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Neuromotor II > MS > Flashcards

MS Flashcards

1
Q

Chronic inflammatory demyelinating disease of the CNS white matter; Severing of axons in acute plaques; Results in conduction block and loss of function; Multifocal disease

A

MS

- Cerebrum; cerebellum; brainstem; spinal cord

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2
Q

What are risk factors for MS?

A
  1. Causacian
  2. Female (3:1)
  3. Young adults
  4. further away from equator (Vit D deficiency)
  5. (think) AI disease triggered by virus or infection
  6. family history (15% of pts have fam hx)
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3
Q

What are the types of MS?

A
  1. Relapsing Remitting
  2. Secondary Progressive
  3. Primary Progressive
  4. Progressive Relapsing
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4
Q

Most common (55% of pts); Clearly defined relapses of worsening neurologic function; Relapses are followed by partial or complete remissions, during which symptoms improve partially or completely

A

Relapsing- remitting

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5
Q

What’s the average length of relapse?

A

6-8 weeks

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6
Q

30% of patients
Follows after the relapsing-remitting course; Most people who are initially diagnosed with RRMS (80%) will eventually transition to this; Disease begins to progress more steadily with or without relapses

A

Secondary progressive

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7
Q

10% of patients
Steadily worsening neurologic function from the beginning; Rate of progression may vary over time, but there are no defined relapses or remissions

A

Primary progressive

  • generally later onset (over 40 y/o)
  • most severe
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8
Q

5% of patients

Steadily progressing disease from the beginning and occasional relapses along the way with some recovery afterwards

A

Progressive relapsing

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9
Q

What are clinical features of MS?

A
  1. Motor - Paresis, spasticity (63%), fatigue (83%), incoordination, ataxia, impaired balance, difficult walking (67%)
  2. **Sensory - Paresthesias, numbness
  3. Pain (54%) - Frequent, localized, mechanical, neuropathic; Trigeminal neuralgia; Lhermitte’s sign; Paroxysmal limb pain (most common type of pain)
  4. **Visual (37%) - Optic neuritis; Diplopia; Nystagmus
  5. Speech and Swallowing - Dysarthria; Dysphagia
  6. Cognitive (55%) - Advanced MS - Impaired attention, slower processing speed, impaired short term memory
  7. Depression (50%)
  8. Bladder dysfunction (60%)
  9. Heat sensitivity (80%)
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10
Q

electric shock like sensation down spine into legs with flexion of the neck

A

Lhermitte’s sign

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11
Q

What are negative prognostic indicators?

A
  1. Male sex
  2. Onset of symptoms after the age of 40
  3. Initial symptoms involving the cerebellum, mental function, or urinary control
  4. Initial symptoms that affect multiple regions of the body
  5. In the first years after onset, attacks that are frequent, or a short time between the first 2 attacks
  6. Incomplete remissions
  7. Rapid progression to disability
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12
Q

What are positive prognostic indicators?

A
  1. Female sex
  2. Onset of symptoms before the age of 40 years
  3. Initial symptoms that are sensory only
  4. Involvement of only one CNS system at time of onset
  5. Full recovery between attacks
  6. Absence or late onset of cerebellar symptoms
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13
Q

How do you diagnose MS?

A

Made by neurologist based on:

  1. History
  2. Clinical findings
  3. 2 or more attacks
  4. Clinical tests - MRI – 2 or more distinct lesions
    - # of lesions doesn’t necessarily indicate severity
    - more loss of axions = more chronic
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14
Q

What are the strategies for tx MS?

A
  1. Acute therapy
  2. Prevention
  3. Symptomatic treatment
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15
Q

What do you use for prevention of MS symptoms?

A 
Disease-modifying agents
For relapsing-remitting MS
ABC Drugs:
1. Avonex/Rebif - Interferon Beta 1a
2. Betaseron - Interferon Beta 1b
3. Copaxone - Glatiramer acetate
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16
Q

IV infusion once per month; It’s an antibody/immunosuppressant - not an interferon; Used for relapsing-remitting MS; Used for patients who have not been helped by the ABC drugs

A

Tysabri

17
Q

First drug for primary progressive MS; IV infusion
2 clinical trails with 1,656 participants compared the drug to Rebif (interferon); Showed reduced relapse rates and reduced worsening of disability compared to Rebif

A

Ocervus

- FDA approval in 2017

18
Q

What is used for acute therapy of MS during relapses?

A

Steroids - Corticosteroids (prednisone, cortisone, methylprednisolone)
ACTH- adrenocorticotropic hormone

  • Shortens relapses
  • No long term effects on the disease
19
Q

What is the outcome measure used to quantify disability in people with MS?

A

Expanded Disability Status Scale (EDSS) for pts with MS

20
Q

How does rehab help MS?

A
  1. Promote functional mobility and independence
  2. Reduce impairments and prevent disability
  3. Reduce or prevent secondary complications
  4. Optimize quality of life
    - Disease cannot be altered by rehab
21
Q

See slide 29 for..

A

MS-specific history questions

22
Q

What should you use for outcome measures of body structure and function?

A
  1. Cardiopulmonary - Maximal inspiratory and expiratory pressures
  2. Neurological - Coordination
  3. Fatigue - Modified Fatigue Impact Scale
23
Q

What should you use for outcome measures of activity?

A
  1. Balance - ABC scale, Berg, DGI, 4 square step, Functional Reach, Trunk Impairment Scale
  2. Mobility - 12-item MS Walking Scale, 6 Min Walk Test, TUG cognitive and manual tasks
24
Q

What should you use for outcome measures of participation restrictions?

A
  1. MS Impact Scale

2. MS Quality of Life Inventory

25
Q

Self-report measure of the impact of MS on an individual’s walking ability; Can monitor change over time

A

12-item MS walking scale

26
Q

What should PT intervention include?

A
  1. Strength program
  2. Aerobic conditioning program
  3. Flexibility exercises
  4. Mobility and balance training
  5. Task specific training
  6. Fall prevention programs**
  7. Orthotics or assistive devices
  8. Energy conservation techniques
27
Q

What should strengthening prescription look like?

A
  • Morning is better (before fatigue sets in)
  • 3-5 days/week on alternate days
  • Circuit training alternating work between UE’s and LE’s
  • Adequate rest periods
  • Progress slowly
  • Do NOT exercise to the point of fatigue
  • Manage core temp - fans, AC, cool water exercise
28
Q

What should strengthening prescription look like?

A
  1. Morning is better (before fatigue sets in)
  2. 3-5 days/week on alternate days from strength
  3. Limited to 60-85% peak HR or 50-70% peak VO2
  4. Up to 30 min total
    - aquatic therapy, walking, biking

Neuromotor II (13 decks)

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