MS + ALS + GBS + CNS Tumor Flashcards
What is the most common kind of MS?
Relapsing Remittent
What are “clinically isolated symptoms” in MS?
How long must they happen for?
The first episode of demyelination in CNS , not yet confirmed to be MS
Must be atleast 24 hours
Note: It’s called exacerbation if its new and recurrent MS symptoms lasting over 24 hours
Exacerbation vs pseudo-exacerbation in MS
Exacerbation: New or recurrent MS symptoms over 24 hours
Psuedo exacerbation- Temporary worsening of MS under 24 hours
Primary vs secondary fatigue in MS
Primary fatigue- due to hypometabolism and location of plaques in CNS
Secondary fatigue- due to increased energy needed to perform activities
What is Uhthoff’s phenomenon in MS?
Excessive heat causes temporary worsening of symptoms
What is lhermittes phenomenon in MS?
Neck flexion cuases electric-shock sensation down spine
What is charcot’s triad in MS?
When the cerebellum is affected
scanning speech
intention tremor
nystagmus
What visual dysfunction occurs with MS?
Diplopia, Marcus-gunn pupil, vision loss, lateral gaze palsy
What are the most common symptoms of MS
Fatigue 83%
Heat Sensitivity 80 %
DIfficulty walking and imbalance 67%
Stiffness Spasms 63%
What do you want to know in your subjective on an MS patient
Fatigue level
Exacerbations
Previous education and insight into MS
PATIENT GOALS
Modified fatigue impact scale MFIS vs Fatigue Severity scale
The one with the longer name (MFIS) asks about fatigue in 4 weeks, other one asks for only 1 week
what gait impairments will someone with MS present with
Extensor spasticity, scissoring, ataxia, uneven steps
The expanded disability scale requires examination by _______
A neurologist
Movement pattern coordination deficit has what kind of prognosis for MS
Good prognosis for recovery
Force production deficit has what kind of prognosis for MS
Poor for chronic progressive
Good for relapsing remittent
What are the 4 PT diagnoses associated with MS
Movement pattern coordination deficit
Force production deficit
Fractionated movement deficit
Hypermetria
Normal life expectancy with ALS
5 years
ALS only affects ____ neurons
MOTOR
Typical ALS presentation:
UMN and LMN without sensory loss
It’s a diagnosis of exclusion that requires both UMN and LMN symptoms with decline in physical function not attributable to other disorders
ALS can start in what 2 places
Can start in limbs, spinal onset
Or in cranial nerves, bulbar onset
What are the most important things in subjective for ALS
Known code status
What are the most important functional activity limitations to assess for ALS
Communication
Swallowing
Breathing
What muscles become especially weak due to ALS
Neck extensors
What is the nutritional goal of ALS patients
Promote weight gain
Should ALS patients perform vigorous exercise
False
Is moderate intensity exercise safe during early ALS
Yes
Guillain barre syndrome onset?
Rapid onset
Guillain barre syndrome affects what gender more
Males more than females
Guillane barre paralysis follows what pattern
Symmetrical
Distal to proximal
how will reflexes present during guillane barre
areflexic or decreased
PT considerations for Guillane Barre
Avoid working to exhaustion
check vitals to avoid BP instability, Cardiac arrythmias, and orthostatic hypo
Important question to ask Guillane Barre patients during subjective
Do they require ventilation
Family support
Guillane Barre prognosis
Acute stage 1-10 days
Peak 2-8 weeks
Improvement can begin approximately 2-3 months post onset
33% fully back to normal after 8 months
How will PT be involved in the ascending stage of guillane barre
education on positioning and respiration
Exercise considerations for guillane barre patients
(MMT)
If less than or equal to 3/5 strength avoid eccentric contraction exercises and avoid overloading muscles
What age groups have CNS tumors at the highest rate
Gender?
0-14
40-70
Males more than females
How do headaches relate to brain tumors
Headache present in 50% of cases, but rarely is the sole complaint
Headache redflags
Interupts sleep or is worse when waking up
elicited by posture changes, cough, or exercise
recent onset is more severe than typical headaches
new onset of headache occurs in older person
associated with nausea, vomiting, papilledema, and focal neurological signs
Important subjective questions for CNS tumor
Family support
What do they know/ understand?
What kind of PT goals should be made for patients with CNS tumors
patient/family focused goals
When recommending equipment and treating pts with CNS tumors, what should we do?
determine what is needed now and plan for the future
How variable is CNS tumor presentation between patients
All CNS tumor patients have completely different presentation
Exercise guidelines for people with CNS tumors
they should be as physically active as possible
