MS and ALS (Big Red Ch. 16-17)

Question 1

MS definition

Answer 1

• Chronic, unpredictable, demyelinating disease of the CNS
• Hardened plaques, inflammation, segmental demyelination, and gliosis

Question 2

Relapsing-Remitting MS

Answer 2

• Clearly defined exacerbations of neurological symptoms followed by periods of partial or complete recovery
• Most common form at diganosis

Question 3

Primary Progressive MS

Answer 3

• Slow, continuous worsening of symptoms
• Associated with later age of onset

Question 4

Secondary Progressive MS

Answer 4

• Starts out as relapsing-remitting
• Change of clinical course into steady, progressive, irreversible decline.

Question 5

Progressive-Relapsing MS

Answer 5

• Steady deterioration from onset with occasional, acute relapses
• Least common form of MS

Question 6

PT for MS patients

Answer 6

• 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

Question 7

Lhermitte’s sign (MS)

Answer 7

Intense, sharp, shooting, burning, electric shock-like pain

Question 8

ALS definition

Answer 8

Degeneration and loss of motor neurons in spinal cord, brainstem, and brain

Question 9

Avg ALS life expectancy

Answer 9

2-5 years from time of diagnosis

Question 10

Risk factors ALS

Answer 10

• Genetic mutation of chromosome 21
• Neurodegeneration from glutamate toxicity
• Autoimmune reaction
• And lots of other stuff….

Question 11

PT considerations for ALS

Answer 11

• 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

Question 12

Early stage ALS presentation

Answer 12

• Mild to moderate weakness in specific muscle groups
• Difficulty with ADLs and mobility towards the end of this stage

Question 13

Early ALS interventions

Answer 13

• Strengthening exercises
• Endurance exercises
• AROM, AAROM, stretching
• Determine potential need for adaptive or assistive devices
• Ergonomic modifications
• Energy conservation
• Education on disease process

Question 14

Middle ALS presentation

Answer 14

• 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

Question 15

Middle ALS interventions

Answer 15

• 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

Question 16

Late ALS presentation

Answer 16

• Wheelchair dependent or bed bound
• Complete dependence with ADLs
• Severe weakness of UE, LE, neck, and trunk muscles
• Dysarthria, dysphagia
• Respiratory compromise
• Pain

Question 17

Late ALS interventions

Answer 17

• PROM
• Pulmonary care
• Hospital bed and pressure-relieving devices
• Skin care, hygiene
• Caregiver education on transfers, positioning, turning, and skin care
• Mechanical lift