Multiple Sclerosis

Question 1

Incidence and Risk

Answer 1

• more common in european descent
• Women twice as likely
• usually affects people between 20-50 years and average onset is 34
• Autoimmune disease that affects the brain and spinal cord (Central Nervous system)

Question 2

General Symptoms of MS

Answer 2

• Symptoms vary due to the location and severity of the attack
• episodes can last for days, weeks or months
• alternate with periods of reduced or no symptoms (remissions)
• Fever, hot baths, sun exposures and stress can trigger or worsen attacks
• Relapses are common- however the disease can continue to get worse without periods of remission
• Nerves in any part of the brain or spinal cord can be damaged so patients can have symptoms in any part of the body

Question 3

Speech and Swallowing and fatigue symptoms

Answer 3

• slurred or difficult-to-understand speech
  - can sound drunk, and balance issues
• Trouble chewing or swallowing
• Fatigue is common as symptoms progress- is often worse in late afternoon- MAJOR PROBLEM

Question 4

Muscle symptoms

Answer 4

• loss of balance
• muscle spasms
• numbness or abnormal sensation in any area
• problems moving arms or legs
• problems walking
• problems with coordination and making small movements
• Tremor in one or more arms or legs
• weakness in one or more arms or legs

Question 5

Bowel and Bladdar symptoms

Answer 5

• constipation or leaking stool
• difficulty beginning to urinate
• frequent need to urinate
• strong urge to urinate
• urine leakage

Question 6

Eye symptoms

Answer 6

• double vision
• eye discomfort
• uncontrollable rapid eye movement (nystagmus)
• Vision loss (usually affects one eye at a time)

Question 7

Numbness, tingling, pain

Answer 7

facial pain
muscle spasms
tingling, crawling or burning feeling in the arms and legs

Question 8

Other brain and nerve symptoms

Answer 8

• decreased attention span, poor judgement, and memory loss
• difficulty reasoning and solving problems
• depression or feelings of sadness
• dizziness and balance problems
• hearing loss
  ANY CRANIAL NERVE CAN BE AFFECTED BY MS

Question 9

Signs and Tests

Answer 9

Symptoms can mimic those of many other disorders

• diagnosed by ruling out other causes
• RELAPSING-REMITTING MS: history of at least 2 attacks, separated by a period of reduced or no symptoms
• MS can be suspected if there are decreased in the function of 2 different parts of the CNS (ex. abnormal reflexes) at 2 different times

Question 10

Neurological Exam

Answer 10

• May show reduced nerve function in one area or spread over many areas of the body. this includes:
• Abnormal reflexes
• decreased ability to move parts of the body
• decreased or abnormal sensation
• loss of nervous system functions

Question 11

Eye Exam

Answer 11

• Abnormal pupil responses
• changes in the visual fields or eye movement
• decreased visual acuity
• problems with the inside part of the eye- occular tract
• rapid eye movements triggered with the eye moves

Question 12

Diagnostic tests for MS

Answer 12

1. Lumbar puncture (Spinal Tap) for cerebrospinal fluid- including CSF oligoclonal banding
2. MRI Scan of brain and spine
3. Nerve function study

Question 13

Complications of MS

Answer 13

1. Depression
2. Difficulty swallowing - affects healthy living
3. Difficulty thinking
4. Less and less ability to care for self
5. Need for indwelling catheter
6. Osteoporosis or thinning bones- balance problems= fractures
7. pressure sores
8. Side effects of meds
9. Urinary tract infections

Question 14

Visual Symptoms

Answer 14

1. Optic Neuritis- Blurred vision, eye pain, loss of colour vision, blindness
2. Diplopia- Double Vision
3. Nystagmus- Jerky eye Movements
4. Ocular Dysmetria- Constand under or overshooting eye movements
5. Internuclear opthalmoplegia- Lack of coordination between the 2 eyes, nystagmus, diplopia
6. Movement and sound phospheres- Flashing lights when moving eyes or in response to a sudden noise
7. Afferent Pupillary defect- Abnormal pupil responses

Question 15

Vision symptoms treatment plan

Answer 15

• affect computer use- focus on substituations for activities ex. listening to music that will not strain the eye
  2. Ask where something is when holding it in front of them to help them to learn how to distinguish where things actually area
  3. Hard time focusing- confined areas best when working with clients
  4. Difficulty focusing
  DRIVING

Question 16

Motor Symptoms

Answer 16

1. Paresis, Monoparesis, Paraparesis, Hemiparesis, Quadreparesis- Muscle weakness- partial or mild paralysis
2. Plegia, paraplegia, hemiplegia, tetraplegia, quadraplegia- Paralysis
3. Spasticity- Loss of muscle tone causing stiffness, pain, and restricting free movement of affected mucles
4. Dysarthria- slurred speech and related speech problems
5. Muscle atrophy
6. Spasms, cramps, hypotonia, clonus, myoclonus- involuntary contraction of muscles- problems with posture- Jerking and twitching muscles
7. Restless leg syndrome
8. Footdrop- problem during walking
9. Dysfunctional Reflexes- MSRs, Babinski’s, Hoffman’s, Chaddocks

Question 17

Motor Symptom Treatment Plan

Answer 17

1. Important to sustain muscles strength by must be careful not to over heat- must teach pt when to stop
2. Footdrop- Foot splint, env & Safety modifications, stretches to maintain ROM, Functional electrical stimulation, ICE, Bruching on tibialis anterior, dorsiflexion exercises
3. Spasticity- use bobath to decrease tone, deep icing, pressure on golgi tendon organ
4. Slurred speech- given pen and paper, liaise with speech lang path., check swallowing, feeding could be a problem, If client has spasticity and slurred speech they may be unable to eat, can do compensatory teaching and work on affected limb- remember forward flexion of head makes it easier to swallow
5. Muscle Atrophy- maintain activity level to maintain strength
6. Spasms and Clonus- functional electrical stimulation, use recipricol inhibitition- hold limb in neutral and golgi tendon organ will kick in and relax the muscle

Question 18

Sensory Symptoms

Answer 18

1. Paraesthesia- partial numbness, tingling, buzzing and vibration sensations
2. Anaesthesia- complete numbness and loss of sensation
3. Neuralgia, Neuropathic and Neurogenic pain- Pain without apparent cause- burning itching and electrical shock sensations
4. L’Hermitte’s- elective shocks and buzzing sensations when moving head
5. Proprioceptive Dysfunction- Loss of awareness of location of body parts
6. Trigeminal Neuraglia- Facial Pain

Question 19

Coordination and Balance Symptoms

Answer 19

1. Ataxia- loss of coordination
2. Intention Tremor- Shaking when performing fine movements
3. Dysmetria- Constant over or undershooting limb movements
4. Vestibular Ataxia- Abnormal balance function in the inner ear
5. Vertigo- Nausea, vomitting, sensitivity to travel sickness
6. Speech ataxia- problems coordinating speech, stuttering
7. Dystonia- Slow limb position feedback
8. Dysdiadochokinesia- Loss of ability to produce rapidly alternating movements, for ex. to move to a rhythm

Question 20

Bowel, Bladdar and Sexual Symtoms

Answer 20

1. Frequent micturation, bladdar spasticity- urinary urgency and incontinence
2. Flaccid bladder, detrusor-sphincter dyssynergia- urinary hesitancy and retention
3. Erectile dysfunction
4. Anorgasmy
5. Retrograde ejaculation- ejaculation into the bladdar
6. Frigidity- inability to become sexually aroused
7. Constipation
8. Fecal urgency
9. Fecal incontinence
   TREATMENT IDEAS
   - adult diapers that are easy on and off
   - erectile dysfunction and anorgasmy- compensatory and tools
   - constipation- increase fibers and water and teach how to disimpact

Question 21

Cognitive Symptoms

Answer 21

1. Depression
2. Cognitive Dysfunction- short term and long term memory problems, forgettfulness, slow word recall
3. Dementia
4. Mood swings, emotional liability, euphoria
5. Bipolar
6. anxiety
7. Aphasia and dysphasia- impairments to speech, comprehension and production

Question 22

Cognitive Symptom treatment plan

Answer 22

Depression and cognitive dysfunction- treat as a clinical symptom with meds and dealing with function activities
- day planners and cell phone
Dementia and mood swings- cannot control emotions- let pt know this is normal and okay and part of disease process
Aphasia and dysphagia- compensatory, facilitation technique (thumb and broca area)

Question 23

Treatment plan advice

Answer 23

As MS will change day to day, week to week so treatment modality and goals must be flexible, accommodating and timely