L6 MS Assessment Flashcards
targeted structure in MS
myelin
how does myelin deteriorate? (what forms and what is the effect?)
sclerotic plaques form in a local region
slow action potentials impairing control of skeletal and smooth muscle and causing weakness/spasticity/sensory loss
why does MS cause fatigue? Primary
neuron require energy metabolism
MS associated with deficient mitochondrial metabolism generating ROS that cause cellular inflammation
mitochondrial injury leading to induction of demyelination and neurodegeneration
Cellular results of mitochondrial dysfunction in MS
respiratory chain deficiency
abn mitochondrial transport
abn mitochondrial gene expression
oxidative damage
impaired energy production
mitochondria and exercise induced neuroprotection: explain relationship
exercise reprograms mitochrondria’s effects on tissues
one of the most important being its regulation of cerebral blood flow which increases with exercise
which sensory fibers does MS affect?
all myelinated ones: alpha, beta, delta
pain unaffected
equal disruption of other sensory systems
three major categories to assess in MS
sensory
motor
motor planning/coordination
these are all myelinated pathways that can be affected
muscle performance assessments in MS
synergistic patterns
ataxia/coordination
flaccidity/weakness
selective strength
speed/accuracy
tone assessment in MS
hypertonicity
DTR
spasticity
spasm
cranial nerve assessment in MS
CN II, III, IV, V, VI, IX, VII
sensory assessment in MS
proprioception
somatosensory
visual
vibration
CN II impairment in MS
visual field loss
blurred vision
presenting symptom of disease
CN III impairments in MS
abnormal horizontal gaze
saccades
CN V impairments in MS
commonly have facial numbness
CN VIII impairments in MS
vertigo
why is proprioception affected in MS
two ways:
muscle spindle and GTO go through dorsal columns in spinal cord which can be impacted
cerebellum processes information, can also be impacted
muscular mechanic impairments in MS
ROM
muscle tone
response time
sensation
postural alignment
postural reactions/feedback/responses
bladder urgency/incontinence/retention
integumentary impairments in MS
skin breakdown
pressure sores
sensory integrity
cognition impairments in MS
STM
orientation
depression
anxiety
reduced processing speed
euphoria
pain impairments in MS
lhermitte’s sign - spinal cord
paresthesia - brain/spinal cord
chronic neuropathic pain - spinal cord
paroxysmal limb pain: intense shooting pain - unclear
what does an MS patient look like in postural control testing?
increased sway in quiet stance, especially in warm conditions
delayed response to perturbation
impaired dual task integration
slowed conduction of sensation and impaired central integration increase fall risk
increased fear of falls
when do falls present in MS?
early, even before walking or balance impairments are evident
testing for fall risk in MS
BEST assessment tool
static standing measure like SOT
types of gait impairment in MS
spastic
ataxic
paretic
impacted by location and extent of lesions
UE outcome measures for MS
boxes/blocks
nine hole peg test
gait outcome measures for MS
20m timed walk test
TUG
fatigue outcome measure for MS
fatigue scale for motor and cognitive function
