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A:NEURO 3 > lecture 4: multiple sclerosis (MS), > Flashcards

lecture 4: multiple sclerosis (MS), Flashcards

1
Q

for a UMN disorder what

  • structures involved
  • tone
  • reflexes
  • sensation
  • involuntary movements
  • voluntary movements
A
  • structures involved: CNS
  • tone: increased
  • reflexes : increased (clonus and babinski)
  • sensation : decreased
  • involuntary movements : mm spasm
  • voluntary movements : synergistic patterns
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2
Q

Wha does a LMN disorder …

structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements

A

structures involved: PNS cranial nerves

tone: decreased

reflexes: decreased

sensation : decreased

involuntary movements : fasciculations

voluntary movements : weak or absent

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3
Q

What does a basal ganglia disorder…

structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements

A

structures involved: BG

tone: increased

reflexes : decreased or normal

sensation : normal

involuntary movements : resting tremor

voluntary movements : bradykinesia , akinesia

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4
Q

What does a cerebellum disorder..

structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements

A

structures involved: cerebellum

tone: decreased

reflexes : decreased

sensation : normal

involuntary movements : none

voluntary movements : ataxia , intention tremor , dysdiadokinesia , dysmetria , nystagmus

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5
Q

what is multiple sclerosis

A

a progressive autoimmune disease characterized by chronic , progressive , inflammatory demyelination of the neurons in the CNS

can affect UMN and LMN

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6
Q

what is myelin produced by in the CNS

A

oligodendrocytes

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7
Q

who is MS most common in

A

african american and in females between 20-50

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8
Q

what is progressive relapsing MS

A

steady decline since onset with super imposed attacks (<10% of cases)

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9
Q

what is secondary progressive MS and when does it follow

A

initial relapsing remitting MS that suddenly begins to have decline without periods of remission

follows on from relapsing/remitting

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10
Q

what is primary progressive MS

A

steady increase in disability without attacks (10-20%)

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11
Q

what is relapsing remitting MS

A

unpredictable attacks which may or may not leave permanent deficits followed by periods of remission

most of the cases (80-90%)

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12
Q

what type of MS is the most common

A

relapsing remitting

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13
Q

what is the clinical isolated syndrome for MS

A

first neurological episode or attack

refers to a first episode of inflammatory demyelination in the eCNS that could become MS

could become MS if hav 1 symptoms over 24 hours , lesion on the brain , increased tone. lhmettris sign , and uhlhoff sign

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14
Q

for a Cliniccally isolated syndrome (CIS) a persons must have symptoms for a least ____ and there is one lesion on the brain and what 3 other things

A

24H

increase tone , lhermitte’s sign and Uhthoff’s sign

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15
Q

what is lhermitte’s sign

A

electric shock like sensation that run down the back , arms and or legs with neck FLEXION

UMN sign

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16
Q

what is uhthoff’s sign

A

temporary worsening of neurological symptoms with increase in temp

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17
Q

what is an MS exacerbations

A

new and recurrent MS symptoms lasting > 24 hours

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18
Q

exacerbating factors for MS include what 3 things

A
  • Viral or bacterial infection (cold, flu, UTI)
  • Organ disease (hepatitis, pancreatitis, asthma attacks)
  • Stress
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19
Q

• ___ stress: divorce, death, job loss, trauma
• ___ stress: exhaustion, dehydration, malnutrition, sleep depravation

A

major
minor

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20
Q

what is Pseudoexacerbations in MS

A

Temporary worsening of MS symptoms (usually <24h)

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21
Q

is misdiagnosis or delayed diagnosis of MS common?

A

yes bc the initial presentation of MS is highly variable

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22
Q

is there a definitive diagnostic test for MS? what kind of diagnosis is it and who is it made by

A

no

diagnosis of exclusion made by neurologist

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23
Q

the diagnosis of MS relies on 2 key features determined from evidence of lesions seen on the MRI , what is it

A

lesions in the CNS in space and time (at least 2 attacks with 2 lesions on the brain)

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24
Q

signs and symptoms of MS vary on the location of the lesion , but early symptoms typical include what 2 things

A
  • Visual disturbances (e.g. diplopia)
  • Paresthesias progressing to numbness, weakness and fatiguability
25
what are **common** **motor** signs and symptoms for MS
* Paresis or paralysis * Fatigue * Spasticity, spasms * Ataxia: incoordination, intention tremor * Postural tremor * Impaired balance and gait
26
what are common pain signs and symptoms for MS
Paroxysmal limb pain, dysesthesias • Headache • Optic or trigeminal neuritis • Hyperpathia • Chronic neuropathic pain
27
what are common sensory signs and symptoms for MS
• Hypoesthesia, numbness • Paresthesia
28
what is the difference between primary fatigue and secondary faitgue for MS
primary is due to the location of plaques and hypometabolism , there is and increased energy needed to send impulse secondary is due to increased energy required to perform activities and is less efficient movements during functions
29
what are **cognitive** symptoms someone wiht MS can have
Difficulties with: * Information processing * Short-term memory * Performing multiple tasks simultaneously * Attention and concentration * Executive function
30
T/F: people with MS can have problems with • Coordination and balance • Gait and mobility • Sleep disorders • Depression
true
31
what is **charocot’s triad** in MS
it is when the cerebellum is affects 1. scanning speech 2. intention tremor 3. nystagmus
32
what are some **visual dysfunctions** someone with MS can have
diplopia (double vision Marcus Gunn Pupil (CN2) - 1 pupil does not respond to light - diminished visual acuity -blind - scotoma (partial loss of vision) - lateral gaze palsy
33
what are the **2 most common** symptoms of MS
fatigue (number 1) heat sensitivity ## Footnote so good to exercsei in the morning and when it is cool so maybe next to a fan
34
a big thing to highlight for the SUBJECTIVE portion of ur PT exam with a person with MS is what
patient goals
35
what is **mixed pattiern , overactive and underactive bladder** impairments for someone wiht MS
* **Mixed pattern:** Overactive (spastic) and underactive (hypoactive/flaccid) bladder * **Overactive**: Increased frequency, urgency, nocturia, incontinence due to detrusor muscle spasm * **Underactive bladder:** Difficulty starting urination (hesitancy), difficulty emptying the bladder completely leading to urine retention
36
what is a spastic bowel for someone with MS
constipation , difficulty emptying the bowel fully
37
what is a flaccid bowel for someone with MS
incontinence , decreased motility, constipation , changes in sensation to defecate
38
what does the the **modified faitgue impact scale** assess for people with MS
the effect of fatigue on physical , cognitive and psychosocial functioning in poeple with MS
39
for the **modified faitgue impact scale** , the higher the score mean what
the greater the faitgue
40
what does the **fatigue severity scale** for MS patients assess
measures **severity** of fatigue and its effect certain **activities** within the last week the **higher** the score the **greater** the fatigue
41
how may **gait** present in someone with MS
extensor spasticity , scissoring , ataxia , uneven steps
42
what **activity limitation** outcome measures are used for MS (3)
* Expanded Disability Status Scale (EDSS) * 12-Item MS Walking Scale (MSWS-12) * MS Functional Composite (MSFC
43
what does the **expanded disability status scale** (**activity** limitation outcome measure) measures and who is it done by
current level of disability done by a neurologist
44
what kind of report is the **12 item MS walking scale** (activity limitation outcome measure) and what does it measure
patient reports measures the impact of MS on walking higher score means greater limitation
45
what kind of outcome measure is the **MS impact scale**
**participation** measures
46
what is the **MS impact scale** ?
the impact of MS on a day to day life during the **past 2 weeks** **self** reported 5 is extreme (higher the score the higher the impact of disease)
47
what’ are the key considerations during PT eval , diagnosis , prognosis for a MS patient
type of ms current phase other co morbidities
48
what is the **movement system impairment diagnoses** for MS
1. Movement Pattern Coordination Deficit 2. Force Production Deficit 3. Fractionated Movement Deficit 4. Hypermetria
49
what is the **movement pattern coordination deficit** for MS
primary movement dysfunction : inability to coordination an intersegmental task due to deficit of timing in and sequencing between segments
50
what are teh **associated** **signs** for **movement pattern coordination deficits** ? and what is the prognosis
o Fractionated movement o Muscle tone: Mild hyperexcitability or rigidity o Normal or mild sensation loss good prognosis
51
what is the **primary** movement dysfucntion of **force production deficit** for MS
weakness
52
what are the **associated signs** for **Force production deficit** - ___ mgmt - mm tone : ___ to __ - sensation is ___ to ____ - coordination may be unable to test due to ___ - ___ postural contrl
- fractionated mgmt - mm tone : mild to flaccid - sensation is normal to mild - coordination may be unable to test due to weakness - poor postural contrl
53
what is the **prognosis** for recovery for force production deficit for **relapsing remitting** and **chronic progressive**
o Relapsing remitting: good potential o Chronic progressive: poor potential
54
what is the **primary** movement deficit for **Fractionated movement deficit** in MS
o Inability to fractionate movement o Associated with hyperexcitability
55
what is the associated signs for fractionated movement deficit in MS o ____ joint dissociations o Associated reactions with ____ effort o Muscle tone: ≥ moderate hyperexcitability
o Decreased joint dissociations o Associated reactions with increased effort o Muscle tone: ≥ moderate hyperexcitability
56
what is the **primary movement dysfucntion** for **hypermetria** in patients with MS
o Inability to grade forces appropriately for the distance and speed aspects of a task
57
what is the associated signs for hypermetria
o Movement against gravity but lacks fluidity o Dysmetria, dysdiadochokinesia
58
what are the PT intervention for MS
o Disease process o Energy conservation o Rest breaks o Heat sensitivity

A:NEURO 3 (26 decks)

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