MULTIPLE SCLEROSIS

Question 1

What is it? who does it primarily impact and what is the age of onset?

Answer 1

Autoimmune disease with no cure
Females
20-40yrs

Question 2

Potential risk factors for MS?

Answer 2

Genetics
Human leukocyte antigen gene dysfunction
Sunlight (further away from equator)
Viruses
smoking / obesity

Question 3

Pathophysiology

Answer 3

Demyelination of myelin sheath.
T-cells recognise myelin as foreign and attack.
B-cells create antibodies
Macrophages (kills the oligodendrocytes) phagocytize myelin

Question 4

What is the myelin sheath important for?

Answer 4

reflexes, accuracy, vision, proprioception and efficiency.

Question 5

Role of the oligodendrocytes?

Answer 5

repair the myelin resulting in improvements in function in people wiht MS, although after a while they will die too and patient will no longer experience the remission.

Question 6

What are the 3 types of MS?

Answer 6

Relapsing Remitting MS (RRMS)
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)

Question 7

What is RRMS?

Answer 7

episodes of new or worsening symptoms (relapses) followed by periods of partial or complete recovery (remissions)

there is accumulation of disability over time, resulting in gradual worsening of the condition.

Question 8

what is SPMS?

Answer 8

Follows an initial RRMS course.
After the RRMS course, progressive worsening of neurologic function (accumulation of disability) over time.

Question 9

What is PPMS?

Answer 9

Worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions.

Question 10

What is clinically isolated syndrome?

Answer 10

Referring to a first episode of inflammatory demyelination in the central nervous system
Must last at least 24 hours
Characteristic of MS but does not meet the diagnostic criteria
People may or may not go onto develop MS
If MRI changes from that single event - Highly likely to get MS (60–80%)
No MRI changes – Less likely to get MS (20%)

Question 11

Primary motor impairments in MS

Answer 11

reduced muscle strength and coordination
spasticity

Question 12

Secondary motor impairments in MS

Answer 12

Reduced muscle length
Reduced CV fitness
Swelling
SH subluxation

Question 13

Why is understanding fatigue in patients with MS important?

Answer 13

Must acknowledge that it is a genuine symptom which can be a direct result of the disease
A lot of patients experience fatigue at some stage
Timing of treatment
Prioritizing
Patient empowerment
Pacing activity/exercise

Question 14

How to manage fatigue in MS?

Answer 14

Monitor using daily diary or disease severity scale
medication
emotional support
energy conservation courses
address heat sensitivity

Question 15

Management of ataxia

Answer 15

Use of external cues (visual, auditory and proprioceptive)
Balance training / Strength exercises
Use of equipment
Use of constrants
Timing tasks
whole task practice: challenge the movement.

Question 16

What is Ataxia?

Answer 16

Loss of dexterity and coordination. Reduced spatial and temporal movement accuracy.
Deficits in: timing, amplitude, force, direction and speed.

Question 17

10 potential signs and symptoms of people with MS

Answer 17

1. Weakness
2. Spasticity
3. Ataxia
4. Fatigue
5. Thermoregulation
6. Numbness – sensory deficit, non-dermatomal
7. Proprioception
8. Bladder/bowel issues
9. Vision problems
10. Speech problems

Question 18

Adaptive motor behaviour in pts with MS

Answer 18

• Walk faster (difficulty slowing)
• Excessive steps
• Excessive pre-shaping (loss of fine motor control)
• Wide BOS
• Table used to brake movement
• Restriction of movement amplitude

Question 19

Management strategies for people with MS

Answer 19

1. Repetitive task-specific training
2. General exercise
3. Falls prevention

Question 20

Repetitive task training

Answer 20

To improve functional movement and strength by practicing specific tasks that the person struggles with in their daily life.
Targets: motor impairments, such as weakness, poor coordination, and difficulty with balance

Question 21

General exercise

Answer 21

To improve overall strength, aerobic capacity, and cardiovascular health, which are often affected in MS due to muscle weakness, spasticity, and fatigue.

Question 22

Falls prevention

Answer 22

To reduce the risk of falls, which are a major concern for people with MS due to balance problems, muscle weakness, and impaired coordination.