L7 MS Interventions Flashcards
education for pts w MS should include:
modifiable risk factors including: smoking, exercise
fatigue levels and how to manage/when not to push, fatigue progressing disease
vaccinations: autoimmune disease should get vaccine
symptoms management and recognizing relapse/remission
triggers for MS relapse
lack of sleep
high stress
inadequate/excess exercise/activity
heat exposure
childbirth
general health status
low vitamin D
UTI
relapse education for MS should include
reduce activity for two weeks
seek medical treatment if significant to alter med dosage if it interferes with function
may experience reduction in cognitive function
med interventions for MS
infusions
DMT: disease modifying therapy started early to reduce progression/exacerbation
medication (oral)
injection
management program for MS should include
prevention: keep general health good
exercise: maintain muscle and CV fitness
fatigue education: monitor triggers
functional training
balance training
assess for fatigue in MS
assess HR/BP
MS related: immune activation, mitochondrial damage causing fatigue
chronic: 6 + weeks 50% of the time
acute: recent onset
intervention for fatigue in MS
LE strengthening
aerobic exercise to improve respiratory system
modify environment
Pt education for fatigue in MS
stop smoking
midday nap 10-30 min with breathing activity
adjust activity levels
well balance low fat diet (? changing research)
drink cool liquids to reduce myelin loss
considerations for exercising MS pts
exercise does not increase disease process if done properly
- avoid increases in core temperature which cause transitory symptom increase
exercise early in diagnosis spares pt cognitive status, reduce lesions
benefits of exercise in MS patients
maintain cognition
remyelination through motor learning
aerobic exercise decreasing lesion formation in white and gray matter
why is motor learning more effective at treating MS than ther ex?
motor learning sends more information to the cerebellum, which is commonly affected in MS
requires more feedback form internal pathways of muscle spindle , cerebellum, proprioception, sensory, vestibular as well as external feedback
exercise guidelines for MS
150 min exercise per week
150 min per week of lifestyle activity
encouraged to make gradual progress towards this goal, not start here
2-3x week aerobic, 10-30 min mod intensity
2-3x week resistance training
aerobic exercise impact on brain structures in MS pts
30 min 3x week 3 months
increase in hippocampus volume
increase in memory
increased functional connectivity
functional and structural reorganization
postural exercises
stable BOS: changing foot position, SL
sway balance exercises: leaning, weight shifting
stepping: intentional and reactive
walking: on line, backwards, on heels/toes
chair yoga effect on MS
90 min 1x weekly 6 month
yoga group showed improved fatigue levels
spasticity management in MS
5-20 minutes to relax, longer than better
flexor spasticity: lying prone with feet hanging off bed
extensor: sidelying position w hips and knees bent, pillow between legs and at chest level
exercise for MS: recommendations and considerations
MS patients SHOULD exercise w strong evidence
- must reduce exercise/activity in exacerbation
- work on muscle power, tolerance, mobility/functional activities
no damaging effects of exercise w these parameters but may temporarily worsen symptoms
dual tasking and MS
impaired in MS due to white and gray matter lesions
results in atrophy to cerebellum, prefrontal cortex, parietal lobe
impacts postural control, motor learning
should train dual tasking in MS rehab/exercise
ways to complete dual task training
postural control: complete activities while standing
multitasking in task based activities
walking and counting
STS or activity with cognitive load
MS and strengthening
STS: train speed, height, foot position, deceleration
progress to squats w UE support
calf raises: BL then UL
step ups
evidence for eccentric exercise improving cortical excitability
cause of balance impairments in MS
sensory input greatly disturbed
along w lesions affecting vestibular, postural control, etc
sensory: slowed proprioception, impaired central integration, pain, spasticity
reliant on vision to reduce sway in quiet standing
balance exercises for MS
sensory based exercise is essential
proprioceptive/vestibular: walk w head turns
move trunk and manipulate object
upright standing
quiet stance with changing foot position
could also augment sensory with vibration
always TASK BASED!
vibration therapy
mainly evidence is for PD
showed improvement in equilibrium and gait w WBV
weighted vest in MS
increases sensation and proprioceptive input
weighted information for balance
immediately improves static and dynamic balance and postural control in gait
increased feedback from vest allows gait tasks to become more unconscious
which exercise type has the greatest impact on gait activities in MS patients?
task based practice with specificity and salience, but few studies show positive results for any gait activities
speed interval training improved endurance by allowing rest and working on speed
strengthening and VR are not shown to be effective
ADs for MS pts
provide early at first sign of postural deficiencies to prevent falls and reduce energy expenditure
cane, trekking poles best
4pt cane reduces walking efficiency
rollator for rest and long term
CV training dosing for MS
mod intensity: 40-60% HRmax, 11-13 RPE
10-30 min
2-3x weekly
gradually increase to maintain HR and RPE intensities
POC for MS pts should include:
functional skills
strength
balance
aerobic training
fatigue management
fall reduction w AD prescription
enjoyable leisure activity
specific exercise intensity
pathophys of spasticity in MS
An UMN lesion leads to weakness and muscle overactivity
weakness leads to disuse, atrophy, and contracture reducing ROM, worsening posture, and impairing function
overactivity causes dynamic or static spasm
dynamic most limiting
lead to impaired function
spasticity treatment options: generalized spasticity
oral medication
spasticity treatment options: focal spasticity
botox injections
3-8 weeks effective and always returns, weakens muscle
use to get stretching and ROM in short term
spasticity treatment options: regional spasticity
intrathecal baclofen
how to manage spasticity in MS pt
only treat if it is impairing function
ankle: splinting, AFO, load joint for strength and ROM
address function, gait, ADLs, pain
factors increasing spasticity in MS
pressure ulcers
bowel/bladder dysfunction
infection
pain
all lead to decreased mobility
medications for spasticity
oral baclofen
gabapentin
CBD/THC
baclofen pump
evidence for Galileo WBV therapy
provides sensory information and resets the spinal reflex
no evidence in stroke pts but some in MS patients for reducing spasticity
- rapid intensity stim stretches muscle spindle at velocity changing and resetting to closer to original length
short term effects can be used to train in functional new range of muscle
TENS and spasticity in MS
reduce spasticity by creating muscle twitch and priming to increase functional activation in activity
100 Hz, .3 ms pulses, 20 min, daily x4 weeks
mechanisms of inhibiting spasticity
reciprocal inhibition
gate theory: TENS or compression
low load prolonged stretch in MS
start slowly to avoid triggering spasticity/clonus
allow lengthening reaction to occur with long stretch
stretched position reduces signaling
aerobic exercise and effects on MS
increases BDNF for neurogenesis, synaptic connections, vascularization, neuroplasticity
improved memory from larger hippocampus
improved serum BDNF, balance, fatigue, and functional exercise capacity, growth factors in brain
dosing aerobic exercise for MS
3xweek, 8 weeks
