MS Interventions Flashcards
treament focus with MS
- Prevention
- Remediation
- Compensation
EDSS 0-2.5 Mild Disability treatment focus
Mostly on Prevention and some remediation
- minimal mobility deficits
- standard tests may not be sensitive enough to detect disease progression or disability
- assessment of pts when symptomatic is extremely helpful
- focus on edu and maximizing fitness levels
EDSS 3-6 Moderate Disability treatment focus
Mostly Remediation with some prevention
- Impairments are more readily apparent
- may or may not begin to impact activity and participation
- secondary impairments develop
treatment considerations for EDSS 3-6
- intermittent versus continuous activity
- can improve tolerance by increasing rest periods
- this is where we spend the most time with patients
treatment focus with EDSS 6.5-9 Severe Disability
Mostly Compensation and some prevention
- sig mobility and functional limitations
- more pronounced comorbidities
- longer remission periods
treatment considerations for EDSS 6.5-9.5
- despite focus being largely compensatory and preventative, it can still be very meaningful
- major goal is to improve safety and efficiency with mobility
EDSS 0 description
normal neuro exam
EDSS 1 description
no disability, minimal signs in one FS
EDSS 1.5 description
no disability, minimal signs in more than one FS
EDSS 2 description
minimal disability in one FS
EDSS 2.5 description
minimal disability in 2 FS
EDSS 3 description
fully ambulatory, moderate disability in one FS
or
mild disability in three or four FS
EDSS 3.5 description
fully ambulatory but with moderate disability in one FS and minimal or more disability in several other FS
EDSS 4 description
fully ambulatory without aid, self-sufficient, up and about some 12 hours a day, able to walk without aid or rest at least 500m without aid/rest
EDSS 4.5 description
- fully ambulatory without aid,
- up and about much of the day,
- able to work a full day, may otherwise have some limitation of full activity or require min A
- able to walk without aid or rest at least 300m
EDSS 5 description
- ambulatory without aid/rest for about 200m
- disability sig enough to impair full daily activities
- e.g to work a full day without special provisions
EDSS 5.5 description
ambulatory without aid for about 100m
disability sig enough to preclude full daily activities
EDSS 6 description
intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100m with or without resting
EDSS 6.5 description
constant bilateral assistance (canes, crutches, braces) required to walk about 20m without resting
EDSS 7 description
unable to walk beyond ~5m even with aid, essentially to wheelchair
wheels self in standard wheelchair and transfers alone, up and about in wheelchair some 12 hours a day
EDSS 7.5 description
unable to take more than a few steps, restricted to wheelchair
may need aid in transfer, wheels self but cannot carry on in standard wheelchair in a full day
may require motorized wheelchair
EDSS 8 description
- essentially restricted to bed or chair or perambulated in wheelchair, but may be out of bed itself much of the days
- retains many self-care functions
- generally has effective use of arms
EDSS 8.5 description
essentially restricted to bed much of day; has some effective use of arm(s); retains some self-care functions
EDSS 9 description
helpless bed pt, can communicate and eat
EDSS 9.5 description
totally helpless bed pt; unable to communicate effectively or eat/swallow
EDSS 10 description
death
intervention components
- gait training and device management
- aerobic training
- balance retraining
- vestibular retraining
- fatigue management
- falls prevention
- comorbidity management
MS-specific rehab goals
- promote independence in functional mobility skills and ADLs
- facilitate max mobility in home and community
- energy conservation techniques
- Vision
- EOM exercises, vestibular rehab, may need patching for diplopia
- improve sensory awareness as impairment progress
- avoid precipitating exacerbations
- patient and family edu
how to avoid precipitating exacerbations
- schedule therapy sessions during optimal times for function
- minimize fatigue
- establish schedule of rest and moderate exercise
- avoid stressors and overheating
Benefits of exercise
- exercise has now been proven to have positive improvements on all of the following for pts with MS
- gait speed, fall risk
- time until AD prescription
- VO2 max
- UE/LE strength
- BMI, triglyceride and VLDL levels
- Depression, anger, anxiety
- fatigue
- cognition
- neuroprotective responses
T/F: benefits of exercise is only for RRMS subtype
FALSE
benefits found with all subtypes and across the majority of progressive stages of the disease
Fatigue and exercise
- research supports use of moderate exercises to modulate fatigue symptoms
- encourage aerobic exercise
- encourage exercise at times of day when fatigue symptoms are minimal and body temperature is lowest
- use fatigue scale to monitor effect of exercise program on QOL
- teach energy conservation techniques
Patient and Family Education
- disease process, clinical manifestations, signs of progression
- prevention of secondary complications
- medication aherence, monitoring effects of meds
- rationale behind prescriptions for assistive devices
- general health and stress management
- depression S/S
- Community resources
