L2 Multiple Sclerosis

Question 1

Multiple Sclerosis

Answer 1

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

Question 2

MS and Black Community

Answer 2

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

Question 3

MS and Hispanic Community

Answer 3

more cases than currently recognized

may impact hispanic people differently

diagnosed at younger age, more likely to have severe MS with more debility

Question 4

Causes of MS

Answer 4

genetic susceptibility
infections factors and virus
environmental factors

Question 5

Vitamin D and MS

Answer 5

those with higher levels of vitamin D and spend longer time in the sun are less likely to develop MS

Question 6

Destruction patterns in MS plaque

Answer 6

1. Cytotoxic attack of myelin sheath via t cell and macrophage inflammation
2. Damage of axon and oligodendrocyte is mediated by cytotoxic products of macrophages

Question 7

Diagnosis of MS

Answer 7

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

Question 8

CP of MS

Answer 8

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

Question 9

What is usually the first symptom of MS?

Answer 9

vision problems

Question 10

Secondary Problems of MS

Answer 10

repeated UTI due to bladder dysfunction

loss of muscle tone, weakness, poor posture, decreased bone density due to inactivity

pressure ulcer

Question 11

Expanded Disability Status Scale

Answer 11

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

Question 12

EDSS Score Range

Answer 12

0-4.5 = impairment to function
5-9.5 = impairment to walking
10 = death

Question 13

Types of MS

Answer 13

Clinically Isolated Syndrome
Relapsing remitting MS
Secondary Progressive
Primary Progressive

Question 14

Clinically Isolated Syndrome CIS

Answer 14

-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

Question 15

Relapsing Remitting MS RRMS

Answer 15

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

Question 16

Secondary Progressive MS

Answer 16

-can develop from RRMS
-disability increases over time, with or without signs of disease activity
-course of disease is to worsen over time

Question 17

Primary Progressive MS

Answer 17

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

Question 18

Medical Treatment for MS

Answer 18

can be medications to modify disease course by modulating or suppressing the inflammatory reactions of the disease or medications to manage symptoms of MS

Question 19

Mild Exacerbations are…

Answer 19

generally not treated

Question 20

Severe exacerbations are

Answer 20

treated with a 3 to 5 day course of corticosteroids such as IV solu-medrol or oral prednisone

Question 21

Exacerbation

Answer 21

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

Question 22

Pseudo-Exacerbation

Answer 22

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

Question 23

Possible triggers for pseudo-exacerbation

Answer 23

-increased core body temp due to infection
-heat or humidity (as little as .5° C change)
-exercise
-bladder or bowel fullness
-UTI

Question 24

PT and Diagnosis of MS

Answer 24

-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

Question 25

During periods of stability and PT

Answer 25

-check for adherence to exercise and PA recommendations
-monitor physical performance and impairments to help guide home exercise program

Question 26

During and after periods of relapse and PT

Answer 26

-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

Question 27

During MS Disease Progression and PT

Answer 27

-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

Question 28

Advanced MS and PT

Answer 28

-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

Question 29

Modified Fatigue Impact SCale

Answer 29

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

Question 30

MS Quality of Life

Answer 30

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

Question 31

Potential impact of spasticity and loss of ROM

Answer 31

-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

Question 32

Treatment for MS will be

Answer 32

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

Question 33

Two hour rule

Answer 33

if patient does not feel like they have recovered from exercise within 2 hours, they did too much

Question 34

Energy Conservation and Pacing for MS

Answer 34

-effective for managing fatigue, especially during flares
-simplify tasks
-using adaptive equipment
-modifying environment
-strategic rest breaks

Question 35

4 Ps of Energy Conservation

Answer 35

pacing
planning
prioritizing
positioning

Question 36

Strengthening for MS

Answer 36

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

Question 37

High intensity resistance training for MS

Answer 37

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

Question 38

Aerobic Exercise Training for MS

Answer 38

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

Question 39

resistance vs aerobic for MS

Answer 39

AT and RT equally effective in improving LE physical function and perceived fatigue

Question 40

Respiratory Function

Answer 40

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