MS Flashcards
what is MS
progressive, ronic infalmmation degeration of the myelin of the CNS
destruction of the mylein sheath and the axons
what are the contributing factors to MS
inflammation
autoimmune
infection
enviromental
what is the peak age for MS
20 - 50
is MS more prevalent in men or women
women - white women
what is the life expectancy of someone with MS
normal
Increased risk for MS
affected family member
viral agents
vit D def
smoking
what are the three factors that contribute mostly to MS
genes
environment
autoimmune response
what is the pathophysiology of MS
abnormal autoimmune responses that attacks - inflammatory cascade
myelin
oligodendrytes
CNS nerve fibers
what does demyelination do
this slow the neural transmission and causes rapid nerve fatigue
I can also cuase a a conduction block
what patho factor contribute to the relapsing-remitting forms of the disease
the decrease in the inflammatory attack
what happens with chronic disease and myelination
there is less remyleination between the attacks that results in axon and cell death
what Certain areas are susceptible to demyelination
optic nerve
periventricular white matter
spinal cord - corticospinal and DCML
cerebellar peducles
where is periventricular white matter located
white matter located immediately adjacent to the CFS filled ventricles of the brain
what is the most common disease course for MS
Relapsing-Remitting
how is Relapsing-Remitting MS characterized
attacks with period of remission
active - replase period
not active - remission period
what kind of MS will those intially with Relapsing-Remitting transition to
Secondary Progressive
what does Secondary Progressive look like
starts off with relapsing remitting disease form and then progresses to irreversible worsening of neurological function
who do we characterize secondary progressiev MS
as ‘active’ or ‘not active’ or ‘with progression’ or ‘without progression’
what is the least common type of MS
primary progressive
primary progressive characterized as
continuous worsening of disease without distinct attacks
progressive disablity from onset
what is the Clinically Isolated Syndrome
he first episode of inflammatory demyelination
when will Clinically Isolated Syndrome be diagnosed as MS
when the secound episode occurs
active - Clinically Isolated Syndrome
if a anothere episode occurs
no active - Clinically Isolated Syndrome
if there are no other episode after the first instance
what are some factors that are associated with relapse
viral of bacterial infections
disease of major organ system
major of minor stresses
Pseudo exacerbation
what are Pseudo exacerbation
temporary worsening of MS symptoms lasting 24 hours or less
can be brought on by heat
what is Uthoff’s symptom
when MS is brought on my heat
how do we diagnose MS
neuro exam
labs and test to rule out mimics of MS
- MRI, lumbar puncture
how good is MRI for looking at MS
90-95 sensitive
key feature of MRI and MS imaging
Dissemination in space
Dissemination in time
what does dissemination mean
to spread out
where are MS lesion normally
Characteristic lesions are periventricular, often ovoid and perpendicular to ventricle
what are Dawson’s fingers
demyelinating plaques through the corpus callosum can help to differentiate MS from other demyelinating conditions
what do we find in the CSF
for MS
Elevated total immunoglobulin (IgG) in CSF
Presence of oligoclonal IgG bands in response to inflammatory demyelinating lesions
what do we find in the CSF
for MS - primary progressive
will have higher levesl of CFS then other types of MS
what are Evoked potentials
the electrical activity in areas of your brain and spinal cord in response to stimulation.
Evoked potentials and MS
Up to 90% of individuals have abnormal evoked potentials
what Evoked potentials are the most helpful in diagnosing MS
visual Evoked potentials
what are the signs and symptoms of MS
Fatigue
Temperature intolerance
Visual symptoms
Gait Dysfunction
Changes in sensation
Motor symptoms
Imbalance/dizziness
Pain
Urinary and sexual dysfunction
Cognitive deficits
Anxiety/depression
Speech and swallowing changes
is fatigue common in those with MS
yes
how does fatigue impact the individual with MS
impact on physical functioning and ability to participate in activity and life roles
what are the central factor the contribute to increase fatigue in those with MS
Neurochemical change
Inflammation
Reduced axonal conduction velocity
Decreased cerebral glucose metabolism
is pain common in those with MS
yes
how is pain with MS described
intense, sharp, shooting, shock-like, or burning
common type of pain see with MS
Trigeminal neuralgia
Lhermitte’s sign (flexion of the neck)
Paroxysmal limb pain
Headache
Neuropathic pain
what is Trigeminal neuralgia
chronic pain disorder that involves sudden attacks of severe facial pain.
what is Lhermitte’s sign
an electric shock-like sensation that occurs on flexion of the neck.
what is Paroxysmal limb pain
come on very suddenly, last only a few seconds or minutes and then disappear just as quickly.
what is Neuropathic pain
sponataneous nerve pain
what is the secondary pain seen with MS
MSK pain
do we see visual changes with MS
yes
what kind of visual chnages do we see with MS
optic neuritis
nys
diplopia
Internuclear Ophthalmoplegia
what are the symptoms of optic neuritis
eye pain
blurring or blindness
central scotoma,
abnormal pupillary light reflex,
usually unilateral
what is central scotoma
a blind spot in the middle of your vision
what is Internuclear Ophthalmoplegia
the failure of the effect eye to add (convergence is intact)
nys in the abd eye
lesion of the medial long fasiculus
what motor systems impairment do we see with MS
issue in the corticospinal tract
UMN - weakness and spac
why do we see balance, dizzyness, and coordination issues with MS
lesions in the BS (vest pahways, visual pathways), cere
what balance issue do we see with MS
tremor
balance, dizzyness
coordination - ataxia
what moevment system issues do we see with MS
Weakness
Fatigue
Spasticity
Impaired postural control
Impaired sensation
Visual changes
Ataxia
do we see cog impairment with MS
yes
70%
what kind of cog deficts do we see
Processing speed,
selective attention,
executive functioning,
visuospatial function
Bowel/bladder dysfunction
Bladder dysfunction in up to 80% of persons with MS
Constipation
why do we see consipation issues for those with MS
lesions to the gastrocolic reflex
inactivity,
spasticity in pelvic floor muscles
what Speech/Swallowing dysfunction
do we see with MS
Muscle weakness, spasticity, tremor, ataxia
Slurred speech, changes to vocal quality
Difficulty chewing, inability to swallow, coughing after meals
is depression an issue in those with MS
yes
rection to the stress of the disease
sexual function is this impacted
yes
what are the features for a better progonosis in those with MS
monofocal onset
Onset with Optic Neuritis or isolated sensory symptoms
low replease rate (2-5 years)
low disablility at 5 years
low MRI lesion load
what does monofocal mean
only affect one area of the central nervous system
what are the feature of a poor prognosis
multifocal onset
what does multifocal mean
multiple areas of the CNS is impacted
short intervals between attacks
disability at 5yrs
high MRI lesion load
first: brainstem, cere, bowel/bladder symptoms
what is the goal for managing MS
Modify or slow disease course
Treat relapses (exacerbations)
Manage symptoms
Improve function and safety
Address emotional health
Acute relapses - meds
Corticosteroid therapy (methylprednisolone)
Plasmapheresis may be used failure to respond to steroids
Disease Modifying Therapeutic Agents (MS Coalition) - goal
prevent future disease activity
Early and successful control of disease is important for reducing disability
what do Injectable synthetic interferon drugs do
Slow down immune system response by reducing inflammation, swelling, and proliferation of T and B cells
examples of Injectable synthetic interferon drugs
Avonex
Rebif
Betaseron
Extavia
Plegridy
pain meds
SSNRIs
antiinflammatory medications
MS is a diagnosis of what
exclusion
what are the most common MS symptoms - IMPORTANT
fatigue, pain, visual changes, motor symptoms, sensory changes, and mobility limitations
exposure ot heat and stress can do what to MS symptoms
exacerbate MS symptoms
when do we start PT in those with MS
As soon as possible after diagnosis!
what is the role of the PT in MS
Preventative interventions
Compensatory interventions
Maintenance interventions
what are Maintenance interventions
intermittent visits to maintain current level of function/ability
what are Compensatory interventions
modifying task, activity, or environment to allow for optimal function
what are Preventative interventions
minimize complications, early detection of impairments, activity limitations, reduce degree of disability
what should be prioritized in the neuro PT exam
CN
sensation
motor
coordination
balance
functional
do you include the mental exam
depends on the pt presentation
what are the common CN deficts that we see with MS
Optic pain and visual changes (optic neuritis)
Diplopia or disconjugate gaze
Facial sensation changes, complaints of facial pain & paresthesia (trigeminal neuralgia)
Dizziness
Dysphagia, impaired gag reflex
what is MS Hug
crawling, electric shock, heavy, lead-like, tightness around rib
what is L’Hermittes Sign
Stabbing electric shock running down spine with cervical flexion
why do we see weakness with MS -primary
due to demyelination of axons, loss of recruitment and firing rate of motor neurons
why do we see weakness with MS - secoundary
deconditioning, compensatory movements, mechanical tightness, pain, poor proprioception
what is a test for func motor movement
9-hole peg test
how do we see balance issue in those with MS
Cerebellar or Brain Stem lesion
Sensory dysfunction
Change in vision
Change in Posture
Comorbid conditions
Core Outcome Measures
for balance and gait
5xSTS
Berg
ABC
10MWT
6MWT
FGA
when to schedule PT sessions
early
should you do PT if indivdual in on replase
no pause until remission
managing Somatosensory deficits
Sensory reorganization training
Resistance exercise
Loading limb through exercise
Education on skin care, pressure relief, maintaining skin integrity
PT Management of Spasticity
Stretching & ROM exercise
Strengthening & functional activities
Orthoses or splinting for contracture prevention
Topical ice can provide short-term effects
edu
Strength Training for those with MS - why might force production be low
reduced ability to activate muscles,
reduced muscle metabolic responses,
muscle weakness due to muscle fiber atrophy, spasticity, and disuse
strength training in those with MS
Alternate with endurance/aerobic training days
Circuit training may be helpful,
alternate UE and LE exercises
Optimal time for individual to rest in between sets
modes of exercise for MS strength training
weight machines, resistance bands, free weights, functional strength training, group exercise
for Aerobic Conditioning what HR do we want to work at
60-80 of max
what to consider with Aerobic Conditioning for those with MS
prevent overheating
consider mornings
Consider alternating days with aerobic conditioning and strength training
what type of aerobic conditioning should
treadmill or overground walking, elliptical, stationary or recumbent bike, swimming, water aerobics, upper body ergometer
Continuous or intermittent - work up to 30 minutes
what balance training - treatment types
include interventions for improving stability during static and/or dynamic tasks
Static balance actives
sitting, quadruped, standing
what commonly leads to gait dysfunctions
Weakness in hip musculature and ankle DF
sensory changes, ataxia, spasticity
what should locomotion training include
Targeted strengthening
Tone management, stretching
Task-specific training incorporating motor leaning principles to enhance skill acquisition
Functional training activities
when are orthotic needed
when walking skill declines
are KFAO used often
not used due to increased energy expenditure
are Wheeled devices often use
in advanced disease
Education - for fatigue
energy conservation
importance of exercises
activity pacing
sleep
stress management
what kind of training in included in the PT session
strength
aerobic
balance
locomotion
