MS and ALS (Big Red Ch. 16-17) Flashcards
1
Q
MS definition
A
- Chronic, unpredictable, demyelinating disease of the CNS
- Hardened plaques, inflammation, segmental demyelination, and gliosis
2
Q
Relapsing-Remitting MS
A
- Clearly defined exacerbations of neurological symptoms followed by periods of partial or complete recovery
- Most common form at diganosis
3
Q
Primary Progressive MS
A
- Slow, continuous worsening of symptoms
- Associated with later age of onset
4
Q
Secondary Progressive MS
A
- Starts out as relapsing-remitting
- Change of clinical course into steady, progressive, irreversible decline.
5
Q
Progressive-Relapsing MS
A
- Steady deterioration from onset with occasional, acute relapses
- Least common form of MS
6
Q
PT for MS patients
A
- Goal is to relieve symptoms, prevent secondary complications, and maintain optimal functioning as long as possible
- RRMS: avoid aggressive exercise when pt is in exacerbation
- PPMS, SPMS, and PRMS: start exercise when deterioration has stabilized and no new symptoms appear
- Exercise within limits of capabilities to slow further deterioration and optimize function
7
Q
Lhermitte’s sign (MS)
A
Intense, sharp, shooting, burning, electric shock-like pain
8
Q
ALS definition
A
Degeneration and loss of motor neurons in spinal cord, brainstem, and brain
9
Q
Avg ALS life expectancy
A
2-5 years from time of diagnosis
10
Q
Risk factors ALS
A
- Genetic mutation of chromosome 21
- Neurodegeneration from glutamate toxicity
- Autoimmune reaction
- And lots of other stuff….
11
Q
PT considerations for ALS
A
- Overuse weakness does NOT typically occur in muscles with MMT 3/5 or greater
- Moderate resistance exercise will increase strength in muscles with MMT 3/5 or greater
- Avoid heavy eccentric exercise
- Encourage frequent rest breaks in exercise and ADLs to prevent overuse fatigue
12
Q
Early stage ALS presentation
A
- Mild to moderate weakness in specific muscle groups
- Difficulty with ADLs and mobility towards the end of this stage
13
Q
Early ALS interventions
A
- Strengthening exercises
- Endurance exercises
- AROM, AAROM, stretching
- Determine potential need for adaptive or assistive devices
- Ergonomic modifications
- Energy conservation
- Education on disease process
14
Q
Middle ALS presentation
A
- Progressive decrease in mobility
- Wheelchair needed for long distances
- Increased w/c use towards end of stage
- Severe to moderate weakness across different muscle groups
- Progressive decrease in ADL skills
- Pain
15
Q
Middle ALS interventions
A
- Support weak muscle groups
- Modifications to workplace/home
- Wheelchair prescription
- Educate caregivers on functional training
- AROM, AAROM, PROM, stretching
- Strengthening and endurance at beginning of stage
- Determine need for pressure relieving devices