Multiple Sclerosis Flashcards

1
Q

What is MS?

A
  • Autoimmune disease
  • Affects 30 in 100,000 in Australasia
  • Mechanism of disease is an immunologically mediated inflammatory response in the CNS
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2
Q

What is the aetiology of MS?

A
  • Affects young adults
  • Genetic involvement
  • Environmental influences
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3
Q

What is the pathophysiology of MS?

A

Demyelination of neurons in the CNS results in disruption of neural transmission & the consequent neurological signs & symptoms

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4
Q

What are the stages of inflammation in MS?

A
  1. Accumulation of inflammatory cells, lymphocytes & monocytes at the lesion site
  2. Active destruction of the oligodendrocyte & its myelin sheath
  3. Depletion of oligodendricytes
  4. Healing of lesion by scar formation (plaques)
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5
Q

What are the most common sites of plaques in MS?

A
  • Periventricular regions
  • Cerebellar white matter
  • Optic nerves
  • Cervical portion of spinal cord
  • Grey-white boundary in cerebrum
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6
Q

What are the 4 types of MS?

A
  • Benign
  • Relapsing-remitting (most common)
  • Secondary progressive (65% of RR patients)
  • Primary progressive (10%)
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7
Q

What does the diagnosis of MS involve?

A
  • Based on MRI, lumbar puncture & clinical assessment

- Diagnosis made after either 2 episodes or evidence of 2 separate lesions

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8
Q

What does the drug therapy management of MS involve?

A
  • Disease modifying therapies e.g. interferon
  • Anti-inflammatories e.g. steroids
  • Alleviation of symptoms e.g. baclofen for spasticity
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9
Q

What are the 2 main ways stem cell treatment for MS could be developed?

A
  • Immunomodulation: Preventing immune damage to the nervous system
  • Remyelination: Repairing the myelin sheath that has already been damaged
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10
Q

What are the impairments in MS?

A
  • Complex, variable & unpredictable (patient to patient, episode to episode)
  • Sensorimotor
  • Autonomic
  • Cognitive
  • Behavioural
  • Language
  • Special senses
  • Fatigue
  • May affect one limb, one side of the body or all 4 limbs
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11
Q

What are the primary motor impairments in MS?

A
  • Loss of strength
  • Loss of dexterity
  • Loss of sensation
  • Spasticity
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12
Q

What should the subjective assessment of an MS patient include?

A
  • Current activities (mobility, ADLs)
  • SHx (family support, carer/care packages, work, leisure)
  • Medication
  • PHx (previous exacerbations, falls, other relevant)
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13
Q

What should the objective assessment of an MS patient include?

A
  • Strength
  • Dexterity
  • Sensation
  • Spasticity & contracture
  • Activity limitations
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14
Q

What are the important components of activity assessment?

A
  • Relevant to the patient’s current level
  • Specific to the patient’s environment
  • Meaningful to the patient
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15
Q

What are some of the measures used in MS?

A
  • Expanded disability status scale
  • MS functional composite
  • MS impact scale
  • Fatigue severity scale (differentiates fatigue from depression)
  • MS self efficacy scale
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16
Q

What are the physio aims in MS?

A
  • Optimise performance in ADLs
  • Prevent unnecessary disability
  • Improve QOL
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17
Q

What does physio for MS involve?

A
  • Preserve/improve muscle strength & aerobic capacity
  • Preserve musculoskeletal integrity
  • Activity training
  • Management of fatigue
  • Providing necessary aids
  • Ensuring interventions are relevant & collaboration in setting goals
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18
Q

What did Cruickshank et al 2015 find regarding PRE training in MS?

A
  • Systematic review of 7 RCTs
  • Patients with MS with mild-mod disability
  • Interventions were PRE training 3 weeks-6 months, 2-5 times weekly
  • Significant increase in strength & improvement in fatigue & QOL
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19
Q

What did Paltamaa et al 2012 find regarding balance training in MS?

A
  • Systematic review of RCTs looking at balance training
  • Examined specific balance training in ambulatory patients with mild-mod MS
  • Significant increase in balance
20
Q

What did Van den Berg 2006 find regarding treadmill training in MS?

A
  • MS patients in a crossover trial to examine the efficacy of TT
  • Patients trained for 30 mins, 3 times/week for 4 weeks
  • Significant increase in walking speed & endurance
21
Q

What is spasticity often associated with in MS?

A

Painful crams & spasms

22
Q

What does the medical management of spasticity include?

A
  • Medication

- Surgical management

23
Q

What are the interventions for contracture?

A
  • Active movement through range
  • Activity training
  • Active assisted movement through range
  • ES
  • Positioning during the day
  • Resting splints
  • Prolonged positioning
  • Serial casting
24
Q

What are the important components of activity training in MS?

A
  • Must be guided by the assessment & goals of the patient
  • Must take into account the nature of MS
  • May include wheelchair skills (transfer & propulsion)
25
What are the principles of activity training?
- High reps - Task specificity - Accurate instructions - Specific & timely feedback - Ensure appropriate strength & flexibility coincides with activity training
26
What are the characteristics of fatigue in MS?
- Considered the most disabling feature - Occurs in up to 80% of MS patients - Not related to degree of disability or mood state - Assessment should identify the nature, extent & precipitation factors in fatigue
27
What does the management of fatigue involve?
- Incorporate rest breaks - Simplify tasks - Time management - Low impact aerobic exercise gradually increasing in intensity, duration & frequency - Address other factors (diet, sleep, depression) - Pharmacological agents have demonstrated limited positive effects
28
What should be considered prior to commencing an aerobic fitness program with an MS patient?
- Patient is medically stable - Medical clearance - Patient has the ability to activate large muscle groups (walking or cycling) - Goals, duration, frequency, intensity, monitoring, mode, barriers, special considerations
29
What are the aerobic testing protocols that can be used in MS?
- Graded cycle ergometer - Balke treadmill test - 6MWT - Shuttle test
30
What is the testing protocol for a graded cycle ergometer?
- Use HR monitor - 3 mins at 25W at 50 RPM - Increase work rate by 10W every 2 mins - Discontinue when the patient is unable to continue or is at 80% predicted HR max
31
What is the testing protocol for the Balke treadmill test?
- Constant speed, incremental graded walking test - Treadmill at 5.3km/hr - Increase grade by 1% per min - Record time when person is unable to continue
32
What is the dose-response principle?
- Dose: Combination of intensity, duration & frequency - Response: Outcome in response to the training - Optimal dose & response will depend on the neurological disability & current fitness level
33
What duration and frequency should be set for aerobic exercise for MS patients?
- Start with sets of 2-3 mins - Increase each session to 30-45 mins - If patient can walk 15-20 mins, train 3 time/week - If patient is unable to walk 15 mins (even with rests) train 5 days/week, twice/day - Increase time then intensity
34
What intensity should be set for aerobic exercise for MS patients?
- Aim for 60-80% HR max - Aim for 15-30 beats above resting HR - Utilise a rating of somewhat hard on BORG scale
35
How is max HR calculated for people on beta blockers?
(220-age) x 0.85 (as beta blockers slow HR)
36
What should monitoring during aerobic exercise include?
- HR - RPE - BP - Signs & symptoms
37
What mode of aerobic exercise should be used for MS patients?
- Mildly impaired patients can use gym equipment or walk OG | - Mod-severe patients can be trialled used treadmill with up to 15% BWS, stepper with harness or cycle ergometer
38
What are some of the barriers to aerobic exercise in MS?
- Cost - Lack of energy - Transportation - Lack of knowledge regarding available exercise programs - Behavioural impairments, especially apathy - Beliefs about exercise - Lack of prior exercise experience
39
What are the special considerations for exercise in MS?
- CAD - Medication e.g. beta blockers - Age - Habitual exercise - Lower limb weakness - Sensory impairments
40
What did Mostert & Kesselring 2002 find regarding exercise in MS?
- Patients with MS randomly assigned to exercise training or non-training group - 5 x 30min bike riding session a week for 4 weeks - Significant increase in work rate & sub-max VO2, improved health perception & increase in activity level - But compliance only about 65%
41
What are the advantages of walking aids?
- Greater stability - Reduced falls risk - Increased walking distance - Increased walking speed - Improved efficiency - Reduced fatigue
42
What are the disadvantages of walking aids?
- Reduced use & strength of lower limbs - Reduced trunk & head movement - Reduced balance stimulus (use of arms for postural adjustments) - Abnormal posture - Compromised upper limb function
43
What are some of the management strategies for immobilisation during disease progression/relapse?
- Respiratory physio - Positioning/splinting to prevent contracture - Positioning to prevent pressure areas - Strength training/FES - Sitting - Education of carers
44
What are some of the services available to MS patients?
- MS society - Independent living centre - Accessible leisure centres - Respite care - Sporting groups - Carer support groups - Vocational rehab
45
When should a wheelchair or scooter be considered?
To allow - Ongoing participation in work or social activities - Community mobility - Fatigue minimisation - Patient to prioritise effort
46
What should physios educate carers about?
- Disease process & its impact on physical activity - Safe & efficient manual handling - Appropriate motor training strategies to maintain or improve activity performance - Appropriate assistive devices
47
What is one of the common first signs of MS?
Visual disturbances (plaques forming on optic nerve)