MS, ALS, GBS, CNS tumors Flashcards
HA red flags
+ interrupts sleep
+ worse with walking and improves throughout the day
+ elicited by postural changes, coughing, exercise
+ recent onset more severe or different than normal
+ new onset in older person
+ associated with nausea, vomiting, papilledema, or focal neuro signs
which structure is affected with MS?
oligodendrocytes (CNS myelin)
which type of MS does NOT have attacks?
primary progressive
which type of MS develops into secondary progressive?
relapsing-remitting
criteria for MS diagnosis
first attack sx must last 24 hr or more
one lesion on brain and:
+ increase in tone
+ Lhermitte’s sign
+ Uhthoff’s sign
pseudoexacerbation of MS last ___ hours
<24
what 2 key features does a MS diagnosis rely on?
dissemination of lesions in the CNS in SPACE AND TIME seen on MRI
(2 attacks and 2 brain lesions)
early S&S of MS
parasthesias progressing to numbness, weakness, and fatiguability**
visual disturbances (ex: diplopia)
primary fatigue with MS
due to location of plaques and hypometabolism
secondary fatigue with MS
due to increased energy required to perform activities (less efficient movements)
what S&S are unique to MS?
- Lhermitte’s sign
- Uhthoff’s phenomenon
- Charcot’s Triad
- Visual dysfunction
what is Charcot’s Triad?
when cerebellum is affected
1. scanning speech
2. intention tremor
3. nystagmus
what symptom of MS is a major concern for PT?
fatigue!
_____ neuralgia and ____ neuritis are secondary impairments of MS
trigeminal neuralgia and optic neuritis
what is a Marcus-Gunn pupil?
abnormal pupillary light reflex - seen with MS
a person with MS has a high score on the modified fatigue impact scale and fatigue severity scale, what does this mean?
greater fatigue severity
(physical, cognitive, psychosocial)
modified fatigue impact scale vs. fatigue severity scale
MFIS - 4 weeks
fatigue severity scale - last week
how may a person with MS present with gait?
extensor spasticity
scissoring
ataxia
uneven steps
what outcome measures assesses activity limitations with MS?
Expanded Disability Status Scale (EDSS)
12-Item MS Walking Scale (MSWS-12)*
MS Functional Composite (MSFC)
Expanded Disability Status Scale (EDSS)
fully ambulatory:
impaired ambulation:
fully ambulatory: 1-4.5
impaired ambulation: 5-9.5
a person with MS has a high score on the 12-Item MS Walking Scale (MSWS-12), what does this mean?
greater limitations with walking
3 components of MS Functional Composite (MSFC)
- timed 25-foot walk test
- 9-hole peg test
- 3-second version of paced auditory serial addition test
what outcome measures assesses participation with MS?
MS Impact Scale*
MS Impact Scale assesses impact within past ______
2 weeks
a person with MS has a high score on the MS Impact Scale, what does this mean?
higher impact of disease on daily function
which type of MS can reach near pre- exacerbation function?
relapsing remitting
which type of MS will have greater strength deficits?
progressive
movement system impairment diagnoses (related to MS)
- movement pattern coordination deficit
- force production deficit
- fractionated movement deficit
- hypermetria
movement pattern coordination deficit
Inability to coordinate an intersegmental task due to deficit of timing and sequencing between segments
fractionated movement deficit
Inability to fractionate movement
Associated with hyperexcitability - associated reactions
hypermetria
Inability to grade forces appropriately for the distance and speed aspects of a task
exercise considerations for pts with MS
heat sensitivity
fatigue
energy conservation
equipment
time of day
what is the most common form of motor neuron disease in adults?
ALS
what structures are affected with ALS?
anterior horn cells (amyotrophic)
pyramidal cells (corticospinal and corticobulbar) in motor cortex (Lateral sclerosis)
T/F: ONLY motor neurons are affected with ALS
T!!!
by the time most pts with ALS report weakness, they’ve lost about ___% of their motor neurons in the areas of weakenss
80%
which mm group is commonly weak with ALS?
neck extensors
ALS Functional Rating Scale scoring
higher = better physical function
what impairments are especially of concern with ALS?
respiratory and swallowing
postural control (neck extensors)
life expectancy for ALS
3-5 years
signs of overwork weakness (ALS)
+ post exercise fatigue interferes with activities
+ feeling weaker or pain >30 mins post exercise
+ excessive soreness 24-48 hrs post
+ severe muscle cramping, heaviness in extremities, prolonged SOB
what structure is affected with GBS?
Schwann cells (LMN!!) of nerve roots and peripheral nerves (rapid loss!)
ALS vs. GBS
ALS: motor only
GBS: can have sensory and ANS issues
what is usually the 1st symptom of GBS?
weakness and NT in hands and feet, ascending limbs
how do motor impairments with GBS present?
distal to proximal**
rapid and progressive
symmetrical
usually unilateral
how do sensory impairments with GBS present?
glove and stocking
_____ of patients with GBS require ventilation
1/3
issues specific to acute stages of GBS
respiratory compromise (weakness)
dysautonomia (orthostatic hypotension, BP instability, cardiac arrythmias) (50%)
a pt with GBS that has a single breath count test of ____ might require mechanical ventilation
> 19
how long does acute stage of GBS last?
1-10 days
when do peak motor symptoms for GBS present?
2-8 weeks post onset
how long does plateau period of GBS last?
2-4 weeks
(80% w/i 3 weeks)
improvement can begin about ___ post onset of GBS
2-3 months
max paralysis for GBS occurs when?
1-2 days of onset
when would pt with GBS be rediagnosed to CIDP?
if function continues to deteroriate or begin to deteriorate again after 8 weeks
PT interventions for ascending phase of GBS
avoid overwork and eccentric***
gentle PROM, AAROM, AROM, positioning
PT interventions for plateau phase of GBS
respiratory care (cough, breath)
AAROM & AROM
functional training and mobility
multi-joint and cross-plane work
PT interventions for descending phase of GBS
desensitize dysthesias
contracture, ulcer, injury prevention
balance and postural control
strengthening (maybe eccentric)
aerobic & functional activities
DME (anticipate improvement)
when can strength training begin for GBS? what are the guidelines?
limited reps low resistance once strength begins to return - plateau
can utilize rhythmic initiation
**if 3/5 or less avoid eccentric!!
what 2 distinct age groups do CNS tumors typically occur in?
0-14
40-70
what is the most common cause of death in children and adolescents 0-19?
primary CNS tumors
secondary metastatic CNS tumors spread through ______
arterial circulation
about ____% of pts with systemic cancer develop brain mets
25%
what is the most common type of non-malignant brain tumor?
meningioma
what is the most common type of malignant brain tumor?
glioblastoma
common S&S of CNS tumor
HA (50%)
seizures
AMS
papilledema
focal neuro signs
what 2 main things need to be monitored for CNS tumor pt?
increased ICP (esp. acutely)**
AMS
