patietns?
38
What are important factors when examining skin integrity?
Areas of insensitivities, bruising and breakdown, continence, positioning, pressure relieving strategies, safety awareness
What is the gold standard for assessing gait?
Basic gait observation
What gait related STOMs are applicable to MS?
- 12-item MS Walking Scale
- Times 25’ Walk Test
- FGA
- TUG
- 6MWT and 2MWT
- SWOC
- Stair and curb negotiation
What balance examinations are applicable for a pt with MS?
Static and dynamic balance, Rivermead
What does RMI stand for?
Rivermead Mobility Index
Describe the RMI
14 self-report and 1 performance based measure that examines gait, balance, and transfers
What does a higher score on the RMI indicate?
Higher function
How can you examine fine motor skills with a pt with MS?
Grip strength, manual dexterity, ADL impact, 9 hole peg test
What does EDSS stand for?
Expanded Disability Status Scale
What is the EDSS?
Objective approach to quantify level of function in eight functional system scores
What does FSS stand for in relation to the EDSS?
Functional system score
How are FSS’s scored?
0-5, 5 indicating high level of problems
What does 0 - 3.5 indicate on the EDSS?
Little to mild disability
What does 4 - 6.5 indicate on the EDSS?
Moderate disability
What does 7 - 9.5 indicate on the EDSS?
Severe disability
Describe the presentation of a pt that scores a 6 on the EDSS?
Requires a walking aid, cane, or crutch to walk 100 m
Describe the presentation of a pt that scores a 4 on the EDSS?
Able to walk without aid or rest for 500 m
Describe the presentation of a pt that scores a 7 on the EDSS?
Essentially restricted to a wheelchair
Describe the presentation of a pt that scores an 8.5 on the EDSS?
Restricted to bed for most of the day, some effective use of arms
What are three additional specific outcome measures for MS?
- MSQOL-54
- MSQLI
- MSIS-29
How is MS officially diagnosed?
McDonald Criteria
What is the prognosis for MS?
Great variability based on the rate of progression that is affected by multiple intrinsic and extrinsic factors
What are the four types of MS?
- Clinically Isolated Syndrome
- Relapsing Remitting MS
- Secondary Progressive MS
- Primary Progressive MS
What 5 types of pt’s are likely to have an unfavorable prognosis?
- Male, > 40
- Initial symptoms involving cerebellum, mental function, urinary control, multiple regions
- Frequent or short time between exacerbations with incomplete remission
- Obesity
- Smoking
What 6 types of pt’s are likely to have a favorable prognosis?
- Female, < 40 yrs onset
- Initial symptoms sensory only
- Involvement of only one CNS region
- Full recovery
- Absent or late onset cerebellar symptoms
- BMI WNL, no smoking
What is the medial life expectancy for MS compared to the general population?
MS: 74.4
General population: 81.8
What is the median survival rate from disease onset for MS?
41 years
What do people with MS usually die as a result of?
Pneumonia, infection, falls, suicide, heart disease due to inactivity
What does the evidence suggest in terms of exercise for MS?
It is disease modifying and considered to be neuroprotective - reduced relapse rate, decreased mobility disability and progression, decreased lesion volume and load
What are the 5 general considerations for treatment for a pt with MS?
- Minimize relapse risk and disability progression and symptom management to improve function and QOL
- Submax intensity with more repetitions and schedules rest which address multiple needs of the patient
- Scheduling
- Overheating and fatigue
- Self-monitoring
How should you structure interventions to address fatigue in pt’s with MS?
Address multiple impairments simultaneously, aerobic and endurance training, heat intolerance, energy conservation and activity pacing, scheduling
What types of MS sensory deficits can you address with interventions?
Visual, proprioception, sensory diets and programs, skin care
What interventions target spasticity and ROM with MS?
NDT, PNF, stretching, phys agents, positioning
What are strength and conditioning interventions for pt’s with MS?
Progressive resistance training, functional, e-stim
When performing strength and conditioning training with an MS pt, should you exercise to the point of fatigue?
No
What is the key to strength and endurance training when treating a pt with MS?
Use intermittent training
Is exercise an accepted disease modifying treatment?
Yes
What are examples of balance and coordination interventions for MS patients?
Vestibular, strength, sensorimotor, static and dynamic balance, gait training, aquatics
What should be considered when performing gait training with pt’s with MS?
Speed intensive training intervals, body weight supported treadmill training, robotic assisted
What are examples of pain management interventions for pt’s with MS?
Address underlying cause, stretching, stress management, TENS, massage, hydrotherapy, ultrasound, postural
What are examples of cognitive training for pt’s with MS?
Dual task, mental rehearsal, memory aids, timing devices, environmental modification, feedback strategies
What education should be provided to pt’s and their families?
Disease process, energy conservation, activity pacing, navigation of health care system, health and wellness, community resources, referrals
What leads to maladaptive changes with MS?
Immobility, not performing tasks, not using systems - some disability can be learned
What is the effect of intermittent training in pt’s with MS?
Decreased reports of fatigue and increased distance ambulated
What is the purpose of cooling during training with pt’s with MS?
Prevent heat build up to maintain adequate nerve conduction
What are general aerobic exercise recommendations for pt’s with mild to moderate MS?
2-3 days per week, gradually increase duration. 11-13 RPE exercise with ergometry, walking, aquatics, elliptical
What are advanced aerobic exercise recommendations for pt’s with mild to moderate MS?
5 days per week, duration of around 40 minutes. Intensity of a 15/20 on RPE. Same exercises but can progress to running or road cycling
What are general resistance exercise recommendations for pt’s with MS?
2-3 days per week, 1-3 sets of 8-15 reps. 5-10 resistance exercises
What principles of neuroplasticity apply to MS?
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity matters
- Salience
