MS, GBS, ALS

Question 1

MS disease type

Answer 1

autoimmune: CNS

Question 2

MS pathology, upper or lower

Answer 2

UMN

Demyleination of CNS axons

Question 3

MS who is impacted

Answer 3

More F (except in progressive MS, more M)
Young onset (20-30 yr)
Caucasian – vitamin D deficiency?

Question 4

how is MS diagnosed

Answer 4

Combo: MRI (lesions), CSF (increase of antibodies), brain’s electrical activity, patient report

Question 5

outcomes MS

Answer 5

Progressive (all 4 types)
Rarely fatal
Lower life expectancy by a few years
Infections

Question 6

types of MS

Answer 6

– Relapsing – remitting (most common)
– Secondary progressive
– Primary progressive
– Progressive - relapsing (very rare)

Question 7

etiology of MS

Answer 7

Environment: distance from equator/Vit D; smoking, past virus/bacterial infection (EBS). Unknown

Question 8

symptoms MS

Answer 8

Fatigue, vision problems, muscle weakness, pain, decreased sensation, numbness, bladder problems, tingling, difficulty walking, dizziness, sexual dysfunction

Question 9

medical treatment or management of MS

Answer 9

Treating attacks: corticosteroids, plasmapheresis
Progression: interferon beta medications, glatiramer acetate, ocrevus
System specific meds: pain, spasticty, fatigue, incontinence

Question 10

What symptoms might require other medication (and considerations for rehab team)? MS

Answer 10

Pain, depression, sleep, fatigue, spasticity

Avoid heat

Question 11

eval/assessment MS

Answer 11

Expanded Disability Status Scale (0-6 still walking; 7 in w/c; 9 in bed)
MS Functional Composite
Timed 25 foot walk test
9 Hole peg test – fine motor
Paced audiroy serial addition test (PASAT)
6 min walk test - endurance

Question 12

therapeutic goals and tx options MS

Answer 12

Promote independence and QOL, decrease symptoms and/or compensatory strategies, EBP

Varies from individual based on type, age, stage, etc. Treat symptoms. Avoid heat. Compensatory strategies for symptoms and energy conservation. Therapeutic Exercise. Caregiver training. Adaptive equipment education. Psychosocial.

Question 13

GB disease type

Answer 13

Autoimmune, Acute polyneuropathy

Question 14

GB pathology and upper/lower

Answer 14

Demyelinating, lower motor neurons

Question 15

who is impacted GB

Answer 15

Equal affect M vs. F

Extrememly rare

Question 16

how is GB diagnosed

Answer 16

Max weakness 2-3 weeks after onset of symptoms
Symmetrical symptoms, absent reflexes
Higher levels of protein in CSF (>.55g/L), <10 WBCs per mm
NCS and EMG are not required, but can help differentiate

Question 17

outcomes of GB

Answer 17

2-5% die from respiratory paralysis or cardiac arrest
Most have full recovery 6-12 mo
30% have residual weakness

Question 18

etiology of GB

Answer 18

Often follows: GI infection (gastroenteritis from campylobacter jejuni), respiratory infection (cytomegalovirus, Epstein-barr virus)

Question 19

symptoms of GB

Answer 19

Symmetrical paresthesia that worsens to paralysis: ascending (starts in feet); respiratory; BP issues such as orthostatic hypotension; arrhythmias

Question 20

medical tx GB

Answer 20

Plasmapherisis (plasma exchange)
Immunoglobulins from donors
No corticosteroids! 
IV antibiotic therapy
Manually move limbs, prevent DVTs

Question 21

What symptoms might require other medication (and considerations for rehab team)? GB

Answer 21

ANS dysfunction: urinary retention, flushing face, cardiac arrhythmias
Respiratory therapist

Question 22

eval for GB

Answer 22

Occupational profile, COPM, ROM, MMT, Barthel ADL index, Activities Specific Balance Confidence Scale, Sensory testing, 9-hole peg test

Question 23

goals and tx options for GB

Answer 23

Prevent DVTs, decrease symptoms, promote independence and QOL, increase strength
Anti coagulative therapy for DVTs, move limbs
Energy conservation, therapeutic exercise, adaptive equipment, strength training

Question 24

ALS disease type

Answer 24

Progressive neuromuscular disease

Question 25

pathology of ALS and upper/lower

Answer 25

Progressive degeneration of both upper and lower motor neurons

Question 26

who is impacted ALS

Answer 26

Mostly 40-60 y.o., but may vary; 60% male, Vets have higher incidence

Question 27

how is ALS diagnosed

Answer 27

Symptom history
EMG of muscle fibers
Nerve conduction study (NCS), MRI for brain/sc, muscle biopsy

Question 28

outcomes of ALS

Answer 28

Fatal (usually 3-5 yrs; can vary)

Question 29

etiology ALS

Answer 29

Genetics: 20 genes implicated (5-10% are familial)
Environmental factors: smoking, lead exposure, electromagnetic fields
(90-95% are sporadic)

Question 30

symptoms of ALS

Answer 30

UMN: weakness, spasticity, hyperreflexia
LMN: weakness, atrophy, fasciulations, hypotinia, areflexia, dysphagia and dysarthria

No sensory involvement

Question 31

medical tx for ALS

Answer 31

No known cure or effective pharm. tx
Riluzole – slow progression of the disease for some people
Edaravone – slow decline of fx

Question 32

What symptoms might require other medication (and considerations for rehab team)? ALS

Answer 32

Respiration, speaking/communication, eating

Question 33

eval for ALS

Answer 33

Occupational profile, COPM

Question 34

ALS goals and tx options

Answer 34

Ambulation, promote independence in ADLs
Prevention of contractures

Energy conservation and breathing, therepautic exercise, ROM, stretching, introduce adaptive equipment