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Neuromuscular Pt Mgt. II > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

Week 2

1
Q

What is Multiple Sclerosis (MS)?

A

A chronic, inflammatory, immune-mediated disease that affects the central nervous system (CNS), leading to demyelination and axonal damage.

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2
Q

What cells are primarily affected in MS?

A

Oligodendrocytes, responsible for myelination in the CNS.

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3
Q

What happens when myelin is damaged in MS?

A

Neural transmission slows down or becomes incomplete, leading to functional impairments.

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4
Q

What is the role of the immune system in MS?

A

The immune system attacks myelin, causing inflammation, demyelination, and neurodegeneration.

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5
Q

What are common neuroanatomical structures affected in MS?

A

Optic nerve, corticospinal tracts, cerebellar peduncles, posterior columns, periventricular white matter.

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6
Q

What is the function of the optic nerve?

A

The optic nerve (CN II) transmits visual information from the retina to the brain, allowing for sight

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7
Q

What is the function of the corticospinal tracts?

A

The corticospinal tracts control voluntary motor movements, particularly skilled movements of the limbs

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8
Q

What is the function of the cerebellar peduncles?

A

The cerebellar peduncles connect the cerebellum to the brainstem and are responsible for coordinating movement, balance, and posture

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9
Q

What is the function of the posterior columns?

A

The posterior columns (dorsal columns) carry sensory information for fine touch, vibration, and proprioception (body position sense)

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10
Q

What is the function of periventricular white matter?

A

Periventricular white matter contains myelinated nerve fibers that facilitate communication between brain regions

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11
Q

What is the female-to-male ratio for MS?

A

3:1, with women being more affected.

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12
Q

At what age is MS most commonly diagnosed?

A

Between ages 20-50, but can occur as young as 2 years old.

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13
Q

What environmental factors may contribute to MS?

A

Epstein-Barr virus (EBV), vitamin D deficiency, smoking, and geographic latitude.

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14
Q

What percentage of MS cases have a genetic link?

A

Approximately 15% have a family history of MS.

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15
Q

What are common symptoms of MS?

A

Fatigue, weakness, visual disturbances, gait impairment, spasticity, cognitive decline, pain, bladder/bowel dysfunction.

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16
Q

What is the most common early symptom of MS?

A

Sensory disturbances, such as numbness, tingling, or burning pain.

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17
Q

What percentage of PwMS experience fatigue?

A

Up to 95%, making it one of the most disabling symptoms.

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18
Q

What is Lhermitte’s Sign?

A

An electric shock-like sensation down the spine when flexing the neck, indicating spinal cord involvement.

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19
Q

What is the MS ‘Hug’?

A

A sensation of tightness or squeezing around the chest due to spasticity in intercostal muscles.

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20
Q

How does heat impact MS symptoms?

A

Increased body temperature can temporarily worsen symptoms, known as a ‘pseudoexacerbation’.

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21
Q

What are the four types of MS?

A

Clinically Isolated Syndrome (CIS), Relapsing-Remitting MS (RRMS), Primary Progressive MS (PPMS), Secondary Progressive MS (SPMS).

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22
Q

What is Clinically Isolated Syndrome (CIS)?

A

A first neurologic episode lasting at least 24 hours, which may or may not progress to MS.

23
Q

What percentage of CIS patients progress to MS?

24
Q

What is the most common type of MS?

A

Relapsing-Remitting MS (RRMS), accounting for 85% of cases.

25
What characterizes RRMS?
Periods of exacerbations followed by remission, with either full or partial recovery.
26
What is the Neurologic Reserve?
Capacity of the brain to compensate for subclinical MS lesions and to recover from relapses. Diagnosis of Relapsing remitting MS is often delayed because of this
27
What characterizes Primary Progressive MS (PPMS)?
A steady worsening of symptoms from onset, with no distinct relapses or remissions. >50% will require assistance w/ ambulation within 10yrs
28
What characterizes Secondary Progressive MS (SPMS)?
Initially presents as RRMS but transitions to a gradual worsening of function with fewer relapses.
29
What criteria are used to diagnose MS?
McDonald Criteria, which requires evidence of damage in at least two separate CNS areas occurring at least one month apart after all other possible diagnoses have been ruled out
30
What imaging technique is most useful for diagnosing MS?
MRI, showing multifocal white matter lesions.
31
What cerebrospinal fluid (CSF) findings support an MS diagnosis?
Presence of oligoclonal bands, indicating inflammation in the CNS.
32
What is the role of evoked potentials in MS diagnosis?
They assess delayed conduction in the optic nerve and other pathways.
33
What are the main goals of MS medical management?
Disease modification, relapse management, symptom control, and rehabilitation.
34
What are common Disease-Modifying Therapies (DMTs) for MS?
Interferon beta, natalizumab, fingolimod, ocrelizumab, among others.
35
What is the goal of DMTs in MS?
To reduce relapse frequency and slow disease progression. achieve no evidence of disease activity
36
What medication is used to improve walking speed in MS?
Dalfampridine (Ampyra).
37
What are common medications for spasticity management in MS?
Baclofen, tizanidine, botox injections, and intrathecal baclofen pumps.
38
What outcome measures are commonly used in MS evaluation?
Berg Balance Test, FGA, 6 Minute Walk Test, Timed 25 Foot Walk Test, MS Functional Composite (MSFC). MoCA, Beck Depression Scale, MFIS (fatigue)
39
What is the Expanded Disability Status Scale (EDSS)?
A scale ranging from 0 to 10 used to classify disability levels in MS. 6 = assistance required to work/walk 7 = wheelchair bound
40
What test assesses fatigue in MS?
Modified Fatigue Impact Scale (MFIS).
41
What are key PT interventions for PwMS?
Aerobic exercise, balance training, strength training, energy conservation, gait training, and task-specific training.
42
What temperature should be maintained for aquatic therapy in PwMS?
No warmer than 80-84°F to prevent heat-induced symptom worsening.
43
What is the recommended weekly exercise prescription for MS patients?
150 minutes of moderate-intensity aerobic exercise per week.
44
Why is task-specific training important in MS rehab?
It promotes neuroplasticity and functional independence.
45
What assistive devices may be used in MS rehabilitation?
AFOs, walkers, wheelchairs, and functional electrical stimulation (FES) devices for foot drop.
46
What factors indicate a favorable prognosis in MS?
Female, early onset, monoregional attacks, complete recovery from relapses, sensory symptoms, early treatment, non-brainstem lesions
47
What factors indicate a poor prognosis in MS?
Male, late onset (>35 years), polyregional attacks, incomplete recovery from relapses, brainstem lesions, late treatment
48
What are the three types of PT interventions in MS?
Preventative (minimizing complications), Restorative (improving function), Compensatory (modifying tasks/environments).
49
What is the most common cause of falls in PwMS?
Gait disturbances, fatigue, and impaired balance.
50
What psychological conditions are common in PwMS?
Depression (50%) and cognitive impairment (40-60%).
51
What bowel/bladder issues are common in MS?
Urinary urgency, incontinence, nocturia, and constipation.
52
What is the recommended strategy for managing fatigue in PwMS?
Energy conservation, environmental modifications, pacing, and exercise.
53
What % of the MS Population experiences heat, vision, pain, optic neuritis, fatigue, cognitive impairments, depression symptoms?
Heat - 70-80% Cold - 20% Visual - 80-85% Pain - 50% Optic Neuritis - 85% Fatigue - 88% (most common)

Neuromuscular Pt Mgt. II (4 decks)

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