MS Flashcards
Trunk flexors and hip ABD best predictor of what?
Plantarflexors?
Trunk flexors and hip ABD: 6MWT
PF: gait speed
Are women or men more likely to have MS?
women
what is the most common MS diagnosis?
relapsing remitting
What three places does MS affect?
CNS, brain, optic nerves
Myelin sheath is scarred causing what
plaques and lesions which vary from person to person in number, location and frequency
Inflammatory response is called what?
exacerbation
MS is an_______ mediated disease
immune mediated
As the disease progresses myelin is lost eventually causing what?
axon to be destroyed
Oligodendrocytes produce what
myelin cells
How are oligodendrocytes effected in MS
destroyed therefore there is reduced ability to remyelinate
What is the criteria called to make an MS diagnosis? What are the three things?
McDonald Criteria
MRI shows multiple plaques in at least two discrete areas, two different times, and plaques have no other explanation
to diagnose MS what are you looking for
a pattern in symptoms
Etiology of MS is….
unknown. But thought to be an autoimmune response to environmental trigger, bacteria/virus
Is MS a genetic disease
Not, not genetic but you are at a greater risk of first degree relative has MS
RRMS
PPMS
SPMS
PRMS
RRMS: relapsing remitting
PPMS: primary progressive
SPMS: secondary progressive
PRMS: progressive relapsing
Characteristics of RRMS
full or near recovery after exacerbation.
Time between exacerbations is variable.
Overtime they lose a bit of function at a time
Characteristics of PPMS
steady decline of function overtime
Characteristics of SPMS
starts as RRMS and then changes to PPMS
Characteristics of PR
Steady decline but there are also serious exacerbations along the way
Does MS affect memory and cognition
Yes in 50% of the population
Some of the biggest symptoms of MS
weakness, fatigue, heat sensitivity, difficulty walking, stiffness and spasms, bladder problems, memory/cognition, pain, major depressive disorder
A transient worsening of temporary symptoms with full recovery is called what?
What can bring one on?
pseudoexacerbations: due to stress, infection, overheating/overexertion
What is often thefirst symptom of MS
optic neuritis: inflammation of the optic nerve
Treatment course and outcome for optic neuritis?
high dose steroids
Most have full or near full recovery 1month-1yr
Characteristics of a favorable prognosis
Onset <35 yrs
monoregional
complete recovery after exacerbation
Female
Characteristics of a less favorable prognosis
Onset >35 yrs
Brainstem symptoms (nystagmus, tremor, ataxia, dysarthria)
Frequent exacerbations
Males
What is dysarthria
a brainstem symptom causing unclear articulation of normal linguistic speech
What is the treatment for acute exacerbations
high-dose IV corticosteroids (HTN, DM, OP, cataracts and ulcers are side effects)
What is the primary reason for departure from work in this population?
fatigue
What is lassitude
primary fatigue that is global unique to MS
What does motor fatigue look like in patients with MS
its primary fatigue: progressive decrease in motor output that worsens as activity progresses
Do generally help with motor fatigue and lassitude?
No these are primary fatigues organic to MS. We help with secondary fatigue
Talk about exercise, patient education, and medication as it related to reducing fatigue in the study we talked about
exercise (aerobic and strength) and patient education reduced fatigue more effectively than medication alone or education alone
All three should be considered in fatigue management
What is primary weakness due to?
plaques in the motor cortex or pyramidal tracts
What is secondary weakness due to?
disuse!
What are Gabapentin (Neurontin) lyrica (pre gabalin) for?
neurogenic pain
Lhermitte’s syndrome
electric shock type sensation triggered by forward head flexion. usually short lived but can be very intense
What is Uthoff phenomenon?
heat sensitivity
What do the drugs for MS due as far as progression of the disease
They are disease MODIFYING drugs, they SLOW the progression, however they do NOT stop progression
Avonex, Betaseron, Copaxone,Rebif, Tysabri are all what?
CRAB drugs: disease modifying medication
Whats the deal with Tysabri
its a CRAB drug (disease modifying) but there are significant side effects
EDSS cut off for ambulation w/o assistive device (higher than this an AD is needed)
4.0
5.0-9.0 on the EDSS is characterized as what?
impairments in ambulation
What does EDSS stand for
Extended disability status score
When are PT’s generally brought into the picture for this patient populalation
exacerbation or change in functional status
What is the first part of the examination for all these patients
VITALS!
What is a primary concern in these individuals?
safety: make sure you assess and create interventions for balance
What balance test is preferred for MS population
Berg balance
Dizziness handicap inventory and MS functional composite should be used in what treatment environment?
Outpatient
Early stage of disease what is your intervention strategy
Preventative –> restorative –> compensatory
Middle stage of disease what is your intervention strategy
Compensatory –> preventative –> restorative
Late stage of disease what is your intervention strategy
Compensatory –> preventative –> restorative
At all disease stages what do these patients need
Education: to pt and family
Psychological support
Referral to other health care professionals
What are some of the most important preventative interventions during the early stage of MS
stretching: they have a lot of spasticity and immobility
Energy conservation
What do restorative interventions look like in both early and middle stages of MS
Balance training: head turns, decrease BOS
ROM
Strength: include trunk flexors, hip ABD, PF
Endurance
Name some compensatory interventions for middle stage of MS
orthoses, adaptive and AD
Strategies for sensory loss (feel the hot water with other arm and cognitive impairments (external cues, devices, memory aids)
name compensatory interventions for late stage of MS
Education of caregivers on transfers and bed mobility
Late stage in MS the interventions are mostly what?
Preventative for more sinister complications
Name important preventative interventions for late stage MS
Pulmonary & skin care hygiene
Anti-pressure devices
Educations of caregivers on prevention of 2nd complications
Can you restore at every level?
Janet says yes!
What did individuals with MS rate their most valuable bodily functions?
Gait and vision
True or false, there is a ton of literature related to MS and exercise
False!
within 15 yrs of diagnosis approximately _____ of people with MS will require the use of a walking aid
50%
What intensity and kind of exercise was well tolerated in individuals with MS
moderate intensity aerobic exercise 2x a week
What three variables improved in the meta-analysis looking at the benefits of exercise training in PwMS?
Walking, balance fatigue: they all improved
walking had a larger effect with a supervised program
What kind of balance exercises in general has shown to be beneficial for this population for increasing fatigue as well as balance.
progressive!
EO, EC, small BOS, moving head
considerations for strength training in PwMS when we know that it improves fatigue, functional capacity and power
frequent recovery breaks PRIOR to onset of fatigue
greater volume
Avoid limitations due to fatigue; WORK WITHIN THEIR FATIGUE
Cooling prior to or during exercise to decrease fatigue during lifting
What muscle groups to target for strength training
Trunk flexors &Hip ABD: largest predictor of 6MWT
Plantarflexors: correlates with gait speed time
What kind of exercise may be most affective to combat fatigue in this population
resistance training
Exercise improves what two things?
mobility and fatigue
What kind of exercise may be most affective to combat mobility issues in this population
aerobic and resistance or a combination; there were mixed findings
What are the benefits of exercise on HRQOL
Health related QOL. There isn’t enough evidence to support the benefits of exercise
BENEFITS OF EXERCISE FOR PwMS
Improved walking (suggest larger effect with supervised programs increase compliance) Improved fitness
Improved strength
Improved balance (suggest greater gains in progressive program)
Potential to improve fatigue (maybe best with resistance training)
on HRQOL
Special considerations for exercise in PwMS: Heat sensitivity (pseudoexacerbations) Use fans/air conditioning Drink lots of fluids Use cooling vest Patient education
Fatigue
Patient education
Community exercise programs is great to maintain functional mobility
Patient education about fatigue after a PT session
Its temporary pain, we know that it helps you out, keep at it!
Intensity of group exercise = 13/20 RPE (somewhat hard)
Outcomes: Berg balance, 10MWT (usual gait speed), 10-stair climb test, Modified Ashworth Scale, Fatigue Severity Scale, MS International QOL Questionnaire
Exercise group made statistically significant gains in all outcomes
No adverse events
Authors recommend life-long exercise
Not a question: The study demonstrated that supervised group exercise training is effective in improving balance, functional status, spasticity, fatigue and QOL in moderately affected people with multiplesclerosis, with no worsening of their clinical status.
