MULTIPLE SCLEROSIS Flashcards
What is it? who does it primarily impact and what is the age of onset?
Autoimmune disease with no cure
Females
20-40yrs
Potential risk factors for MS?
Genetics
Human leukocyte antigen gene dysfunction
Sunlight (further away from equator)
Viruses
smoking / obesity
Pathophysiology
Demyelination of myelin sheath.
T-cells recognise myelin as foreign and attack.
B-cells create antibodies
Macrophages (kills the oligodendrocytes) phagocytize myelin
What is the myelin sheath important for?
reflexes, accuracy, vision, proprioception and efficiency.
Role of the oligodendrocytes?
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.
What are the 3 types of MS?
Relapsing Remitting MS (RRMS)
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)
What is RRMS?
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.
what is SPMS?
Follows an initial RRMS course.
After the RRMS course, progressive worsening of neurologic function (accumulation of disability) over time.
What is PPMS?
Worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions.
What is clinically isolated syndrome?
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%)
Primary motor impairments in MS
reduced muscle strength and coordination
spasticity
Secondary motor impairments in MS
Reduced muscle length
Reduced CV fitness
Swelling
SH subluxation
Why is understanding fatigue in patients with MS important?
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
How to manage fatigue in MS?
Monitor using daily diary or disease severity scale
medication
emotional support
energy conservation courses
address heat sensitivity
Management of ataxia
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.
What is Ataxia?
Loss of dexterity and coordination. Reduced spatial and temporal movement accuracy.
Deficits in: timing, amplitude, force, direction and speed.
10 potential signs and symptoms of people with MS
- Weakness
- Spasticity
- Ataxia
- Fatigue
- Thermoregulation
- Numbness – sensory deficit, non-dermatomal
- Proprioception
- Bladder/bowel issues
- Vision problems
- Speech problems
Adaptive motor behaviour in pts with MS
- 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
Management strategies for people with MS
- Repetitive task-specific training
- General exercise
- Falls prevention
Repetitive task training
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
General exercise
To improve overall strength, aerobic capacity, and cardiovascular health, which are often affected in MS due to muscle weakness, spasticity, and fatigue.
Falls prevention
To reduce the risk of falls, which are a major concern for people with MS due to balance problems, muscle weakness, and impaired coordination.
