Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NeuroPT2 > MS > Flashcards

MS Flashcards

1
Q

Multiple Sclerosis is a ______ disease

A

Demyelinating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do demyelinating dis’s do and what is the MOST COMMON form?

A
  • DEC speed and quality of impulse conduction (saltatory conduction)
  • MS is most common form
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Demyelination can occur due to:

A
  • Systemic disease
  • Malnutrition
  • Toxic exposure
  • Infection
  • Anoxia→ deprivation of O2
  • Ischemia→ local
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MS Defined:

A

Demyelinating dis. characterized by a course of demyelination relapses & remissions, superimposed upon gradual neurologic deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Keep in mind w/ MS:

A

ANY CNS white matter can be affected→ presentation will vary

*episodic AND chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MS Prevalence

A

Female > Male; 2:1 ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MS High Risk Areas

A

FURTHER AWAY FROM EQUATOR

  • Northern US, Northern Europe, Southern Canada, New Zealand, Southern Australia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MS Etiology:

A

Interaction b/w genetic predisposition & an inciting environmental antigen→ produces autoimmune demyelinating response in susceptible host

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Theory of autoimmune response in MS:

A

CNS myelin becomes infected by virus and is perceived as antigen

*immune system then targets the “antigen” aka destroys myelin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stress and MS

A

Stress does NOT HELP MS!

not proven*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathophysiology of MS:

A
  • Demyelinating lesions→ Plaques
    • sharply delineated lesions viewed on MRI
  • Inflammation may result in Mass Effect (obj in skull that pushes brain)
    • acute exacerb’s tx’d w/ steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

More pathophys MS:

A
  • IF oligodendrocytes survive→ remyelination may occur
    • later stages→ if few remain, remyelination partial @ best
  • End Stage Patho:
    • myelin replaced by fibrous scarring (gliosis)→ inhibits impulse transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

*Types of MS:

4:

A
  1. Relapsing-Remitting (most common)
    1. aka Exacerbating-Remitting
  2. Relapsing-Progressive
    1. aka Exacerbating-Progressive
  3. Primary-Progressive
    1. aka Chronic-Progressive
  4. Secondary-Progressive
    1. the one that begins as Relapse-Remitting then Chronic-progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of MS:

Relapsing-Remitting

aka Exacerbating-Remitting

A
  • Ep’s of rapid, abrupt deterioration w/ variable degrees of recovery over time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of MS:

Relapsing-Progressive

aka Exacerbating-Progressive

A
  • Relapses w/ lg degrees of residual impairs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Types of MS:

Primary-Progressive

aka Chronic-Progressive

A
  • Steady, progressive deterioration
  • Pace of deterioration may be steady OR varied
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Types of MS:

Secondary-Progressive

aka the one that BEGINS as relapse-remitting THEN becomes chronic (primary)-progressive

A

one that BEGINS as relapse-remitting THEN becomes chronic (primary)-progressive

  • Sometimes Full recovery
  • Sometimes Partial recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MS:

Definitive Dx requires WHAT?

A
  • Requires clinical or para-clinical evidence of 2 or more spatially & temporally distinct lesions
    • aka 2 diff areas @ 2 diff times***
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MS Dx and MRI Findings:

A
  • Lesions may NOT correlate w/ s/s
  • Lesions may BE PRESENT in absence of s/s
  • CSF via Lumbar Puncture
    • elevated IgG→ immune system elevation
    • Oligoclonal bands→ destruction of oligodendrocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Not Quite MS…

A
  • Clinically Isolated Syndrome (CIS)
    • looks like exacerbation but happens 1 time
  • Radiologically Isolated Syndrome (RIS)
    • Single time, has radiograph similar to MS, only one incident shown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Primary S/S MS:

A
  • Presents in # of ways→ depends on loc. of demyelination
  • Need useful SC vs. Cerebral (where plaques are)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Primary S/S MS:

Fatigue

A
  • Single most common complaint in MS*
  • Out of proportion to task causing it
  • Present even if strength normal
  • Fatigue→ Sx’s, HOW pt feels
  • Fatigability→ Sign, change in motor perform
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PRIMARY Fatigue

A

Caused by actual MS

  • Lassitude→ sx of severe fatigue
  • DEC conductivity→ reduced impulse propagation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SECONDARY Fatigue

A

Consequence

  • infx
  • spasticity
  • ataxia
  • weakness
  • depression
  • sleep deprivation
  • polypharmacy (lots diff meds)
  • decond.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Fatigue in PWMS and PT Implications

A
  • Ex. Type
    • Diminished ability to tolerate lg amts of ex
    • DO: Intermittent tx
  • Ex. Scheduling
    • Schedule ex @ times of INC energy if they are willing to use that time to Ex.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PRIMARY s/s MS:

Sensory Changes

A
  • Parasthesias→ partial sensation loss
  • Dysesthesias→ abnorm sensation (burning)

MORE FREQ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

PRIMARY s/s MS:

Optic Neuritis

A

Optic neuritis

*NOTE: some have abrupt loss of vision 2-3d

COMMON

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PRIMARY S/S MS:

Weakness

A
  • PRIMARY→ from plaques (demyelination)
  • SECONDARY→ disuse, deconditioning, disuse atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PRIMARY S/S MS:

Weakness

A note about Flexibility

A
  • MS does NOT directly cause prob w/ flex, but weakness and other sx cause probs
  • W/out adequate flex→ person loses norm biomechanics for gait & balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PRIMARY S/S MS:

Spasticity

*know the Mod Ashworth Scale!!

A
  • UMN Syndrome common in PWMS
  • worsens over time
  • IF spinal origin→ Intrathecal Baclofen pump
    • NOT USEFUL IF CORTICAL LVL MS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PRIMARY S/S MS:

Heat Sensitivity

A
  • Common
  • Worse fatigue and weakness w/ elevation in body temp
  • transitory→ NOT permanent
  • Some benefit from cooling BEFORE ex.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Primary S/S MS:

Ataxia

A
  • Due to plaques in cerebellum and DCML
  • B/L
  • Dysmetria, dysdiadochokinesia, tremor, vertigo
    • CNS vs. PNS vertigo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Primary S/S MS:

Pain

A
  • Spasms from hypERtonia
  • Burning dysesthesias from plaques in thalamus or spinothalamic tract
  • MSK pain from inapp. mvmt patterns → weakness, disuse atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Primary S/S MS:

Psychiatric

A
  • Euphoria→ late stages
  • Depression
  • Most common Cog. changes→ memory loss, impaired safety awareness***
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Secondary S/S MS:

Weakness and Fatigue that occur due to MS causes what?

A

Series of 2* probs → VERY IMPORTANT TO PT’s!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

2* S/S MS:

MSK issues

A
  • Inapp mvmt patterns due to:
    • Weakness
    • Fatigue
    • Spasticity
  • Overuse syndromes/tendonitis 2* to spasticity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

2* S/S MS:

Weakness

A

PRIMARY weakness cannot be affected by ex, 2* CAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

2* S/S MS:

Posture

A
  • due to prolonged sitting
  • Can benefit from pos’ing out of shortened pos.
  • Poor posture leads to skin breakdown, contracture, resp. comps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2* S/S MS:

Balance Loss

A
  • Combo of 1* and 2* effects
  • 1*
    • weakness, spasticity, ataxia, sensory loss, diminished motor control, visual loss, depression, fatigue
  • 2*
    • 2* weakness, contractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Other 2* S/S MS:

A
  • Osteoporosis
  • Infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Medical Mgmt MS:

One you should know

A

Ocrevus→ only FDA approved med to tx progressive types→ Slows progression

  • Steroids
    • Tx of choice for acute exacerbation
    • suppresses immune function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

MS and Spasticity

Keep in mind..

A

Spasticity can be Useful!

  • Eradication of spasticity can diminish underlying strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MS and 2* Fatigue

A
  • Improve fitness thru ex.
  • Energy Conservation tech’s combined w/ meds
    • → Tx of choice for fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Psychosocial Factors MS

A

Demanding dis. for both pt and caregiver→ unpredictable and hard to see

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Rehab/PT Mgmt MS:

A
  • No cure
  • Tx focused on medically controlling current exacerbation
  • Prevent 2* deficits
  • EDUCATION→ teach pt and family as much as poss. about disease esp self mgmt of comps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

MS and Evidence for Exercise

A
  • Aerobic, MSK strength, Resp endurance
    • Good therapeutic response to Ex.
    • PTs should be confident in prescribing ex. in PWMS
47
Q

NOTE: Great Quote

A

“PWMS respond to exercise the same way as those w/out MS: they become More Fit!!!”

48
Q

MS more commonly dx’d b/w ___ and ____

A

30 and 35yo

49
Q

Pathological features of MS:

Radiographs

“Plaques”

A

see pics

50
Q

Primary s/s MS:

Where? Clinical Presentation?

A
  • MS can affect white matter anywhere t/o CNS
  • Clinical presentation depends on loc of demyelination
    • may not correlate w/ imaging findings
  • Wide variety s/s
51
Q

Common s/s in PWMS

A

See pics

52
Q

2 Ways to Classify MS:

A
  1. Disease subtype→ Phenotype
  2. Disease severity
53
Q

Sub-Types of MS:

4

A
  1. Relapsing-Remitting→ most common
  2. Progressive-Relapsing
  3. Primary (Chronic)-Progressive
  4. 2* Progressive
54
Q

Subtypes MS:

Relapsing-Remitting

*most common

A
  • Rapid, abrupt deterioration w/ variable degs of recovery over time
  • aka exacerbating-remitting
55
Q

Subtypes MS:

Progressive-Relapsing

aka Exacerbating-Progressive

A
  • Relapses w/ lg deg of residual impairment
56
Q

Subtypes MS:

Chronic-Progressive

aka Primary-Progressive

A
  • Steady progressive deterioration
    • PACE of deterioration may be steady or varied
57
Q

Subtypes MS:

2* Progressive

A
  • BEGINS as relapsing-remitting THEN becomes chronic-progressive
58
Q

MS Education for pt.

Exacerbation vs. Pseudo-Exacerbation

Talk about pseudo-exacerbation

A
  • Transient (temporary) worsening of sx’s that can occur due to stress, infection, overheating, overexertion→ Full recovery occurs
    • EX. Person w/ pseudo-exacerbation
      • Temp. change in sensory sx’s due to exercise but will recover completely w/in short pd of time
59
Q

Remember…for definitive dx for MS you NEED:

A
  • 2 clinical or para-clinical spatial and temporal distinct lesions @ 2 diff times
    • 2 clinical findings OR
    • 2 radiological findings @ 2 diff times
60
Q

Not Quite MS:

A
  • CIS→ Exacerbation happens ONCE
  • RIS→ Radiographic evidence ONCE

w/ both→ more likely to dev. MS in future

61
Q

MOST COMMON DISABILITY SCALE FOR MS

A

EDSS

Extended Disability Status Scale

*Low reliability

*see pics

62
Q

WHERE DO WE SEE MOST PWMS?

Following EDSS

A

SEE PICS

63
Q

MS:

Disease Severity

A
  • Other measures
    • Disease Steps (previous picture)
    • Pt-Determined Disease Steps
  • NOTE: plastic changes/compensations BEFORE sx’s reach clinical threshold aka become noticeable
  • Relapse→ could be old recurring sx’s OR new sx’s
64
Q

Med. Interventions for PWMS:

3:

A
  1. Mgmt of Acute Exacerbations
  2. Long-term dis. mgmt
  3. Sx mgmt
65
Q

Med. Interventions for PWMS:

Mgmt of Acute Exacerbation

A
  • Goal: Halt inflamm process
  • Tx:
    • high dose methylprednisolone: IV
    • high dose prednisone: oral
    • acthar (ACTH): subq/intramuscular

ALL= immunosuppress/anti-inflamm

66
Q

Disease Modifying Agents for MS:

know this one

A

*Ocrevus→ only drug FDA approved to tx progressive MS

*Botoxin for hypertonia

67
Q

MS:

Med. Sx Mgmt

A
  • B&B dysf
  • depression
  • dizzy/vertigo
  • emotional changes
  • Fatigue
  • itching
  • pain
  • sex. dysf
  • spasticity
  • tremors
  • walking diff.
68
Q

The Examination for MS pt.

A
  • Some MS-specific considerations
  • Hx-taking
  • Tests & Measures
69
Q

Examination for MS:

MS-Specific Considerations

A
  • Systems review should consider BOTH observed and occult (not seen, pt not complaining about it)
    • CV/Pulm
      • autonomic→ monitor resp to ex.
    • Integumentary
    • Neuro/MSK
  • PT Exam MUST ID Pt. problems that are primary (due to MS) AND secondary (consequence of another impair, act. limit., or participation restrict), or combination

NOTE: 2* problem IF quick response to intervention

70
Q

MS Examination:

Taking the Hx

A
  • verbal/non-verbal comm.
  • What do you see w/ simple observation?
    • facial express
    • posture
    • equip
    • spont. mvmts
  • Things to Consider:
    • PMH
    • Social Hx
    • Current LOF
    • Overall lvl of phys act.
    • Any prev/current rehab/ex program
71
Q

MS Examination:

Other questions to consider

*have gen. idea

A

see pics

72
Q

MS Pt. Exam:

Fatigue

A
  • Special consideration for PWMS
  • Participation-level measures→ “Trait”
    • what they exp most of the time
      • MFIS- canvas
      • FSS- canvas
      • FSMC- canvas
  • Immediate measures→ “State”
    • how you feel right now
      • VAS of Fatigue
73
Q

MS Pt. Exam:

Integumentary

A

check skin

ask questions about skin safety– esp lot of time in bed, w/c, sitting chair

74
Q

What should be measured during the MS pt. Examination?

A
  • Vital signs→ vitals are vital!!!
  • A/PROM
  • Strength/motor control
  • UMN signs
  • Sensation
  • Pain
  • Posture
  • Balance+Fall hx
  • Cerebellar function
    • tremor
    • *coordination
    • nystagmus
  • Bed mobility-functional mobility
  • Transfers-functional mobility
  • Walking + Gait-functional mobility
  • Stair climbing-functional mobility
75
Q

Vital Signs and PWMS

A
  • IMPORTANT!!!
  • CV autonomic dysf common in PWMS
    • orthostatic dysreg, cardiac arrhythmias, blunted ex responses
76
Q

A/PROM in PWMS

A

56.4% have contracture in @ least one major UE or LE jt

  • Ankle=43.9%
  • Shoulders=13.1%
  • Hips=28.8%
  • Knees=17%
77
Q

Flexibility in PWMS

A
  • w/ out adequate flex→ person loses norm biomechs necessary for walking, gait, balance
  • HIGHER prevalence in those w/ progressive types of MS
78
Q

Strength and Motor Control in PWMS

A

70% have weakness (MMT = 3/5) in one mm group

  • LE= ankle, knee, hips (50-53%)
  • UE= shoulder, elbow, wrist (61-62%)

*NOTE: differentiate whether person has normal motor control, then test strength accordingly

79
Q

*Changes in flex and strength are often present very EARLY in disease, even in absence of limits in function!

A

see pics

80
Q

Testing UMN Signs

A
  • Spasticity
    • Mod Ashworth
  • DTRs
    • biceps, tris, brachioradialis, quad, gastroc
  • Clonus
    • wrist, ankle
  • Babinski
81
Q

Examining Pain in PWMS:

A
  • Consider:
    • location(s)
    • description
    • intensity when worst
    • worsened by..
    • improved by..
    • activities impaired
  • NOTE: important to diff whether pain is primary (neurogenic), secondary (jt pain due to compensatory mvmt patterns), or unrelated to MS (MSK source of pain)
82
Q

Bed Mobility and Transfers in PWMS

A
  • GEN measured w/ observational analysis
  • Consider objective tests:
    • 5STS
    • timed mobility tests
  • Observe carefully to assist in eval’ing critical contributors to limits.
83
Q

Posture in PWMS Exam

A

Sitting AND standing

*if bed/chair bound→ posture in these environments must be considered

84
Q

Balance in PWMS: Taking a Fall Hx

A
  • Ask SPECIFIC QUESTIONS about falls
    • people have poor recall of falls unless catastrophic/injurious
  • dig deep!
    • how/when/why falls happening?
    • how many? frequent?
  • SPLATT (another slide)
85
Q

SPLATT Questions: Related to Falls

SPLATT:

A
  • S: Symptoms @ time of fall
  • P: Previous falls you’ve had
  • L: Location of falls
  • A: Activity you were doing
  • T: Time of day
  • T: Trauma→ injured @ all?
86
Q

Balance Exam in PWMS:

A

REVIEW BALANCE!!!

  • Consider test(s) to use
  • Standing:
    • Berg
    • DGI
    • MiniBEST
    • 4-Square Step Test
    • Functional Reach
  • Sitting:
    • Function in Sitting Test
    • Trunk Impairment Scale

USE CLINICAL DECISION MAKING SKILLS!

87
Q

Walking and Gait in PWMS

A
  • 40-50% PWMS exp. walking diff.→ 70% report one of their most limiting problems
  • 30-40% of care partners report walking limits causes sig caregiver burden and neg. impacts their QOL
88
Q

Contributors to Walking and Gait Dysf in Pts w/ MS

A

see pics

89
Q

Examining Walking and Gait in PWMS

A
  • Observational Analysis*→ W/ and W/out AD
  • Distance? Device? Assist needed?
  • Repeatable measures of walking:
    • Timed 25’-Walk Test
    • 2, 3, 6-Min Walk Test
    • 12-item MS Walking Scale- canvas
90
Q

Other Considerations for Examination of PWMS:

A
  • Vision
    • acuity
    • oculomotor function
  • Vestib Function
    • Substantially HIGHER incidence of peripheral vestib dysf in PWMS vs age/sex matched peers
  • Mentation/cognition
  • Resp strength/cough/breath support
    • use PFTs!
    • common early in disease
91
Q

3 places where Fatigue MUST be Considered:

A
  1. Examination
  2. Evaluation
  3. Intervention
92
Q

Fatigue…

A
  • Essential part of neuro. disability
  • Part of mobility loss in neuro patho may be due to fatigue
  • MUST BE CONSIDERED IN:
    • Exam
    • Eval
    • Intervents.
93
Q

Fatigue vs. Fatigability vs. Pathologic fatigue/fatigability

A
  • Fatigue= Symptom
    • Subjective state of being tired
    • Feeling of not being able to perform a task or activity effectively, if at all
  • Fatigability= Sign (change in ability)
    • Observational decline in performance during sustained activity
    • Can be observed on ANY prolonged and/or intensive task

NOTE: Pathologic fatigue or fatigability→ happens faster or more severely than expected in a non-disabled person*

94
Q

Recognizing Fatigue vs. Fatigability

Fatigue (symptom):

A
  • NO ENERGY
    • pt c/o fatigue
    • pt avoids ex program or other activities
    • caregiver report
    • dec’d scores on self-report fatigue measures
    • can also present as depression, anxiety
95
Q

Recognizing Fatigue vs. Fatigability

Fatigability (Sign):

A
  • progressive slowing of gait
  • progressive weakness of rep’d contracts
  • worsening of sensation/speech/vision during repetitive task
  • DECd performance on a functional measure following exertion
  • physio. measures→ temp, EMG, CV
  • Pt caregiver complaint/ID
96
Q

Interaction of Primary and Secondary Fatigue/Fatigability

A

Less mvmt is performed→ Deconditioning results→ tasks become “unlearned”

*Where can we as clinicians intervene in this cycle?→ALL LVLS!

97
Q

SPECIAL CONSIDERATION: FATIGABILITY

A
  • Decline in performance w/ repetition OR during a prolonged work bout
  • Need frequent breaks/rest!!!
98
Q

Ex. Fatigability

A

6MWT

see pics…

99
Q

Crux about Fatigability

A
  • Evidence that there is a declination in performance after rep’d attempts and/or other fatiguing activity in PWMS
  • Found in:
    • Rxn time testing
    • Postural control
    • Functional balance tests
    • Gait and walking
    • Speech and communication function
100
Q

Fatigue vs. Fatigability

*Key thing to remember

A

Always differentiate symptom from sign!

101
Q

Fatigue is a ______

A

Symptom

102
Q

Fatigability is a _____

A

Sign

103
Q

Evaluation

aka…

A

Putting it all together!!!

104
Q

What is the Evaluation?

A
  • Time to consider all of the findings and develop hypotheses that may be confirmed or refuted by these findings
  • Add. testing/measuring/questioning may be needed to confirm/refute equivocal findings
  • End Result→ Includes overall assessment of the pts condition, along w/ specific prob list of what needs to be addressed
105
Q

Developing Intervention Plan

A
  • HOW are you developing plan?
  • What are “General” probs you might ID→ ones that may be amenable to trad. interventions?
  • What are MS-specific probs that will req more individualized plan?
106
Q

Remember in PWMS….

A

“Persons w/ MS respond to exercise the same way as those w/out MS: they become more fit!”

-Karpatkin, 2005

107
Q

Developing Intervention Plan

What should it focus on?

A
  • Focus on maximizing function!
  • Consider components of the motor relearning program
    • task analysis
    • practice whole task
    • practice missing components
    • transference of training
  • Address impairs of body structure/function as needed
108
Q

Considering Fatigue

A
  • MUST BE CONSIDERED when working w/ PWMS
  • One of the main limiters of the effectiveness of PT interventions for PWMS
  • Must be balanced w/ the need to maximize therapy dosing
109
Q

What can be done to combat fatigue during PT Interventions?

2 Leads:

A
  1. Intermittent Training
    1. work up until fatigability then break
  2. Maximal Strength Training
    1. Ex. 4 sets of 4 reps @ 90% 1RM
110
Q

Intermittent Training

A

Work up until fatigability then break

111
Q

Maximal Strength Training ***

A

Ex. 4 sets of 4 reps @ 90% 1RM

112
Q

What about interventions for those who are more disabled?

A
  • Maintain max. flex and strength
  • Protect skin
  • Address person-specific goals
  • other ideas:
    • mech. lifts
    • chest PT
    • incentive spirometer
    • etc..
  • In the late to end stage:
    • you may fill role of hospice PT
      • help do things THEY WANT TO DO
      • participate where they want to participate
113
Q

Bottom Line for PWMS:

A
  • DON’T hesitate to work w/ PWMS
  • Conduct comprehensive exam bc no pre-defined clinical picture*
  • Treat as aggressively as tolerated→ DO NOT UNDERDOSE!
  • Refer to other pro’s as approp.
  • Be in touch w/ more knowledgeable mentors to help when you’re not sure what to do!

NeuroPT2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions