MS and ALS, Neurogenic Shock, and Stroke

Question 1

What are key clinical considerations for massage therapists when working with MS and ALS patients?

Answer 1

• MS involves complex CNS functions; ALS has a more predictable progression.
• Each case is unique, requiring individualized treatment.
• Understand patients’ goals and prioritize physical comfort and emotional well-being.

Question 2

What are the general massage treatment goals for MS and ALS patients?

Answer 2

1. Stress reduction, relaxation, and promotion of well-being.
2. Soft tissue rehabilitation and maximization of function.

Question 3

What are important case history considerations for MS and ALS patients?

Answer 3

• Clarify and record motor, sensory, and psychoemotional symptoms.
• Reassess after MS exacerbations, during recovery phases, post-partum, or with infections, injuries, stress, or overheating.

Question 4

How should massage therapists handle psychoemotional symptoms in MS and ALS patients?

Answer 4

• Be supportive and accepting.
• Promote physical comfort and restorative sleep.
• Be sensitive to emotional lability and avoid assumptions about cognitive function, especially in non-verbal patients.

Question 5

How does spasticity affect massage treatment?

Answer 5

• High or low muscle tone increases susceptibility to injury.
• Be cautious with muscle dystrophy and avoid triggering the “MS hug.”
• Adjust pressure and techniques accordingly.

Question 6

What are key hydrotherapy considerations for MS and ALS patients?

Answer 6

• MS patients: Avoid heat due to intolerance; cooling can improve function.
• ALS patients: Temperature response varies; consult patients about preferences.

Question 7

How do mobility aids affect treatment planning?

Answer 7

• Mobility aids can cause usage problems in soft tissue structures.
• Focus on treating related discomfort and maintaining flexibility and mobility.

Question 8

What are some common medications for MS and ALS, and how do they affect treatment?

Answer 8

• MS Medications: Injectable interferons, dimethyl fumarates, and monoclonal antibodies.
• ALS Medications: Rilutek (riluzole) and Radicava (edaravone).
• Adjust treatments for side effects, such as weakened immune function or altered sensory responses.

Question 9

What exercises are beneficial for MS and ALS patients?

Answer 9

• Regulated, paced exercise with rest periods.
• Stretching and range of motion to reduce tone, prevent contractures, and improve mobility.
• Breathing exercises for ALS to maintain lung function.

Question 10

What precautions should be taken during advanced ALS care or MS exacerbations?

Answer 10

• Gentle, soothing treatments focused on relaxation and pain control.
• Avoid manipulations that may cause tissue damage, especially with corticosteroid use.
• Monitor for fatigue and deep vein thrombosis (DVT).

Question 11

What is MS pseudoexacerbation, and how does it differ from an actual exacerbation?

Answer 11

• MS pseudoexacerbation: Temporary worsening of symptoms due to overstimulation, heat, or overexercise.
• Unlike an actual exacerbation, it resolves in a few days and is not caused by disease activity.

Question 12

How should massage therapists communicate with non-verbal ALS patients?

Answer 12

• Use assistive devices like writing boards or alphabet boards.
• Watch for facial expressions and agree on non-verbal signals like blinking for responses.

Question 13

What is neurogenic shock, and what causes it?

Answer 13

Neurogenic shock refers to hypotension and bradycardia caused by peripheral vasodilation due to the interruption of descending sympathetic tracts after severe CNS damage (brain or cervical/high thoracic T6 or above).

Question 14

How long does neurogenic shock last, and what is the focus of treatment during the first 7 days?

Answer 14

• Duration: Can vary greatly, up to four or five weeks.
• Treatment focus (first 7 days): Maintain a high mean arterial pressure to ensure sufficient spinal cord perfusion.

Question 15

What considerations should be made before providing massage therapy during neurogenic shock?

Answer 15

1. Stability of CNS damage site (ensure no active hemorrhage).
2. Stability of cardiovascular and respiratory functions.
3. Physical or emotional benefits for the patient.
4. Impact of medications.
5. Consent issues.

Question 16

Is massage therapy recommended during neurogenic shock?

Answer 16

Generally, massage therapy is avoided during neurogenic shock. However, shortened, adapted light massage treatments may be considered with physician approval and clear indications of benefit.

Question 17

What is spinal shock, and how does it relate to neurogenic shock?

Answer 17

• Spinal shock: Immediate, temporary loss of total power, sensation, and reflexes below the level of injury, often associated with neurogenic shock.
• Relation: Spinal shock includes loss of reflexes and sensorimotor functions and can recover in 24-48 hours, but may last longer in severe cases.

Question 18

How does spinal shock differ from neurogenic shock in terms of definition and mechanisms?

Answer 18

Spinal shock:
• Definition: Immediate, temporary loss of power, sensation, and reflexes below the injury.
• Mechanism: Peripheral neurons temporarily unresponsive to brain stimuli.

Neurogenic shock:
• Definition: Sudden loss of sympathetic nervous system signals.
• Mechanism: Disruption of autonomic pathways leading to vasodilation and loss of sympathetic tone.

Question 19

What is the definition of spinal shock?

Answer 19

Spinal shock is the immediate, temporary loss of power, sensation, and reflexes below the level of injury.

Question 20

What is the definition of neurogenic shock?

Answer 20

Neurogenic shock is the sudden loss of sympathetic nervous system signals.

Question 21

How does blood pressure (BP) differ in spinal shock versus neurogenic shock?

Answer 21

Both spinal shock and neurogenic shock involve hypotension.

Question 22

How does the pulse differ in spinal shock versus neurogenic shock?

Answer 22

Both spinal shock and neurogenic shock involve bradycardia.

Question 23

What happens to the bulbocavernosus reflex in spinal shock?

Answer 23

The bulbocavernosus reflex is absent in spinal shock.

Question 24

What happens to the bulbocavernosus reflex in neurogenic shock?

Answer 24

The bulbocavernosus reflex is variable in neurogenic shock.

Question 25

What type of motor function is associated with spinal shock?

Answer 25

Spinal shock causes flaccid paralysis.

Question 26

What type of motor function is associated with neurogenic shock?

Answer 26

Neurogenic shock causes paralysis.

Question 27

When does spinal shock occur, and how long does it last?

Answer 27

Spinal shock occurs 48–72 hours immediately after spinal cord injury (SCI) and typically resolves within that time.

Question 28

When does neurogenic shock occur, and how long does it last?

Answer 28

Neurogenic shock occurs 48–72 hours immediately after spinal cord injury (SCI) and can last longer depending on severity.

Question 29

What is a stroke (CVA)?

Answer 29

An interruption of blood flow to the brain leading to infarction of brain tissue. It is sometimes referred to as a “brain attack”

Question 30

How common is stroke as a cause of death and disability in the United States?

Answer 30

How common is stroke as a cause of death and disability in the United States?

Question 31

What is a transient ischemic attack (TIA)?

Answer 31

A “warning stroke” caused by a temporary blockage of an artery, resulting in brief symptoms without permanent brain injury.

Question 32

How can you distinguish a TIA from a major stroke?

Answer 32

There is no way to predict if stroke symptoms will lead to a TIA or a major stroke.

Question 33

What percentage of strokes are ischemic/occlusive?

Answer 33

Approximately 80-90% of strokes are ischemic/occlusive.

Question 34

What causes ischemic strokes?

Answer 34

Blockage of a vessel by:
• Atherosclerosis and related thrombosis
• Other causes of thrombosis
• Embolism

Question 35

What is a penumbra in the context of an ischemic stroke?

Answer 35

A border zone of minimally perfused cells surrounding a central core of dead or dying cells.

Question 36

What determines cell survival in the penumbra during an ischemic stroke?

Answer 36

1. Speed of restored circulation
2. Volume of toxic products from dying cells
3. Degree of cerebral edema
4. Alterations in local blood flow

Question 37

What are key signs of an ischemic stroke?

Answer 37

Neurological signs and shock, with symptoms often evolving over a few hours to a few days.

Question 38

How are ischemic strokes treated early?

Answer 38

Thrombolytic therapy or surgery to restore circulation can prevent the stroke or minimize damage.

Question 39

What characterizes embolic strokes?

Answer 39

Sudden onset without warning signs, often occurring after a recent myocardial infarction (MI).

Question 40

What percentage of strokes are hemorrhagic?

Answer 40

Approximately 10-20% of strokes are hemorrhagic.

Question 41

What causes hemorrhagic strokes?

Answer 41

Rupture of a vessel due to:
• Hypertension
• Aneurysm
• Malformations or weaknesses in vessels (e.g., genetic defects, trauma, cancer-related erosion)

Question 42

What factors often contribute to hemorrhagic strokes?

Answer 42

Blood vessel damage/weakness combined with hypertension.

Question 43

What is the fatality rate for hemorrhagic strokes?

Answer 43

Very high, with emergency treatment focusing on stabilization and bleeding control.

Question 44

What are common symptoms of a hemorrhagic stroke?

Answer 44

• Severe headache, possibly with vomiting
• Rapid onset of neurological signs based on the brain damage location
• Signs/symptoms of shock