L2 Multiple Sclerosis Flashcards
Multiple Sclerosis
disease where the immune system mistakenly attacks myelin in the CNS
has a variety of CP. rarely fatal and most people have normal life expectancy
S/S onset occurs between 20 to 40, most likely females
MS and Black Community
more black people have MS than previously thought
low levels of vitamin D are associated with MS, black skin is often not seen to have vitamin D deficiency
black people might face more aggressive progression and greater disability. Poorer recovery
MS and Hispanic Community
more cases than currently recognized
may impact hispanic people differently
diagnosed at younger age, more likely to have severe MS with more debility
Causes of MS
genetic susceptibility
infections factors and virus
environmental factors
Vitamin D and MS
those with higher levels of vitamin D and spend longer time in the sun are less likely to develop MS
Destruction patterns in MS plaque
- Cytotoxic attack of myelin sheath via t cell and macrophage inflammation
- Damage of axon and oligodendrocyte is mediated by cytotoxic products of macrophages
Diagnosis of MS
lesions occur in the white matter of brain, which show up brighter in MRI
lumbar puncture helps to rule out other diseases
evoked potential tests to measure how quickly the nervous system can react to stimulation
CP of MS
S/S are directly related to where plaques have formed
common include fatigue, bladder dysfunction, UMN weakness, sensory changes, vision problems, cognitive changes, depression, vertigo, ataxia
What is usually the first symptom of MS?
vision problems
Secondary Problems of MS
repeated UTI due to bladder dysfunction
loss of muscle tone, weakness, poor posture, decreased bone density due to inactivity
pressure ulcer
Expanded Disability Status Scale
Scale used by neurologists to quantify the severity of disability and to document change in disability over time
ranges from 0 to 10, with higher score indicating more disability
EDSS Score Range
0-4.5 = impairment to function
5-9.5 = impairment to walking
10 = death
Types of MS
Clinically Isolated Syndrome
Relapsing remitting MS
Secondary Progressive
Primary Progressive
Clinically Isolated Syndrome CIS
-S/S last at least 24 hours
-high risk of developing RRMS if MRI shows plaques
S/S = vision problems, vertigo, loss of face sensation, weakness in extremities, ataxia, bladder issues
Relapsing Remitting MS RRMS
most common, 85% at initial dx have this
clearly defined attacks or new or increasing neurologic symptoms (relapses)
followed by periods of remission, where disease does not progress during this
Secondary Progressive MS
-can develop from RRMS
-disability increases over time, with or without signs of disease activity
-course of disease is to worsen over time
Primary Progressive MS
neurologic function worsens or disability accumulates as soon as symptoms appear, without early relapses or remissions
only about 15% of people with MS have PPMS
Medical Treatment for MS
can be medications to modify disease course by modulating or suppressing the inflammatory reactions of the disease or medications to manage symptoms of MS
Mild Exacerbations are…
generally not treated
Severe exacerbations are
treated with a 3 to 5 day course of corticosteroids such as IV solu-medrol or oral prednisone
Exacerbation
new or worsening S/S lasting at least 24 hours
usually associated with inflammation and demyelination in the CNS
separated from last esacerbation by at least 30 days
Pseudo-Exacerbation
Temporary flare-up of symptoms lasting less than 24 hours
symptoms nots associated with CNS inflammation or damage
symptoms return to baseline when trigger is minimized or eliminated
Possible triggers for pseudo-exacerbation
-increased core body temp due to infection
-heat or humidity (as little as .5° C change)
-exercise
-bladder or bowel fullness
-UTI
PT and Diagnosis of MS
-PT should educate pt to stay active, mobile, safe, and comfortable
-establish baseline of performance and impairments
-determine evidence based exercise and physical activity program
During periods of stability and PT
-check for adherence to exercise and PA recommendations
-monitor physical performance and impairments to help guide home exercise program
During and after periods of relapse and PT
-intensive therapy to help restore previous level of function
-initial exam/eval may be abbreviated because of fatigue
-assess need for AD, adaptive equipment, to help individual optimize safety and independence
-provide support, while providing hope and optimism
During MS Disease Progression and PT
-overarching goal is to maintain safety and functional independence, with adaptive equipment
-continue to encourage exercise and PA, making adjustments to their current capacity
-be sensitive to emotional and social impact of disease progression
-cognitive impairments will become more prominent as disease progresses. may need to include care partner, smart phone apps, reminders, written instructions
Advanced MS and PT
-significant disease burden with progression of physical, emotional, and cognitive issues
-non-ambulatory and increased risk for secondary health conditions
-support family and caregivers with wellness strategies
-focus on functional improvements, like respiratory exercises, equipment, etc
Modified Fatigue Impact SCale
Questionnaire that assesses the effects of fatigue in terms of physical, cognitive, and psychosocial functioning
has 21 items, score ranges 0-84. Higher score indicates greater fatigue
MS Quality of Life
common multidimensional health related QOL measure that combines generic and MS specific items into a single instrument
has a physical and mental health score
higher score indicates higher QOL
Potential impact of spasticity and loss of ROM
-increased energy cost of movement
-cause movement errors with gait and transfers
-poor posture/positioning
-safety problems
-contractures
-pain
-sleep interruption
-skin breakdown
-interference with self-catheterization and hygiene
-interference with breathing
Treatment for MS will be
driven by the impairments experienced by the patient
can be recovery, compensation, slow loss of function, maintenance, driven by stage of disease and expected recovery
Two hour rule
if patient does not feel like they have recovered from exercise within 2 hours, they did too much
Energy Conservation and Pacing for MS
-effective for managing fatigue, especially during flares
-simplify tasks
-using adaptive equipment
-modifying environment
-strategic rest breaks
4 Ps of Energy Conservation
pacing
planning
prioritizing
positioning
Strengthening for MS
should be 2-3 times a week
1-3 sets, 8-15 reps at 60-80% 1 RM
can be resistance, weights, bands
should alternate UE/LE to avoid fatigue. Prioritize large multi joint muscle groups first
High intensity resistance training for MS
Frequency: 2x/wk
Intensity: High more than 80% 1 RM
Type: Weights
Time: > 6 weeks
this dose has positive impact on TUG, walking endurance, gait speed, and balance
Aerobic Exercise Training for MS
RPE = 3-5/10
20-30 min, 3-4 days/week
shorter sessions, multiple times a day for cuulative effect is better for fatigue
vigorous exercise should be avoided during exacerbation
resistance vs aerobic for MS
AT and RT equally effective in improving LE physical function and perceived fatigue
Respiratory Function
20-80% of people with MS have inspiratory and expiratory muscle weakness
present with early and chronic MS
respiratory muscle training 3 times/week for 30 minutes
