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Neuro Rehab > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

explain the etiology of MS

A

specific causes are unknown
can be due genetic susceptibility
can be associated with Vitamin D deficiency / smoking

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2
Q

incidence of MS in relation to
- gender
- age
- race
- proximity to equator

A

women > men
young adult onset (20-40)
caucasian
increased frequency further from equator

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3
Q

what is the pathophysiology of MS

A

chronic inflammatory demyelination of CNS via autoimmune disorder

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4
Q

what is the result of demyelination

A

slowed/blocked neural signals

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5
Q

when axons are demyelinated, what occurs

A

fibrous astrocytes fill the space and undergo gliosis

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6
Q

what is gliosis

A

glial scarring causing plaques

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7
Q

MS is marked by

A

hardened plaques throughout CNS white matter and optic nerve

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8
Q

the CNS white matter that plaques form in affect the _____ and _____ tracts

A

motor and sensory

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9
Q

what qualifies an MS diagnosis

A

damage that is present in 2 or more separate CNS areas

damage that has occurred at 2 separate points in time with one month in between

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10
Q

what methods are used to diagnose MS

A

MRI
visual evoked potential tests
lumbar puncture for CSF analysis

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11
Q

what are visual evoked potential tests

A

measures of nerve conduction along the visual pathway

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12
Q

T1 MRI characteristics

A

better for anatomical detail
FAT = white
FLUID = black

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13
Q

T2 MRI characteristics

A

better for pathology
FAT = bright white
FLUID = bright white

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14
Q

what is a T2 FLAIR

A

T2 image where CSF and vitreous fluids are suppressed

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15
Q

what are T2 FLAIR MRIs for

A

identification of MS plaques near ventricles

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16
Q

what is clinically isolated syndrome

A

1st episode of CNS inflammatory demyelination

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17
Q

what causes clinically isolated syndrome to become relapsing remitting MS

A

2nd episode of CNS inflammatory demyelination after MRI confirmation

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18
Q

if CIS is not active, what does that mean for relapses

A

not active = no relapses

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19
Q

what is the most common form of MS? what is the % of cases associated?

A

relapsing remitting MS

85%

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20
Q

what are relapses defined as? what about remission?

A

relapse = acute inflammatory attack with worsening neurological function

remission = full or partial recovery

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21
Q

what is secondary progressive MS? what does it start as

A

steady decline in neurologic function w/ accumulation of disability

RRMS

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22
Q

explain relapses associated with secondary progressive MS

A

can be with or without them

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23
Q

how is primary progressive MS described? what is the incidence of it?

A

continuous worsening without distinct attacks

15% of patients with MS

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24
Q

what is the timeframe associated with MS relapses/exacerbations

A

more than 24 hours

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25
Q

what can cause relapses

A

overall deterioration in health
viral/bacterial infections
stress

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26
Q

what are psuedoexacerbations

A

temporary worsening of symptoms for less than 24 hours

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27
Q

what can cause psuedoexacerbations

A

heat or increased body temp
- fever, prolonged exercise, change in climate

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28
Q

sensory disturbances associated with MS

A

paresthesia (pins and needles)
hypothesia (numbness)
heat intolerance
altered prop and vibration sensation

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29
Q

explain altered prop/vibration sensation in regards to peripheral receptors and CNS pathways

A

DCML pathway into CNS is damaged rather than peripheral receptors

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30
Q

pain associated with MS

A

acute / chronic pain
headaches
migraines
sharp shooting electric shock like pain (lhermitte’s sign)

trigeminal neuralgia

31
Q

visual changes associated with MS

A

diplopia
diminished acuity
nystagmus
gaze palsy
optic neuritis
internuclear ophthalmoplegia

32
Q

what is internuclear ophthalmoplegia

A

lateral gaze palsy

33
Q

what motor abnormalities are associated with MS

A

UMN S/S
ataxia
asthenia
disuse weakness

34
Q

what is asthenia? is this common in MS

A

complete sensation loss

no, it is rare

35
Q

what time of the day is best to complete therapeutic intervention

A

mornings > nights

36
Q

what causative factors can affect one’s level of fatigue with MS

A

inflammation
axonal conduction velo
imbalance of NT levels
decreased glucose metabolism

37
Q

what psychological factors can affect one’s level of fatigue with MS

A

self efficacy
motivation
cognitive dysfunction

38
Q

what coordination/balance abnormalities are associated with MS

A

cerebellar or sensory ataxia
postural/intention tremor
hypotonia
dizziness/vertigo
disequilibrium

39
Q

what systemic deficits lead to gait/mobility deficits in those with MS

A

weakness
fatigue
spasticity
vision changes

40
Q

what DME / ADs are used to fix gait deficits

A

AFOs
custom wheelchairs

41
Q

what speech/swallowing deficits are associated with MS

A

dysarthria
dysphonia
dysphagia
aspiration pneumonia

42
Q

what is dysphonia

A

change in vocal quality leading to abnormal sounding voice

43
Q

what cognitive deficits are associated with MS

A

decreased processing speed
short-term memory loss
decreased attention/concentration
executive function impaired

44
Q

what cognitive functions are maintained in those with MS

A

reading
conversing
long term memory

45
Q

how is pt affect changed by MS

A

increased:
depression
anxiety
psuedobulbar effect
apathy

46
Q

bowel and bladder deficits associated with MS

A

reduced control
spastic or flaccid bowel/bladder
dyssynergic bladder
constipation

47
Q

what bladder symptoms are associated with MS

A

urgency
frequency
nocturia
incontinence/leaking

48
Q

why can constipation occur

A

inactivity
poor diet
medication
depression

49
Q

male and sexual deficits associated with MS

A

decreased sensation
erectile dysfunction / vaginal dryness
decreased libido

50
Q

medical management of MS

A

corticosteroids
synthetic interferon drugs

51
Q

what do corticosteroids treat

A

acute relapses, shortening the duration of them

52
Q

how do corticosteroids work

A

exert powerful anti-inflammatory / immunosuppressive effects

53
Q

side effects of corticosteroids

A

HTN
mood changes
fluid retention
hyperglycemia
insomnia

54
Q

how do synthetic interferon drugs treat MS

A

disease modifying therapy that decrease immune system response by reducing inflammation

55
Q

corticosteroids vs interferon drugs in treatment of disease progression

A

cortico = do not modify disease course

inter = reduce disease activity

56
Q

when should PT referral be implemented for those with MS

A

at time of diagnosis for baseline assessments and education

57
Q

what cognitive screens should be done on inital MS eval

A

MMSE
– may determine need for referral

58
Q

what affect screening can be done in acute assessment of MS

A

beck depression inventory

59
Q

what is the screen used for fatigue

A

modified fatigue impact scale

60
Q

what screenings need to be done in acute MS patients

A

cognitive
affect
fatigue
visual acuity / oculomotor function

61
Q

impairment specific interventions

A

pain management
ROM - flexibility
strengthening muscles due to disuse
endurance

62
Q

restorative interventions

A

task-oriented training
–> hoping to complete the movement in the way it was previously performed
postural control

63
Q

will strengthening muscles due to disuse change chronic UMN weakness? if not, what do we need to focus on?

A

no, focus on task specific movements that use multiple muscle groups that are weak

64
Q

compensatory interventions

A

AD to reduce falls
adaptive equipment for ADLs
wheelchairs / AFOs
training in new (adapted) movement patterns

65
Q

preventative interventions

A

skin integrity
home safety
postural deformities
maintenance exercise program
education

66
Q

what education needs to be provided to patients with MS

A

fatigue management
lifestyle modifications
exercise
disease progression

67
Q

fatigue management strategies

A

cooling agents
simplified work/ADLs
sleep regulation
stress management
nutrition education

68
Q

exercise guidelines for those with RRMS

A

avoid exercise/exertion during an exacerbation, but may resume when remission is evident

69
Q

exercise guidelines for those with PPMS

A

exercise within limits of capabilities

70
Q

exercise guidelines for MS (generally) in regards to
- frequency
- resistance training
- circuit training
- form of work

A

alternate days of any variety of resistance
- discontinuous work that alternates between UE and LEs

71
Q

exercise precautions for those with
MS associated with
intensity level
equipment
mode of instruction and exertion

A

moderate intensity

equipment / environment appropriate for level of impairments/ataxia balance

monitor with Borg RPE

72
Q

is exercising to the point of fatigue indicated in those with MS?

A

no, contraindicated actually

SILLY

73
Q

if doing aquatherapy, what temperature does the water need to not exceed

A

84°F

74
Q

how long should muscle fatigue post exercise last?

A

should not be present for more than 24 hours

Neuro Rehab (9 decks)

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