Multiple Sclerosis Flashcards
What are the overarching goals of PT for multiple sclerosis patients?
help patient achieve/maintain optimal functional independence, safety, and quality of life
provide resources for equipment needs, community support/programs and education
What goal setting guidelines should be followed for MS patients?
What special treatment planning should be used for MS patients?
- patient driven goals
- functional goals
- principle of task specificity
- provide rest intervals
- avoid overheating
- transition to home/community program
What are the patient goals/interventions as soon as a patient is diagnosed with MS?
- education
- connection w/ support systems
- exercise/activity guidelines
- fatigue issues
- gait/balance or other impairments
follow up as needed
What should be the patient goals/interventions after an MS relapse or attack?
goal should be to return to baseline function
pt. may wait a couple of weeks after onset to resume therapy
What should be the patient goals/interventions with the progressiveness of MS?
- avoid deconditioning
- maximizing independent function
- assessing for mobility aids
What should be the patient goals/interventions during the advanced stages of MS?
- seated trunk positioning/control
- transfers
- upper limb strength/function
- respiratory function
- equipment needs such as a standing device can help w/ weight bearing, stretching, bowel/bladder relief, and respiration
What are the keys to successful compliance of an HEP?
What are some possible issues that would affecting compliance?
- goal orientated
- meaningful
- variable
- enjoyable
- fatigue
- depression
- lack of support
- cognitive dysfunction
What are the benefits of of exercise for MS patients?
- aerobic and muscular fitness
- fatigue
- depression
- functionality
- cognition
- sleep quality
associated w/ reduced rates of relapse and slowed disability progression
What are the guidelines for exercising with MS?
30 minutes of moderate intensity aerobic training and resistance training to all major muscles groups twice a week
What are the traditional signs that are evidence for a diagnosis of MS?
- evidence of damage in at least two separate areas of the CNS
- evidence that the damage occurred at two distinct points in time at least one month apart
- other possible causes have been ruled out
What is the revised diagnosis for MS?
In patients w/ a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of MS
What are the clinical features of MS?
- optic neuritis (visual loss or pain w/ eye movement)
- brainstem/cerebellar dysfunction (ataxia, dysarthria, etc.)
- pyramidal symptoms (paresthesia, spasms, loss of dexterity)
- spinal cord involvement (sensory or motor loss, loss of bowel control)
- fatigue
- heat intolerance
- cognitive dysfunction (processing, new learning or memory/executive functions)
- depression
- sexual dysfunction
What is the goal for medicational management for MS?
- modify disease course
- manage relapses
- manage symptoms
What are signs for a good prognosis of MS?
What are poor prognosis signs?
Good: few attacks, good recovery from attacks, relapsing-remitting, early medical management and adherence
Poor: multiple attacks, poor recovery from attacks, primary progressive type, pyramidal, brainstem, or cerebellar signs
How does prognosis change based on age and sex?
What other signs predict a better prognosis?
women have a better prognosis than men and those younger than 35 at onset have a better prognosis
long duration between exacerbations
short duration of symptoms during exacerbations
remission of initial impairments
only 1 impairment during the first year
What are the most common problems patients complain of when they have MS?
- fatigue (most common)
- walking and balance deficits
- bowel and bladder dysfunction
- pain/abnormal sensations
- visual disturbance
- cognitive dysfunction
- ataxia
What is the difference between acute and chronic fatigue for MS?
What scale is recommended for tracking MS fatigue?
Acute fatigue has been present on over 50% of the days or if there has been jump in fatigue in the past 6 weeks and if fatigue is reported to limit functional ability or quality of life
chronic fatigue lasts longer than 6 weeks and is frequently present
Use the modified fatigue impact scale (MFIS)
True or False: In ataxic gait, balance may be more of an issue than lower limb incoordination.
What scale is good for tracking ataxic gait? How is it scored?
What outcome measures does MS Edge recommend for MS gait?
True
Expanded disability status scale (EDSS)
- score of 0-4=able to walk w/o assistance
- score of 4-7.5=primarily walking distance and assistance levels (6=walking w/ cane)
- score of 7.5-9.5=main determinants are ability to transfer from w/c to bed and self care
- score of 10=death from MS
12-item MS walking scale
- 6 MWT
- DGI
- TUG
- Timed 25-foot walk
What outcome measures does MS-Edge recommend for balance deficits in MS patients?
- activities-specific balance confidence scale
- Berg Balance
- Functional Reach
What are common bladder and bowel issues with MS?
Bladder dysfunction is most commonly nuerogenic overactive bladder
-urgency, frequency, incontinence, difficulty emptying the bladder
Bowel Dysfunction
-constipation, involuntary loss of bowel control
What often is the cause of pain in MS patients?
altered sensation (dysesthesia)
also could be in the form of headaches, nueropathic extremity pain, or LBP
What are the two pain classifications?
Central Nueropathic: continous (dysesthesia) or intermittent (spontaneous, paroxysmal)
Nonneuropathic (nociceptive): MSK such as LBP or headaches or could be treatment induced
How will sensory loss distribute if it comes from the spinal cord? What if it is from brain involvement?
dermatomal if spinal cord
homunculus distribution if brain is involved
What causes weakness in MS patients?
Axonal damage which leads to reduced/slowed force production, peripheral muscle fiber changes, and disuse atrophy
What are signs of cerebellar involvement of MS?
What can spasticity contribute to?
- Ataxia
- intention tremor
- hypotonia
- vestibular inputs/balance issues
Fatigue
How can you test for disdiadochokinesia?
How can you test for dysmetria?
rapid alternating pronation/supination and having pt. walk fast
finger to nose, heel to shin tests or peg test or circle trace
What are the three direct predictors of participation limitations?
What is the unemployment rate for MS patients after diagnosis?
- Fatigue- most significant contributor to decreased participation
- Physical Function-strength, balance, and gait
- Psychological variables-mood depression, etc.
together these explained 88% of the variance of participation
Over half of MS patients are unemployed 10yrs after diagnosis
What outcome measures does MS EDGE recommend for tracking the quality of life in MS patients?
MS Impact Scale (MSIS-29) which has a physical and psychological scale
MS Quality of Life (MS-QOL 54) which has 12 subscales including role limitations, emotional well being, and cognitive function
What is Multiple Sclerosis?
an immune-related response in which antibodies induce demyelination by antibody-dependent, cell-mediated cytotoxicity
cytokines attack myelin, macrophages help uptake myelin, oligrodenderocyte apoptosis leads to an increase in demyelination, increased axonal injury occurs and becomes sclerosed
What are the risk factors of MS?
Environmental Factors:
- vitamin D deficiency (people further from equator have greater risk)
- smoking (increased risk)
- infection (people with a histroy of epstein-barr virus or herpes virus 6 have greater risk)
Genetic Factors:
- first degree relatives have increased risk
- females at more risk than males (2-3x more likely)
What is the most common age of diagnosis for MS?
between 20-50
What are the 4 types of MS?
Clinically isolated syndrome
relapsing remitting
primary progressive
secondary progressive
What is clinically isolated syndrome?
What are the two types of episode?
What is the prognosis?
refers to a first episode of neurologic symptoms that lasts at least 24 hours
monofocal-single neuro sign or symptom
multifocal-more than one neuro sign or symptom caused by a lesion
usually has no associated fever or infection and is followed by a complete or partial recovery
What is relapsing remitting MS?
When is increase in disability confirmed?
most common disease course
clearly defined attacks of new or increasing neuro symptoms
disabiltiy confirmed when person exhibits the same level of disability at the next scheduled neuro eval 6-12 months later
What is primary progressive MS?
How is it different from Secondary progressive?
Worsening neuro function from the onset of symptoms w/o early relapses or remission
follows an initial relapse-remitting course but then progressively gets worse after an episode (will happen to most relapse-remitting patients)
What is active/non-active MS?
relapses or new increasing neurologic dysfunction (active) followed by full or partial recovery in the absence of fever or infection (non active)
