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Neuromus 3 > MS > Flashcards

MS Flashcards

1
Q

what is MS

A

progressive, ronic infalmmation degeration of the myelin of the CNS

destruction of the mylein sheath and the axons

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2
Q

what are the contributing factors to MS

A

inflammation

autoimmune

infection

enviromental

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3
Q

what is the peak age for MS

A

20 - 50

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4
Q

is MS more prevalent in men or women

A

women - white women

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5
Q

what is the life expectancy of someone with MS

A

normal

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6
Q

Increased risk for MS

A

affected family member

viral agents

vit D def

smoking

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7
Q

what are the three factors that contribute mostly to MS

A

genes

environment

autoimmune response

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8
Q

what is the pathophysiology of MS

A

abnormal autoimmune responses that attacks - inflammatory cascade

myelin

oligodendrytes

CNS nerve fibers

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9
Q

what does demyelination do

A

this slow the neural transmission and causes rapid nerve fatigue

I can also cuase a a conduction block

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10
Q

what patho factor contribute to the relapsing-remitting forms of the disease

A

the decrease in the inflammatory attack

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11
Q

what happens with chronic disease and myelination

A

there is less remyleination between the attacks that results in axon and cell death

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12
Q

what Certain areas are susceptible to demyelination

A

optic nerve

periventricular white matter

spinal cord - corticospinal and DCML

cerebellar peducles

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13
Q

where is periventricular white matter located

A

white matter located immediately adjacent to the CFS filled ventricles of the brain

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14
Q

what is the most common disease course for MS

A

Relapsing-Remitting

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15
Q

how is Relapsing-Remitting MS characterized

A

attacks with period of remission

active - replase period
not active - remission period

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16
Q

what kind of MS will those intially with Relapsing-Remitting transition to

A

Secondary Progressive

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17
Q

what does Secondary Progressive look like

A

starts off with relapsing remitting disease form and then progresses to irreversible worsening of neurological function

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18
Q

who do we characterize secondary progressiev MS

A

as ‘active’ or ‘not active’ or ‘with progression’ or ‘without progression’

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19
Q

what is the least common type of MS

A

primary progressive

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20
Q

primary progressive characterized as

A

continuous worsening of disease without distinct attacks

progressive disablity from onset

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21
Q

what is the Clinically Isolated Syndrome

A

he first episode of inflammatory demyelination

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22
Q

when will Clinically Isolated Syndrome be diagnosed as MS

A

when the secound episode occurs

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23
Q

active - Clinically Isolated Syndrome

A

if a anothere episode occurs

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24
Q

no active - Clinically Isolated Syndrome

A

if there are no other episode after the first instance

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25
Q

what are some factors that are associated with relapse

A

viral of bacterial infections

disease of major organ system

major of minor stresses

Pseudo exacerbation

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26
Q

what are Pseudo exacerbation

A

temporary worsening of MS symptoms lasting 24 hours or less

can be brought on by heat

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27
Q

what is Uthoff’s symptom

A

when MS is brought on my heat

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28
Q

how do we diagnose MS

A

neuro exam

labs and test to rule out mimics of MS
- MRI, lumbar puncture

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29
Q

how good is MRI for looking at MS

A

90-95 sensitive

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30
Q

key feature of MRI and MS imaging

A

Dissemination in space
Dissemination in time

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31
Q

what does dissemination mean

A

to spread out

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32
Q

where are MS lesion normally

A

Characteristic lesions are periventricular, often ovoid and perpendicular to ventricle

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33
Q

what are Dawson’s fingers

A

demyelinating plaques through the corpus callosum can help to differentiate MS from other demyelinating conditions

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34
Q

what do we find in the CSF
for MS

A

Elevated total immunoglobulin (IgG) in CSF

Presence of oligoclonal IgG bands in response to inflammatory demyelinating lesions

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35
Q

what do we find in the CSF
for MS - primary progressive

A

will have higher levesl of CFS then other types of MS

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36
Q

what are Evoked potentials

A

the electrical activity in areas of your brain and spinal cord in response to stimulation.

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37
Q

Evoked potentials and MS

A

Up to 90% of individuals have abnormal evoked potentials

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38
Q

what Evoked potentials are the most helpful in diagnosing MS

A

visual Evoked potentials

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39
Q

what are the signs and symptoms of MS

A

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

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40
Q

is fatigue common in those with MS

A

yes

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41
Q

how does fatigue impact the individual with MS

A

impact on physical functioning and ability to participate in activity and life roles

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42
Q

what are the central factor the contribute to increase fatigue in those with MS

A

Neurochemical change

Inflammation

Reduced axonal conduction velocity

Decreased cerebral glucose metabolism

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43
Q

is pain common in those with MS

A

yes

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44
Q

how is pain with MS described

A

intense, sharp, shooting, shock-like, or burning

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45
Q

common type of pain see with MS

A

Trigeminal neuralgia

Lhermitte’s sign (flexion of the neck)

Paroxysmal limb pain

Headache

Neuropathic pain

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46
Q

what is Trigeminal neuralgia

A

chronic pain disorder that involves sudden attacks of severe facial pain.

47
Q

what is Lhermitte’s sign

A

an electric shock-like sensation that occurs on flexion of the neck.

48
Q

what is Paroxysmal limb pain

A

come on very suddenly, last only a few seconds or minutes and then disappear just as quickly.

49
Q

what is Neuropathic pain

A

sponataneous nerve pain

50
Q

what is the secondary pain seen with MS

A

MSK pain

51
Q

do we see visual changes with MS

A

yes

52
Q

what kind of visual chnages do we see with MS

A

optic neuritis

nys

diplopia

Internuclear Ophthalmoplegia

53
Q

what are the symptoms of optic neuritis

A

eye pain

blurring or blindness

central scotoma,

abnormal pupillary light reflex,

usually unilateral

54
Q

what is central scotoma

A

a blind spot in the middle of your vision

55
Q

what is Internuclear Ophthalmoplegia

A

the failure of the effect eye to add (convergence is intact)

nys in the abd eye

lesion of the medial long fasiculus

56
Q

what motor systems impairment do we see with MS

A

issue in the corticospinal tract

UMN - weakness and spac

57
Q

why do we see balance, dizzyness, and coordination issues with MS

A

lesions in the BS (vest pahways, visual pathways), cere

58
Q

what balance issue do we see with MS

A

tremor

balance, dizzyness

coordination - ataxia

59
Q

what moevment system issues do we see with MS

A

Weakness
Fatigue
Spasticity
Impaired postural control
Impaired sensation
Visual changes
Ataxia

60
Q

do we see cog impairment with MS

A

yes

70%

61
Q

what kind of cog deficts do we see

A

Processing speed,

selective attention,

executive functioning,

visuospatial function

62
Q

Bowel/bladder dysfunction

A

Bladder dysfunction in up to 80% of persons with MS

Constipation

63
Q

why do we see consipation issues for those with MS

A

lesions to the gastrocolic reflex

inactivity,

spasticity in pelvic floor muscles

64
Q

what Speech/Swallowing dysfunction
do we see with MS

A

Muscle weakness, spasticity, tremor, ataxia

Slurred speech, changes to vocal quality

Difficulty chewing, inability to swallow, coughing after meals

65
Q

is depression an issue in those with MS

A

yes

rection to the stress of the disease

66
Q

sexual function is this impacted

A

yes

67
Q

what are the features for a better progonosis in those with MS

A

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

68
Q

what does monofocal mean

A

only affect one area of the central nervous system

69
Q

what are the feature of a poor prognosis

A

multifocal onset

70
Q

what does multifocal mean

A

multiple areas of the CNS is impacted

short intervals between attacks

disability at 5yrs

high MRI lesion load

first: brainstem, cere, bowel/bladder symptoms

71
Q

what is the goal for managing MS

A

Modify or slow disease course

Treat relapses (exacerbations)

Manage symptoms

Improve function and safety

Address emotional health

72
Q

Acute relapses - meds

A

Corticosteroid therapy (methylprednisolone)

Plasmapheresis may be used failure to respond to steroids

73
Q

Disease Modifying Therapeutic Agents (MS Coalition) - goal

A

prevent future disease activity

Early and successful control of disease is important for reducing disability

74
Q

what do Injectable synthetic interferon drugs do

A

Slow down immune system response by reducing inflammation, swelling, and proliferation of T and B cells

75
Q

examples of Injectable synthetic interferon drugs

A

Avonex
Rebif
Betaseron
Extavia
Plegridy

76
Q

pain meds

A

SSNRIs

antiinflammatory medications

77
Q

MS is a diagnosis of what

A

exclusion

78
Q

what are the most common MS symptoms - IMPORTANT

A

fatigue, pain, visual changes, motor symptoms, sensory changes, and mobility limitations

79
Q

exposure ot heat and stress can do what to MS symptoms

A

exacerbate MS symptoms

80
Q

when do we start PT in those with MS

A

As soon as possible after diagnosis!

81
Q

what is the role of the PT in MS

A

Preventative interventions

Compensatory interventions

Maintenance interventions

82
Q

what are Maintenance interventions

A

intermittent visits to maintain current level of function/ability

83
Q

what are Compensatory interventions

A

modifying task, activity, or environment to allow for optimal function

84
Q

what are Preventative interventions

A

minimize complications, early detection of impairments, activity limitations, reduce degree of disability

85
Q

what should be prioritized in the neuro PT exam

A

CN

sensation

motor

coordination

balance

functional

86
Q

do you include the mental exam

A

depends on the pt presentation

87
Q

what are the common CN deficts that we see with MS

A

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

88
Q

what is MS Hug

A

crawling, electric shock, heavy, lead-like, tightness around rib

89
Q

what is L’Hermittes Sign

A

Stabbing electric shock running down spine with cervical flexion

90
Q

why do we see weakness with MS -primary

A

due to demyelination of axons, loss of recruitment and firing rate of motor neurons

91
Q

why do we see weakness with MS - secoundary

A

deconditioning, compensatory movements, mechanical tightness, pain, poor proprioception

92
Q

what is a test for func motor movement

A

9-hole peg test

93
Q

how do we see balance issue in those with MS

A

Cerebellar or Brain Stem lesion
Sensory dysfunction
Change in vision
Change in Posture
Comorbid conditions

94
Q

Core Outcome Measures
for balance and gait

A

5xSTS
Berg
ABC
10MWT
6MWT
FGA

95
Q

when to schedule PT sessions

A

early

96
Q

should you do PT if indivdual in on replase

A

no pause until remission

97
Q

managing Somatosensory deficits

A

Sensory reorganization training

Resistance exercise

Loading limb through exercise

Education on skin care, pressure relief, maintaining skin integrity

98
Q

PT Management of Spasticity

A

Stretching & ROM exercise

Strengthening & functional activities

Orthoses or splinting for contracture prevention

Topical ice can provide short-term effects

edu

99
Q

Strength Training for those with MS - why might force production be low

A

reduced ability to activate muscles,

reduced muscle metabolic responses,

muscle weakness due to muscle fiber atrophy, spasticity, and disuse

100
Q

strength training in those with MS

A

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

101
Q

modes of exercise for MS strength training

A

weight machines, resistance bands, free weights, functional strength training, group exercise

102
Q

for Aerobic Conditioning what HR do we want to work at

A

60-80 of max

103
Q

what to consider with Aerobic Conditioning for those with MS

A

prevent overheating

consider mornings

Consider alternating days with aerobic conditioning and strength training

104
Q

what type of aerobic conditioning should

A

treadmill or overground walking, elliptical, stationary or recumbent bike, swimming, water aerobics, upper body ergometer

Continuous or intermittent - work up to 30 minutes

105
Q

what balance training - treatment types

A

include interventions for improving stability during static and/or dynamic tasks

106
Q

Static balance actives

A

sitting, quadruped, standing

107
Q

what commonly leads to gait dysfunctions

A

Weakness in hip musculature and ankle DF

sensory changes, ataxia, spasticity

108
Q

what should locomotion training include

A

Targeted strengthening

Tone management, stretching

Task-specific training incorporating motor leaning principles to enhance skill acquisition

Functional training activities

109
Q

when are orthotic needed

A

when walking skill declines

110
Q

are KFAO used often

A

not used due to increased energy expenditure

111
Q

are Wheeled devices often use

A

in advanced disease

112
Q

Education - for fatigue

A

energy conservation

importance of exercises

activity pacing

sleep

stress management

113
Q

what kind of training in included in the PT session

A

strength

aerobic

balance

locomotion

Neuromus 3 (7 decks)

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