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NI2 > Multiple Sclerosis > Flashcards

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
Q

What are the principles of activity training?

A
  • High reps
  • Task specificity
  • Accurate instructions
  • Specific & timely feedback
  • Ensure appropriate strength & flexibility coincides with activity training
26
Q

What are the characteristics of fatigue in MS?

A
  • 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
Q

What does the management of fatigue involve?

A
  • 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
Q

What should be considered prior to commencing an aerobic fitness program with an MS patient?

A
  • 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
Q

What are the aerobic testing protocols that can be used in MS?

A
  • Graded cycle ergometer
  • Balke treadmill test
  • 6MWT
  • Shuttle test
30
Q

What is the testing protocol for a graded cycle ergometer?

A
  • 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
Q

What is the testing protocol for the Balke treadmill test?

A
  • 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
Q

What is the dose-response principle?

A
  • 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
Q

What duration and frequency should be set for aerobic exercise for MS patients?

A
  • 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
Q

What intensity should be set for aerobic exercise for MS patients?

A
  • Aim for 60-80% HR max
  • Aim for 15-30 beats above resting HR
  • Utilise a rating of somewhat hard on BORG scale
35
Q

How is max HR calculated for people on beta blockers?

A

(220-age) x 0.85 (as beta blockers slow HR)

36
Q

What should monitoring during aerobic exercise include?

A
  • HR
  • RPE
  • BP
  • Signs & symptoms
37
Q

What mode of aerobic exercise should be used for MS patients?

A
  • 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
Q

What are some of the barriers to aerobic exercise in MS?

A
  • 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
Q

What are the special considerations for exercise in MS?

A
  • CAD
  • Medication e.g. beta blockers
  • Age
  • Habitual exercise
  • Lower limb weakness
  • Sensory impairments
40
Q

What did Mostert & Kesselring 2002 find regarding exercise in MS?

A
  • 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
Q

What are the advantages of walking aids?

A
  • Greater stability
  • Reduced falls risk
  • Increased walking distance
  • Increased walking speed
  • Improved efficiency
  • Reduced fatigue
42
Q

What are the disadvantages of walking aids?

A
  • 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
Q

What are some of the management strategies for immobilisation during disease progression/relapse?

A
  • Respiratory physio
  • Positioning/splinting to prevent contracture
  • Positioning to prevent pressure areas
  • Strength training/FES
  • Sitting
  • Education of carers
44
Q

What are some of the services available to MS patients?

A
  • MS society
  • Independent living centre
  • Accessible leisure centres
  • Respite care
  • Sporting groups
  • Carer support groups
  • Vocational rehab
45
Q

When should a wheelchair or scooter be considered?

A

To allow

  • Ongoing participation in work or social activities
  • Community mobility
  • Fatigue minimisation
  • Patient to prioritise effort
46
Q

What should physios educate carers about?

A
  • 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
Q

What is one of the common first signs of MS?

A

Visual disturbances (plaques forming on optic nerve)

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