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Unit 11 > MS > Flashcards

MS Flashcards

1
Q

Trunk flexors and hip ABD best predictor of what?

Plantarflexors?

A

Trunk flexors and hip ABD: 6MWT

PF: gait speed

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2
Q

Are women or men more likely to have MS?

A

women

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3
Q

what is the most common MS diagnosis?

A

relapsing remitting

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4
Q

What three places does MS affect?

A

CNS, brain, optic nerves

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5
Q

Myelin sheath is scarred causing what

A

plaques and lesions which vary from person to person in number, location and frequency

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6
Q

Inflammatory response is called what?

A

exacerbation

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7
Q

MS is an_______ mediated disease

A

immune mediated

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8
Q

As the disease progresses myelin is lost eventually causing what?

A

axon to be destroyed

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9
Q

Oligodendrocytes produce what

A

myelin cells

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10
Q

How are oligodendrocytes effected in MS

A

destroyed therefore there is reduced ability to remyelinate

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11
Q

What is the criteria called to make an MS diagnosis? What are the three things?

A

McDonald Criteria

MRI shows multiple plaques in at least two discrete areas, two different times, and plaques have no other explanation

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12
Q

to diagnose MS what are you looking for

A

a pattern in symptoms

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13
Q

Etiology of MS is….

A

unknown. But thought to be an autoimmune response to environmental trigger, bacteria/virus

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14
Q

Is MS a genetic disease

A

Not, not genetic but you are at a greater risk of first degree relative has MS

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15
Q

RRMS
PPMS
SPMS
PRMS

A

RRMS: relapsing remitting
PPMS: primary progressive
SPMS: secondary progressive
PRMS: progressive relapsing

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16
Q

Characteristics of RRMS

A

full or near recovery after exacerbation.

Time between exacerbations is variable.

Overtime they lose a bit of function at a time

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17
Q

Characteristics of PPMS

A

steady decline of function overtime

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18
Q

Characteristics of SPMS

A

starts as RRMS and then changes to PPMS

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19
Q

Characteristics of PR

A

Steady decline but there are also serious exacerbations along the way

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20
Q

Does MS affect memory and cognition

A

Yes in 50% of the population

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21
Q

Some of the biggest symptoms of MS

A

weakness, fatigue, heat sensitivity, difficulty walking, stiffness and spasms, bladder problems, memory/cognition, pain, major depressive disorder

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22
Q

A transient worsening of temporary symptoms with full recovery is called what?

What can bring one on?

A

pseudoexacerbations: due to stress, infection, overheating/overexertion

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23
Q

What is often thefirst symptom of MS

A

optic neuritis: inflammation of the optic nerve

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24
Q

Treatment course and outcome for optic neuritis?

A

high dose steroids

Most have full or near full recovery 1month-1yr

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25
Q

Characteristics of a favorable prognosis

A

Onset <35 yrs
monoregional
complete recovery after exacerbation
Female

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26
Q

Characteristics of a less favorable prognosis

A

Onset >35 yrs
Brainstem symptoms (nystagmus, tremor, ataxia, dysarthria)
Frequent exacerbations
Males

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27
Q

What is dysarthria

A

a brainstem symptom causing unclear articulation of normal linguistic speech

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28
Q

What is the treatment for acute exacerbations

A

high-dose IV corticosteroids (HTN, DM, OP, cataracts and ulcers are side effects)

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29
Q

What is the primary reason for departure from work in this population?

A

fatigue

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30
Q

What is lassitude

A

primary fatigue that is global unique to MS

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31
Q

What does motor fatigue look like in patients with MS

A

its primary fatigue: progressive decrease in motor output that worsens as activity progresses

32
Q

Do generally help with motor fatigue and lassitude?

A

No these are primary fatigues organic to MS. We help with secondary fatigue

33
Q

Talk about exercise, patient education, and medication as it related to reducing fatigue in the study we talked about

A

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

34
Q

What is primary weakness due to?

A

plaques in the motor cortex or pyramidal tracts

35
Q

What is secondary weakness due to?

A

disuse!

36
Q

What are Gabapentin (Neurontin) lyrica (pre gabalin) for?

A

neurogenic pain

37
Q

Lhermitte’s syndrome

A

electric shock type sensation triggered by forward head flexion. usually short lived but can be very intense

38
Q

What is Uthoff phenomenon?

A

heat sensitivity

39
Q

What do the drugs for MS due as far as progression of the disease

A

They are disease MODIFYING drugs, they SLOW the progression, however they do NOT stop progression

40
Q

Avonex, Betaseron, Copaxone,Rebif, Tysabri are all what?

A

CRAB drugs: disease modifying medication

41
Q

Whats the deal with Tysabri

A

its a CRAB drug (disease modifying) but there are significant side effects

42
Q

EDSS cut off for ambulation w/o assistive device (higher than this an AD is needed)

A

4.0

43
Q

5.0-9.0 on the EDSS is characterized as what?

A

impairments in ambulation

44
Q

What does EDSS stand for

A

Extended disability status score

45
Q

When are PT’s generally brought into the picture for this patient populalation

A

exacerbation or change in functional status

46
Q

What is the first part of the examination for all these patients

A

VITALS!

47
Q

What is a primary concern in these individuals?

A

safety: make sure you assess and create interventions for balance

48
Q

What balance test is preferred for MS population

A

Berg balance

49
Q

Dizziness handicap inventory and MS functional composite should be used in what treatment environment?

A

Outpatient

50
Q

Early stage of disease what is your intervention strategy

A

Preventative –> restorative –> compensatory

51
Q

Middle stage of disease what is your intervention strategy

A

Compensatory –> preventative –> restorative

52
Q

Late stage of disease what is your intervention strategy

A

Compensatory –> preventative –> restorative

53
Q

At all disease stages what do these patients need

A

Education: to pt and family
Psychological support
Referral to other health care professionals

54
Q

What are some of the most important preventative interventions during the early stage of MS

A

stretching: they have a lot of spasticity and immobility

Energy conservation

55
Q

What do restorative interventions look like in both early and middle stages of MS

A

Balance training: head turns, decrease BOS

ROM

Strength: include trunk flexors, hip ABD, PF

Endurance

56
Q

Name some compensatory interventions for middle stage of MS

A

orthoses, adaptive and AD

Strategies for sensory loss (feel the hot water with other arm and cognitive impairments (external cues, devices, memory aids)

57
Q

name compensatory interventions for late stage of MS

A

Education of caregivers on transfers and bed mobility

58
Q

Late stage in MS the interventions are mostly what?

A

Preventative for more sinister complications

59
Q

Name important preventative interventions for late stage MS

A

Pulmonary & skin care hygiene

Anti-pressure devices

Educations of caregivers on prevention of 2nd complications

60
Q

Can you restore at every level?

A

Janet says yes!

61
Q

What did individuals with MS rate their most valuable bodily functions?

A

Gait and vision

62
Q

True or false, there is a ton of literature related to MS and exercise

A

False!

63
Q

within 15 yrs of diagnosis approximately _____ of people with MS will require the use of a walking aid

A

50%

64
Q

What intensity and kind of exercise was well tolerated in individuals with MS

A

moderate intensity aerobic exercise 2x a week

65
Q

What three variables improved in the meta-analysis looking at the benefits of exercise training in PwMS?

A

Walking, balance fatigue: they all improved

walking had a larger effect with a supervised program

66
Q

What kind of balance exercises in general has shown to be beneficial for this population for increasing fatigue as well as balance.

A

progressive!

EO, EC, small BOS, moving head

67
Q

considerations for strength training in PwMS when we know that it improves fatigue, functional capacity and power

A

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

68
Q

What muscle groups to target for strength training

A

Trunk flexors &Hip ABD: largest predictor of 6MWT

Plantarflexors: correlates with gait speed time

69
Q

What kind of exercise may be most affective to combat fatigue in this population

A

resistance training

70
Q

Exercise improves what two things?

A

mobility and fatigue

71
Q

What kind of exercise may be most affective to combat mobility issues in this population

A

aerobic and resistance or a combination; there were mixed findings

72
Q

What are the benefits of exercise on HRQOL

A

Health related QOL. There isn’t enough evidence to support the benefits of exercise

73
Q

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

A 
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

74
Q

Patient education about fatigue after a PT session

A

Its temporary pain, we know that it helps you out, keep at it!

75
Q

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

A

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.

Unit 11 (5 decks)

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