Multiple Sclerosis Flashcards
explain the etiology of MS
specific causes are unknown
can be due genetic susceptibility
can be associated with Vitamin D deficiency / smoking
incidence of MS in relation to
- gender
- age
- race
- proximity to equator
women > men
young adult onset (20-40)
caucasian
increased frequency further from equator
what is the pathophysiology of MS
chronic inflammatory demyelination of CNS via autoimmune disorder
what is the result of demyelination
slowed/blocked neural signals
when axons are demyelinated, what occurs
fibrous astrocytes fill the space and undergo gliosis
what is gliosis
glial scarring causing plaques
MS is marked by
hardened plaques throughout CNS white matter and optic nerve
the CNS white matter that plaques form in affect the _____ and _____ tracts
motor and sensory
what qualifies an MS diagnosis
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
what methods are used to diagnose MS
MRI
visual evoked potential tests
lumbar puncture for CSF analysis
what are visual evoked potential tests
measures of nerve conduction along the visual pathway
T1 MRI characteristics
better for anatomical detail
FAT = white
FLUID = black
T2 MRI characteristics
better for pathology
FAT = bright white
FLUID = bright white
what is a T2 FLAIR
T2 image where CSF and vitreous fluids are suppressed
what are T2 FLAIR MRIs for
identification of MS plaques near ventricles
what is clinically isolated syndrome
1st episode of CNS inflammatory demyelination
what causes clinically isolated syndrome to become relapsing remitting MS
2nd episode of CNS inflammatory demyelination after MRI confirmation
if CIS is not active, what does that mean for relapses
not active = no relapses
what is the most common form of MS? what is the % of cases associated?
relapsing remitting MS
85%
what are relapses defined as? what about remission?
relapse = acute inflammatory attack with worsening neurological function
remission = full or partial recovery
what is secondary progressive MS? what does it start as
steady decline in neurologic function w/ accumulation of disability
RRMS
explain relapses associated with secondary progressive MS
can be with or without them
how is primary progressive MS described? what is the incidence of it?
continuous worsening without distinct attacks
15% of patients with MS
what is the timeframe associated with MS relapses/exacerbations
more than 24 hours
what can cause relapses
overall deterioration in health
viral/bacterial infections
stress
what are psuedoexacerbations
temporary worsening of symptoms for less than 24 hours
what can cause psuedoexacerbations
heat or increased body temp
- fever, prolonged exercise, change in climate
sensory disturbances associated with MS
paresthesia (pins and needles)
hypothesia (numbness)
heat intolerance
altered prop and vibration sensation
explain altered prop/vibration sensation in regards to peripheral receptors and CNS pathways
DCML pathway into CNS is damaged rather than peripheral receptors
pain associated with MS
acute / chronic pain
headaches
migraines
sharp shooting electric shock like pain (lhermitte’s sign)
trigeminal neuralgia
visual changes associated with MS
diplopia
diminished acuity
nystagmus
gaze palsy
optic neuritis
internuclear ophthalmoplegia
what is internuclear ophthalmoplegia
lateral gaze palsy
what motor abnormalities are associated with MS
UMN S/S
ataxia
asthenia
disuse weakness
what is asthenia? is this common in MS
complete sensation loss
no, it is rare
what time of the day is best to complete therapeutic intervention
mornings > nights
what causative factors can affect one’s level of fatigue with MS
inflammation
axonal conduction velo
imbalance of NT levels
decreased glucose metabolism
what psychological factors can affect one’s level of fatigue with MS
self efficacy
motivation
cognitive dysfunction
what coordination/balance abnormalities are associated with MS
cerebellar or sensory ataxia
postural/intention tremor
hypotonia
dizziness/vertigo
disequilibrium
what systemic deficits lead to gait/mobility deficits in those with MS
weakness
fatigue
spasticity
vision changes
what DME / ADs are used to fix gait deficits
AFOs
custom wheelchairs
what speech/swallowing deficits are associated with MS
dysarthria
dysphonia
dysphagia
aspiration pneumonia
what is dysphonia
change in vocal quality leading to abnormal sounding voice
what cognitive deficits are associated with MS
decreased processing speed
short-term memory loss
decreased attention/concentration
executive function impaired
what cognitive functions are maintained in those with MS
reading
conversing
long term memory
how is pt affect changed by MS
increased:
depression
anxiety
psuedobulbar effect
apathy
bowel and bladder deficits associated with MS
reduced control
spastic or flaccid bowel/bladder
dyssynergic bladder
constipation
what bladder symptoms are associated with MS
urgency
frequency
nocturia
incontinence/leaking
why can constipation occur
inactivity
poor diet
medication
depression
male and sexual deficits associated with MS
decreased sensation
erectile dysfunction / vaginal dryness
decreased libido
medical management of MS
corticosteroids
synthetic interferon drugs
what do corticosteroids treat
acute relapses, shortening the duration of them
how do corticosteroids work
exert powerful anti-inflammatory / immunosuppressive effects
side effects of corticosteroids
HTN
mood changes
fluid retention
hyperglycemia
insomnia
how do synthetic interferon drugs treat MS
disease modifying therapy that decrease immune system response by reducing inflammation
corticosteroids vs interferon drugs in treatment of disease progression
cortico = do not modify disease course
inter = reduce disease activity
when should PT referral be implemented for those with MS
at time of diagnosis for baseline assessments and education
what cognitive screens should be done on inital MS eval
MMSE
– may determine need for referral
what affect screening can be done in acute assessment of MS
beck depression inventory
what is the screen used for fatigue
modified fatigue impact scale
what screenings need to be done in acute MS patients
cognitive
affect
fatigue
visual acuity / oculomotor function
what are impairment specific interventions most often performed in MS population
pain management
ROM - flexibility
strengthening muscles due to disuse
endurance
what is the goal of restorative interventions? in MS population, what are examples of this?
hoping to complete the movement in the way it was previously performed
task-oriented training
postural control
will strengthening muscles due to disuse change chronic UMN weakness? if not, what do we need to focus on?
no, focus on task specific movements that use multiple muscle groups that are weak
compensatory interventions in MS populations
AD to reduce falls
adaptive equipment for ADLs
wheelchairs / AFOs
training in new (adapted) movement patterns
preventative interventions
skin integrity
home safety
postural deformities
maintenance exercise program
education
what education needs to be provided to patients with MS
fatigue management
lifestyle modifications
exercise
disease progression
fatigue management strategies
cooling agents
simplified work/ADLs
sleep regulation
stress management
nutrition education
exercise guidelines for those with RRMS
avoid exercise/exertion during an exacerbation, but may resume when remission is evident
exercise guidelines for those with PPMS
exercise within limits of capabilities
resistance exercise guidelines for MS (generally) in regards to
- frequency
- resistance training
- circuit training
- form of work
alternate days of any variety of resistance
- discontinuous work that alternates between UE and LEs
exercise precautions for those with
MS associated with
intensity level
equipment
mode of instruction and exertion
moderate intensity
equipment / environment appropriate for level of impairments/ataxia balance
monitor with Borg RPE
is exercising to the point of fatigue indicated in those with MS?
no, contraindicated actually
SILLY
if doing aquatherapy, what temperature does the water need to not exceed
84°F
how long should muscle fatigue post exercise last?
should not be present for more than 24 hours
