MS Flashcards

1
Q

What is MS

A

Demyelination of the nerve occurs resulting in scar tissue formation that affects nerve transmissions in widely scattered areas of the brain and spinal cord

  • Starts with an inflammatory process, followed by the loss of
    myelin that surrounds the nerve axons.
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2
Q

Scar tissue, known as sclerotic plaques

A

develops at the sites of demyelination.

These plaques cause a slowing, disruption or blockage of nerve transmissions.

With increased plaque formation, symptoms become more severe.

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3
Q

Who MS affects

A
  • This disease strikes people during a very active time in life.
  • Average onset: between 20 and 40 years, however, it can happen as early as
    15 and as late as 45.
  • Women are slightly more affected than men.
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4
Q

MS etiology genetics

A

⚬ There is a genetic link, but not an inherited disease. Has been found in 25% to 30% of monozygotic twins.
Risk increased if a first degree relative has is (parents, siblings, children)

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5
Q

Etiology - Environmental factor

A

Higher occurrence of MS the farther you live from the equator, such as North America & Northern Europe

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6
Q

Etiology viral factor

A

Such as measles, canine distemper, human herpesvirus-6, Epstein-Barr, Chlamydia pneumonia: causes
overactivity of the immune response which results in the demyelination of the axons.

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7
Q

Etiology Immunological factor

A

Abnormal immune response causes inflammation/ damage to the CNS. T cells & B cells can causes an
autoimmune response - attacking the myelin

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8
Q

Diagnosis

A

Difficult to diagnose in early stages

  • Medical history & neurological examination
  • MRIs, Evoked Potentials (EP), Lumbar puncture (LP)
  • Doctors look for evidence of damage in at least 2 separate areas of the CNS - brain, spinal cord, & optic nerves
  • Evidence that damage occurred at different points in time
  • Rule out all other possible diagnoses
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9
Q

Clinically
Isolated
Syndrome (CIS)

A
  • Earliest from
  • Refers to a single episode of neurological
    symptoms that relate to MS
  • MRI shows evidence of abnormality in brain or
    spinal cord
  • People who experience this may or may not go on
    to develop MS
  • Having multiple attacks of the symptoms changes
    the diagnosis to relapsing-remitting MS
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10
Q

Relapsing-remitting MS (RRMS)

A
  • Most common
  • Characterized by unpredictable but defined relapse - aka: attacks, flair ups, exacerbations
  • New symptoms appear or existing ones get worse
  • In between relapses - recovery can range from
    complete, nearly complete to pre-relapse function
    or remission
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11
Q

Secondary Progressive MS (SPMS)

A
  • Relapsing-remitting eventually transition to
    secondary progressive
  • This phase has progressive worsening but
    fewer relapses
  • Sometimes there are occasional relapses &
    minor remissions/ plateaus
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12
Q

Primary progressive MS (PPMS)

A
  • Characterized by slow accumulation of disability without defined relapses
  • Can stabilizes for periods of time
  • Can have minor temporary improvement
  • No periods of remission
  • Approximately 15% of MS patients are
    diagnosed with PPMS
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13
Q

Which matter is affected and where are lesions commonly found

A

Specific S&S depend on location of lesions in the CNS & the extent of the lesions

⚬ White matter is affected

⚬ Lesions are commonly found in the brain stem, cerebellum & spinal cord

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14
Q
  • Optic & Trigeminal nerve S&S
A

⚬ Optic nerve S&S: visual acuity, colour blindness, visual field defects, diplopia

⚬ Total blindness is uncommon

⚬ Trigeminal nerve S&S: trigeminal neuralgia

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15
Q

Signs & Symptoms

A
  • Fatigue
  • Spasticity
  • Weakness
  • Impaired proprioception
  • Intention tremors
  • Circumducted gait
  • Altered posture
  • Vertigo
  • Bladder dysfunction, UTIs
  • Bowel dysfunction
  • Compensatory changes of unaffected or
    overused limbs
  • Paresthesia
  • Cold extremities or sweating abnormalities
  • Edema, may be present
  • Speech disturbances i.e. dysarthria and
    slurring
  • Mood swings, depression, euphoria, cognitive
    problems i.e. forgetfulness and inattentiveness
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16
Q

Exacerbating
Symptoms

A
  • Vitamin/ mineral and essential fatty acid
    deficiencies
  • Amalgam dental fillings
  • Food allergies: dairy produces, increased
    intake of polyunsaturated fats
  • Stressful events, over exertion, heat, fever,
    injury, emotional upset
17
Q

MS Contraindications

A
  • Techniques that can fatigue the patients

⚬ frictions, vigorous work that increases SNS firing - inducing fatigue

  • Heat applied over large areas
  • Deep techniques in areas of altered sensation
  • Decubitus ulcers - local massage

⚬ If you see red, inflamed areas over bony prominences the patient should be
referred to their MD

18
Q

History/ Intake

A
  • Are other conditions present? infection, cold, flu - potentially increases susceptibility to fatigue
  • Last attack? remissions?
  • Diminished or loss of sensory perception, limb proprioception?
19
Q

Assessment/ Special Tests

A
  • ROM
  • Sensory testing
  • Specific orthopedic tests
20
Q

Goals

A
  • Decrease SNS, prevent fatigue
  • Improve/ maintain tissue health, decrease edema
  • Limit contratures, address postural changes/imbalances
  • Address secondary conditions/ temporarily decrease spasticity/ maintain joint health, ROM
21
Q

Homecare/ Therex

A
  • encourage ADLs to the level of their ability
  • encourage movement rehab programs if they have difficulties with balance & shifting weight -
    yoga, tai chi
  • swimming or walking - as long as they don’t over fatigue
  • modified weight training in a cool environment
    ⚬ ensure they are taking rest periods up to 5 mins
    ⚬ submaximal resistance - they’re not using their full strength - resisting against gravity,
    gradually increasing to resistance bands
  • Patient education - tissue health, self lymphatic drainage, cool hydro, signs of gangrene