Multiple Sclerosis MS

Question 1

MS Health condition & BFS Impairments (MS)

Answer 1

Chronic, autoimmune, inflammatory disease that attacks the central nervous system
Particularly affects the CNS myelin sheath and eventually the axons
The most common neurologic condition in young adults
Diagnosis requires dissemination of lesions in space and time
May have autonomic dysfunction
May have cognitive impairments

Question 2

MS Medications

Answer 2

IV or PO methylprednisolone
Plasmapharesis
Cyclophosphamide
Disease modifying:
- Natlizumab
*B-cell depleting:
- Ritumximab
- Ocrevus (ocrelizumab)
- Kesimpta (ofatumumab)
- Briumvi (ublituximab)

Question 3

MS Diagnosis specific tests & measures

Answer 3

Expanded Disability Status Scale (EDSS)
McDonald criteria
Modified Fatigue Impact Scale (MFIS)
12-Iten MS Walking Scale (MSWS-12)
MS Functional Composite (MSFC)
MS Impact Scale (MSIS-29)
MS Quality of Life (MS QoL-54)

Question 4

MS Interventions

Answer 4

Aerobic exercise - 3 d/wk, mod intensity, 10-30min
Gait training - treadmill training low-mod intensity 2-3x/wk, intermittent rest
Balance training - individualized 40min/week of task-specific training, dual/cog
Resistance training - 1-3 sets, 8-15 reps, 2-3x/wk, 60-80% 1RM

Question 5

MS Special considerations

Answer 5

Fatiguability & fatigue
Heat intolerance
Pain is common
Dizziness is common
Optic neuritis is a common first sign

Question 6

MS fun fact

Answer 6

MS is the most common neurological condition in young adults

Question 7

Types of MS

Answer 7

Relapsing-Remitting MS
- 85% of initial MS diagnoses
Primary-progressive MS
- Progression without relapses
Secondary-Progressive MS
- Progression with relapses

Question 8

MS Disability levels from EDSS

Answer 8

Mild disability (0-3.5)
- Can walk at least 500m
- Min severity of systemic
Moderate disability (4.0-5.5)
- Can walk 100-500m
- Mod severity of systemic
Severe disability (6.0-10)
- Cannot walk 100m

Question 9

MS Diagnosis

Answer 9

Dissemination in space
- Lesions in 2 of 4 areas
Dissemination in time
- Multiple relapses/new lesions
- Active and nonactive lesions
- Inflammatory CSF

Question 10

MS Prognosis

Answer 10

Positive factors:
- RRMS
- Complete recovery from flares
- Reduced disability at 5 years
Negative factors:
- Age
- Male
- Not of European descent
- High relapse rate
- Initial symptoms include brainstem involvement

Question 11

MS Signs & Symptoms

Answer 11

Fatigue
Difficulty with ambulation
Stiffness
Spasms
Cognition
Bladder involvement
Pain
Emotional Involvement
Optic Neuritis
Diplopia
Bowel involvement
Tremors
Sexual dysfunction
Arm motion difficulty
Swallowing
Speech
Seizures
Limb weakness
Tingling/Paresthesia
Dizziness or Vertigo

Question 12

BEEMs Program

Answer 12

3 Components
- Standing on different surfaces
- Mobility-based balance
- Visual stability: saccadic, smooth pursuit, VOR
3 Parameters for progression
- Visual input changes
- Somatosensory input changes
- Vestibular input changes
Intensity
- Symptom limitations: nausea, dizziness, lightheadedness
- Postural stability: sway, time to loss of balance
Frequency
- 1-2x/wk, 45min, 6-8 weeks, daily home practice