Module 10 Flashcards
Define multiple sclerosis (MS):
Multiple Sclerosis is a progressive and chronic inflammatory demyelinating disease of the central nervous system (CNS) (Doring et al. 2012). This is where the immune system attacks the central nervous system, damaging the protective myelin sheath around nerve fibers, this results in motor and cognitive decline causing progressive neurological disability over time.
Question 2MS Pathophysiology
Describe the pathophysiology of multiple sclerosis (MS):
Multiple sclerosis occurs when T cells invade the central nervous system (CNS), leading to tissue injury and demyelination as a result of the activation of these cells. This process results in plaque deposits, scarring, demyelination, and relative preservation of axons.
Identify and define the four types of multiple sclerosis (MS):
- Relapsing-Remitting MS: Relapse is unpredictable, where new symptoms appear or existing symptoms worsen, lasting from days to months or even years.
- Secondary Progressive MS: Adevelopment of progressive disability later in the disease course with superimposed relapses - (8/10 people with RMMS develop SPMS).
- Primary Progressive MS: MS with distinct attacks and a slow onset withsteadily worsening symptoms. Disability and deficits gradually accumulate and may either plateau or continue to progress over several months or years.
- Relapsing Progressive MS: Gradual progression of disability from onset of disease with relapses.
You are working at the Sporting wheelies disabled association gym and a new client has been referred who is a 47 year old female with multiple sclerosis who uses a wheelchair:
Identify 3 effects of MS
For each effect, identify at least one (1) relevant adjustment you would you make to an exercise program to take account of the effect.
Motor weakness:Focus on low-resistance, high repetition exercises to improve muscular endurance without excessive strain. Also using resistance bands or cable machines with adjustable weights to allow controlled movements that can accommodate her strength level and prevent fatigue.
Visual disturbances: Position equipment in well-lit, clutter-free areas to enhance spatial awareness and minimize any falls risk or disorientation,
Bladder and bowel problems: Choose seated or supported exercises to reduce abdominal pressure and avoid any discomfort.
Kalb et al (2020) published a paper entitled “Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course”. In the paper they provided a consensus recommendation for exercise and lifestyle physical activity for individuals with MS at disability levels 0-9.0 on the EDSS. In the paper the authors divided people with MS into three broad EDSS categories: 0-4.5; 5.0-6.5; and 7.0-9.0.
What does EDSS stand for?
Describe the functional limitations which characterise each of the three EDSS categories.
Key recommendations are summarised in the abstract – briefly describe four of these.
- EDSS stands for the Expanded Disability Status Scale, a method of quantifying disability in multiple sclerosis (MS) and monitoring changes in disability over time.
2.
EDSS 0-4.5: Minimal to mild disability including mild weakness, coordination issues, or sensory symptoms but do not severelyimpact daily functioning or walking ability.
EDSS 5.0-6.5: Moderate disability & limited walking ability, may require assistance (cane) to walk short distances. Daily activities may be moderately impacted due to fatigue ot motor impairments.
EDSS 7.0-9.0: Severe disability with significant mobility restrictions, may rely on a wheelchair for mobility. Limited ability to perform daily activities independently and may experience substantial weakness, fatigue, and difficulty with self-care.
3. - Engage in Regular Exercise: Individuals with MS, regardless of disability level, should engage in regular aerobic and strength training exercises to improve fitness, mobility and quality of life.
- Adapt Physical Activity to Disability Level: Recommendations should be tailored according to the individual’s EDSS score, ensuring exercises are suitable and feasible given their specific limitations.
- Encourage Lifestyle Physical Activity: Incorporating physical activity into daily routines is emphasized, especially for those with limited mobility, as it can support functional independence and reduce sedentary behavior.
- Prioritize Safety and Professional Supervision: Exercise programs for people with high disability levels (EDSS7.0-9.0) should be conducted under professional supervision, focusing on safety and adapted exercises to support functional capabilities.
Latimer-Cheung et al. (2013) reviewed 54 articles that compared effects of Physical activity on Adults with MS.
Identify and describe two (2) areas in which strong evidence of a beneficial effect was reported, and two (2) areas in which evidence was inconsistent.
Identify two limitations of the research reviewed in the paper.
Two areas with strong evidence of a beneficial effect:
Muscle Strength:Physical activity, especially strength training, significantly improves muscle strength in adults with MS.
Quality of Life: Exercise consistently enhances quality of life, reducing fatigue and improving mood.
Two areas with inconsistent evidence of a beneficial effect:
Cognitive Function: There were mixed findings on whether physical activity improves cognitive abilities like memory and processing speed.
Disease Progression: There was inconclusive evidence on whether exercise slows the progression of MS.
Two limitations of the research were:
Varied Study Designs: Differences in exercise types and protocols made comparisons difficult.
Small Sample Sizes: Many studies had limited participants, reducing generalizability.
You are working at a community gym and a new client has been referred who is a 27 year old female with multiple sclerosis. She was diagnosed 4 years prior and currently has difficulty with high order balance tasks, and extremes in temperature adversely affect her function, particularly cold temperatures. She has a mildly ataxic gait but walks without aids, except for long distances when she uses a walking cane because fatigue makes her balance a little worse. Her goal is to improve balance and stability and become involved in yoga.
Identify 2 activities/exercises that you would prescribe your client in the gym - indicate a progression and regression for each exercise
For balance, I would prescribe a single-leg stance on a stable surface, progressing to an unstable surface like a balance pad, or regressing to a tandem stance or allowing support from a stable object if needed.
To improve core strength and posture, I would recommend a seated cable row, with progression to a stability ball for added core engagement or regression to a lighter resistance band if the cable machine is challenging.
You are working at a community gym and a new client has been referred who is a 27 year old female with multiple sclerosis. She was diagnosed 4 years prior and currently has difficulty with high order balance tasks, and extremes in temperature adversely affect her function, particularly cold temperatures. She has a mildly ataxic gait but walks without aids, except for long distances when she uses a walking cane because fatigue makes her balance a little worse. Her goal is to improve balance and stability and become involved in yoga.
Indicate how you would modify/adapt the prescription to take account of the affect of the MS.
To accommodate her MS, I would schedule sessions during moderate temperatures, as cold environments can worsen her symptoms. Additionally, I would incorporate more frequent rest breaks to prevent fatigue, ensuring she maintains proper form and reduces the risk of balance issues as she tires.
You are working at a community gym and a new client has been referred who is a 27 year old female with multiple sclerosis. She was diagnosed 4 years prior and currently has difficulty with high order balance tasks, and extremes in temperature adversely affect her function, particularly cold temperatures. She has a mildly ataxic gait but walks without aids, except for long distances when she uses a walking cane because fatigue makes her balance a little worse. Her goal is to improve balance and stability and become involved in yoga.
Provide a rationale for the two exercises you have selected.
The single-leg stance on a stable surface is effective for improving balance and proprioception, which are critical for maintaining stability and preventing falls, particularly for someone with ataxic gait.
The seated cable row strengthens the back and core muscles, which are essential for postural control and balance, helping to counteract any compensatory movements that may arise from her MS symptoms.
Based on the information presented in the ESSA position statement for ExRx for people with MS, HIIT could be employed for clients with MS.
How would you apply evidence in a program for a Female, 43 yrs old, dx 5 yrs ago, who has balance disturbances during walking?
Please outline the mode of training, a clinical justification based on the a) clients presentation and b) your knowledge of the effects of MS broadly.
Mode of Training:
This program would involve intervals of moderate to high-intensity activities, such as cycling or treadmill walking, alternating with lower-intensity recovery periods, alongside bodyweight exercises like squats or step-ups to improve strength and stability.
Justification:
a). HIIT can address the clients balance issues by enhancing cardiovascular fitness and lower limb strength in shorter sessions, which helps mitigate fatigue.
b). HIIT has been shown to improve strength, endurance, and overall cardiovascular health in individuals with MS, enhancing balance and reducing fall risk by improving coordination and stability while potentially alleviating fatigue.
The ESSA Position Statement outlines several special considerations which are required to accommodate the effects of MS.
Describe how you would account for the following effects of MS and provide two (2) strategies for each with clinical reasoning.
Fatigue.
Reduced exercise tolerance.
Thermoregulation impairment.
Fatigue
Strategy 1: Incorporate Rest Breaks - Scheduling frequent, short rest breaks during exercise sessions allows the client to recover and manage fatigue, preventing overexertion, which can exacerbate symptoms.
Strategy 2: Utilize Shorter, More Frequent Sessions - Implementing shorter exercise sessions (20-30mins) several times a week can help maintain consistency and reduce the risk of fatigue, allowing the client to engage in regular physical activity without becoming overwhelmed.
Reduced Exercise Tolerance
Strategy 1: Monitor Intensity with RPE - Using RPE allows the client to self-regulate exercise intensity, ensuring they stay within a manageable level that accounts for their reduced exercise tolerance while still promoting cardiovascular fitness.
Strategy 2: Gradual Progression of Intensity - Gradually increasing the intensity of exercises helps the client adapt to physical activity without overwhelming them, building tolerance over time while maintaining safety and comfort.
Thermoregulation Impairment
Strategy 1: Exercise in a Temperature-Controlled Environment - Conducting sessions in a cool, well-ventilated space helps minimize overheating, which can worsen MS symptoms and impair performance.
Strategy 2: Incorporate Hydration Strategies - Encouraging regular fluid intake before, during, and after exercise helps maintain hydration and regulates body temperature, reducing the risk of overheating and supporting overall exercise performance.
