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Neuro 2 > MS Interventions > Flashcards

MS Interventions Flashcards

1
Q

treament focus with MS

A
  1. Prevention
  2. Remediation
  3. Compensation
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2
Q

EDSS 0-2.5 Mild Disability treatment focus

A

Mostly on Prevention and some remediation

  1. minimal mobility deficits
  2. standard tests may not be sensitive enough to detect disease progression or disability
  3. assessment of pts when symptomatic is extremely helpful
  4. focus on edu and maximizing fitness levels
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3
Q

EDSS 3-6 Moderate Disability treatment focus

A

Mostly Remediation with some prevention

  1. Impairments are more readily apparent
  2. may or may not begin to impact activity and participation
  3. secondary impairments develop
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4
Q

treatment considerations for EDSS 3-6

A
  1. intermittent versus continuous activity
  2. can improve tolerance by increasing rest periods
  3. this is where we spend the most time with patients
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5
Q

treatment focus with EDSS 6.5-9 Severe Disability

A

Mostly Compensation and some prevention

  1. sig mobility and functional limitations
  2. more pronounced comorbidities
  3. longer remission periods
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6
Q

treatment considerations for EDSS 6.5-9.5

what is the major goal?

A
  1. despite focus being largely compensatory and preventative, it can still be very meaningful
  2. major goal is to improve safety and efficiency with mobility
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7
Q

EDSS 0 description

A

normal neuro exam

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8
Q

EDSS 1 description

A

no disability, minimal signs in one FS

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9
Q

EDSS 1.5 description

A

no disability, minimal signs in more than one FS

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10
Q

EDSS 2 description

A

minimal disability in one FS

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11
Q

EDSS 2.5 description

A

minimal disability in 2 FS

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12
Q

EDSS 3 description

A

fully ambulatory, moderate disability in one FS

or

mild disability in three or four FS

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13
Q

EDSS 3.5 description

A

fully ambulatory but with moderate disability in one FS and minimal or more disability in several other FS

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14
Q

EDSS 4 description

A

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

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15
Q

EDSS 4.5 description

A
  1. fully ambulatory without aid,
  2. up and about much of the day,
  3. able to work a full day, may otherwise have some limitation of full activity or require min A
  4. able to walk without aid or rest at least 300m
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16
Q

EDSS 5 description

A
  1. ambulatory without aid/rest for about 200m
  2. disability sig enough to impair full daily activities
    • e.g to work a full day without special provisions
17
Q

EDSS 5.5 description

A

ambulatory without aid for about 100m

disability sig enough to preclude full daily activities

18
Q

EDSS 6 description

A

intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100m with or without resting

19
Q

EDSS 6.5 description

A

constant bilateral assistance (canes, crutches, braces) required to walk about 20m without resting

20
Q

EDSS 7 description

A

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

21
Q

EDSS 7.5 description

A

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

22
Q

EDSS 8 description

A
  1. essentially restricted to bed or chair or perambulated in wheelchair, but may be out of bed itself much of the days
  2. retains many self-care functions
  3. generally has effective use of arms
23
Q

EDSS 8.5 description

A

essentially restricted to bed much of day; has some effective use of arm(s); retains some self-care functions

24
Q

EDSS 9 description

A

helpless bed pt, can communicate and eat

25
Q

EDSS 9.5 description

A

totally helpless bed pt; unable to communicate effectively or eat/swallow

26
Q

EDSS 10 description

A

death

27
Q

intervention components

A
  1. gait training and device management
  2. aerobic training
  3. balance retraining
  4. vestibular retraining
  5. fatigue management
  6. falls prevention
  7. comorbidity management
28
Q

MS-specific rehab goals

A
  1. promote independence in functional mobility skills and ADLs
  2. facilitate max mobility in home and community
  3. energy conservation techniques
  4. Vision
    • EOM exercises, vestibular rehab, may need patching for diplopia
  5. improve sensory awareness as impairment progress
  6. avoid precipitating exacerbations
  7. patient and family edu
29
Q

how to avoid precipitating exacerbations

A
  1. schedule therapy sessions during optimal times for function
  2. minimize fatigue
  3. establish schedule of rest and moderate exercise
  4. avoid stressors and overheating
30
Q

Benefits of exercise

A
  1. 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
31
Q

T/F: benefits of exercise is only for RRMS subtype

A

FALSE

benefits found with all subtypes and across the majority of progressive stages of the disease

32
Q

Fatigue and exercise

A
  1. research supports use of moderate exercises to modulate fatigue symptoms
  2. encourage aerobic exercise
  3. encourage exercise at times of day when fatigue symptoms are minimal and body temperature is lowest
  4. use fatigue scale to monitor effect of exercise program on QOL
  5. teach energy conservation techniques
33
Q

Patient and Family Education

A
  1. disease process, clinical manifestations, signs of progression
  2. prevention of secondary complications
  3. medication aherence, monitoring effects of meds
  4. rationale behind prescriptions for assistive devices
  5. general health and stress management
  6. depression S/S
  7. Community resources

Neuro 2 (30 decks)

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