Multiple Sclerosis - Exercise Testing And Prescription Flashcards
MS is a disease caused by a reaction to what?
Which cells are ultimately activated to cause neural degeneration?
Reaction to = Myelin and oligodendrocyte glycoproteins.
This reaction activates T cells which attache to capillaries in the brain to ultimately activate macrophages, which digests the myelin sheaths.
Your patient has MS, at first their symptoms appear quite mild. You agree to see them another time to discuss an ex program to improve their QoF. On the second meeting, 4 weeks later, you notice their symptoms are far worse.
What form of the disease does the patient most likely have?
What is the typical progression of this form?
The patient most likely has Relapsing-Remitting, as its the most common form of the disease (~85%) and its characterised by periods of ‘atttack’ and periods of remission.
It’s possible that they’ve got progressive replacing, however this is far less common (~5%) and its progression means that remission is never significant, as it seemed in the patient you met.
If the patient has RRMS, it’s possible within 10-20 years that they’ll develop secondary progressive MS (SPMS), which is a decline in health with some small periods of relapse-remit. The key is to determine a program + meds that can delay the progression.
One consequence of MS is slowed transmission of both motor and sensory nerves. A decrease transmission of motor nerves leads to physical impairments, what are some symptoms of sensory failure?
How might these influence your ex prescription?
Thermoregulation problems - thermoneurtral environment
Poor balance and posture - increased fall risk, req more training
Lack of pain sensation - difficult to just injury/fatigue, so req close supervision, especially when hands/feet are strapped to machines.
Bladder control a problem - need to empty bladder before ex, and also during if liquids are req.
Many MS and Diplegic(upper limb particularly) and extrapyramidal CP patients would benefit from constraint-induced therapy.
How much time should be devoted to such training in a typical program?
Over what time frame would you expect to see considerable improvements?
Training is often done 4-6 (often 5) days a week for - 6 hours per day.
You would expect considerable improvement over the first few weeks. But some patients req months/years of training.
