Multiple Sclerosis

Question 1

Etiology

Answer 1

Chronic and progressive demyelinatination of the CNS. The demylenation produces scar tissue and plaque along the myelin shealth of nerve fibers and interfere with an axon’s ability to conduct impulses. This results in impaired nerve conduction and inflammation, which leads to neurological dysfunction.

Question 2

Signs and Symptoms

Answer 2

Initial: visual disturbances, dizziness, weakness with a pattern of exacerbation and remission
Motor: decreased balance, coordination, muscle contraction; partial/complete paralysis, muscle spasticity (especially in LEs), fatigue, intention tremors, dysphagia, impaired sensation, optic neuritis, slurred/slow speech, bladder and bowl disorder, decreased sex drive, cognitive deficits, Emotional dysregulation (depression, lability, inappropriate euphoria)

Question 3

Diagnosis

Answer 3

CSF analysis, nerve conduction studies, demeyelination does show up on medical imaging. However exacerbation and remission or continuous progress must occur over six months and no other clinical explanation

Question 4

Prognosis

Answer 4

progression is unpredictable and varying from person to person because pattern of demeylenation can be different for everyone. Can be benign or malignant
Types: relapse-remitting, secondary progressive, secondary progressive with relapse, primary progressive, progressive relapsing

Question 5

Interdisciplinary Team Management

Answer 5

Medications: muscle relaxants;
PT (conditioning and tone reduction); SLP (swallowing difficulties, cognition, communication); OT (functional performance, cognition)

Question 6

OT evaluation and goal setting

Answer 6

Occupational profile, pain levels, types of prescribed medication, ask about dizzy, balance, falls, sleep, incontinence, fatigue, sensation, fine motor

Standardized tools: Modified fatigue impact scale, Back Depression inventory, FIM, nine-hole or perdue pegs, monofilament sensation, Ashworth Scale for spasticity

Question 7

OT interventions

Answer 7

Contraindications: Heat, increased emotional or physical stress, excessive physical activity, alcohol,

Low Vision Intervention to reduce fall risk including making recommendation to eye-doctor; Sensory reeducation; Bladder/Bowel training and recording; body mechanics, stretching to reduce spasticity, splints, HEP, fatigue management, improve/provide proximal stability, collaborate for feeding and eating with SLP

Question 8

Managing Spasticity

Answer 8

stretching, yoga, maintain hips at 90* or more to reduce extensor tone, aquatic therapy for pain

Question 9

Managing Fatigue

Answer 9

Can result from sleep disturbance, mood changes, poor nerve conduction, muscle weakness or spasticity, medication side effects

Have client monitor what causes fatigue during time of day; reduce extended standing, AFO when appropriate, ergonomics, cooling techniques, energy conservation