lecture 4: multiple sclerosis (MS), Flashcards
for a UMN disorder what
structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements
structures involved: CNS
tone: increased
reflexes : increased (clonus and babinski)
sensation : decreased
involuntary movements : mm spasm
voluntary movements : synergistic patterns
Wha does a LMN disorder …
structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements
structures involved: PNS cranial nerves
tone: decreased
reflexes: decreased
sensation : decreased
involuntary movements : fasciculations
voluntary movements : weak or absent
What does a basal ganglia disorder…
structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements
structures involved: BG
tone: increased
reflexes : decreased or normal
sensation : normal
involuntary movements : resting tremor
voluntary movements : bradykinesia , akinesia
What does a cerebellum disorder..
structures involved
tone
reflexes
sensation
involuntary movements
voluntary movements
structures involved: cerebellum
tone: decreased
reflexes : decreased
sensation : normal
involuntary movements : none
voluntary movements : ataxia , intention tremor , dysdiadokinesia , dysmetria , nystagmus
what is multiple sclerosis
a progressive autoimmune disease characterized by chronic , progressive , inflammatory demyelination of the neurons in the CNS
what is myelin produced by in the CNS
oligodendrocytes
what is MS most common in
african american and in females between 20-50
what is progressive relapsing MS
steady decline since onset with super imposed attacks (<10% of cases)
what is secondary progressive MS and when does it follow
initial relapsing remitting MS that suddenly begins to have decline without periods of remission
follows on from relapsing/remitting
what is primary progressive MS
steady increase in disability without attacks (10-20%)
what is relapsing remitting MS
unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
most of the cases (80-90%)
what type of MS is the most common
relapsing remitting
what is the clinical isolated syndrome for MS
first neurological episode or attack
refers to a first episode of inflammatory demyelination in the eCNS that could become MS
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
24H
increase tone , lhermitte’s sign and Uhthoff’s sign
what is lhermitte’s sign
electric shock like sensation that run down the back , arms and or legs with neck FLEXION
what is uhthoff’s sign
temporary worsening of neurological symptoms with increase in temp
what is an MS exacerbations
new and recurrent MS symptoms lasting > 24 hours
exacerbating factors for MS include what 3 things
• Viral or bacterial infection (cold, flu, UTI)
• Organ disease (hepatitis, pancreatitis, asthma attacks)
• Stress
• ___ stress: divorce, death, job loss, trauma
• ___ stress: exhaustion, dehydration, malnutrition, sleep depravation
major
minor
what is Pseudoexacerbations in MS
Temporary worsening of MS symptoms (usually <24h)
is misdiagnosis or delayed diagnosis of MS common?
yes bc the initial presentation of MS is highly variable
is there a definitive diagnostic test for MS? what kind of diagnosis is it and who is it made by
no
diagnosis of exclusion made by neurologist
the diagnosis of MS relies on 2 key features determined from evidence of lesions seen on the MRI , what is it
lesions in the CNS in space and time (at least 2 attacks with 2 lesions on the brain)
signs and symptoms of MS vary on the location of the lesion , but early symptoms typical include what 2 things
• Visual disturbances (e.g. diplopia)
• Paresthesias progressing to numbness, weakness and fatiguability
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
what are common pain signs and symptoms for MS
Paroxysmal limb pain, dysesthesias
• Headache
• Optic or trigeminal neuritis
• Hyperpathia
• Chronic neuropathic pain
what are common sensory signs and symptoms for MS
• Hypoesthesia, numbness
• Paresthesia
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
what are cognitive symptoms someone wiht MS can ave
Difficulties with:
• Information processing
• Short-term memory
• Performing multiple tasks
simultaneously
• Attention and concentration
• Executive function
T/F: people with MS can have problems with
• Coordination and balance
• Gait and mobility
• Sleep disorders
• Depression
true
what is charocot’s triad in MS
it is when the cerebellum is affects
- scanning speech
- intention tremor
- nystagmus
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
what are the 2 most common symptoms of MS
fatigue (number 1)
heat sensitivity
a big thing to highlight for the SUBJECTIVE portion of ur PT exam with a person with MS is what
patient goals
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
what is a spastic bowel for someone with MS
constipation , difficulty emptying the bowel fully
what is a flaccid bowel for someone with MS
incontinence , decreased motility, constipation , changes in sensation to defecate
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
for the modified faitgue impact scale , the higher the score mean what
the greater the faitgue
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
how may gait present in someone with MS
extensor spasticity , scissoring , ataxia , uneven steps
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
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
what kind of report is the 12 item MS walking scale and what does it measure
patient reports
measures the impact of MS on walking
giher score means greater limitation
what kind of outcome measure is the MS impact scale
participation measures
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)
what’ are the key considerations during PT eval , diagnosis , prognosis for a MS patient
type of ms
current phase
other co morbidities
what is the movement system impairment diagnoses for MS
- Movement Pattern Coordination Deficit
- Force Production Deficit
- Fractionated Movement Deficit
- Hypermetria
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
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
what is the primary movement dysfucntion of force production deficit for MS
weakness
what are the associated signs for Force production deficit
- fractionated mgmt
- mm tone : mild to flaccid
- sensation is normal to mild
- coordination may be unable to test due to weakness
- poor postural contrl
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
what is the primary movement deficit for Fractionated movement deficit in MS
o Inability to fractionate movement
o Associated with hyperexcitability
what is the associated signs for fractionated movement deficit in MS
o Decreased joint dissociations
o Associated reactions with increased effort
o Muscle tone: ≥ moderate hyperexcitability
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
what is the associated signs for hypermetria
o Movement against gravity but lacks fluidity
o Dysmetria, dysdiadochokinesia
what are the PT intervention for MS
o Disease process
o Energy conservation
o Rest breaks
o Heat sensitivity
