Multiple Sclerosis (MS)

Question 1

MS Overview / Introduction

Answer 1

• Autoimmune disease causing inflammation and damage to myelin coating that is wrapped around CNS nerve fibers
• Cause unknown
• Females, 20-40 years old
• Optic nerves, white matter spinal tracts, spinal cord, and cerebellar peduncles attacked

Question 2

MS Types

Answer 2

• Relapsing / Remitting = 85%, unpredictable attacks which may or may not leave permanent deficits followed by periods of remission, relapses are periods of worsening of neuro function lasting longer than 24 hours, remissions are periods of complete or partial resolution of symptoms
• Primary Progressive = 10%, disease progression and steady functional decline from onset, no relapses or remissions, typically later onset

Question 3

MS Factors that Influence Exacerbations

Answer 3

• Stress
• Viral or bacterial infections
• Sleep deprivation
• Dehydration
• Exhaustion
• Warm temperature (heat denatures myelin, heat breaks down myelin, and myelin does not regenerate itself)

Question 4

MS Patient Profile

Answer 4

• Female
• 20-40 years old
• Uthoff’s Sign (heat intolerance, symptoms that present after pt is exposed to heat)
• Quad D’s (diplopia, dysarthria, dysphagia, and dysphonia)
• SPASTICITY
• Lhermitte’s Sign (electric like shock sensation when flexing neck)

Question 5

MS Prognosis

Answer 5

• Relapsing / Remitting = live 10 years less than average but able to maintain functional ADL level majority of life
• Late Stage = full assistance, chronic care facility, w/c bound, preventative and maintenance therapy
• Primary Progressive = poor prognosis, with rapid decline in function to late stage MS

Question 6

MS Impairments

Answer 6

• Weakness (corticospinal tract impacted and cerebellar issue)
• Spasticity
• Balance (loss of sensory system)
• Gait (cerebellar dysfunction)
• Energy conservation and fatigue

Question 7

MS Side Note**

Answer 7

• Hypothyroidism is also common in this same demographic (female, 20-40 year old) and also has heat intolerance issues

Question 8

MS Treatment

Answer 8

• Diplopia = eye patch
• Low vision = constructing colors, floor markers
• Diminished proprioception = weight on extremities, tapping, verbal cues, biofeedback
• Overheating = avoid aquatics more than 85 degrees and avoid working into fatigue
• Work early in the morning
• PF spasticity and foot drop = hinged AFO with PF stop
• Ataxic Gait = pool walking to reduce fatigue and tone, ankle weights
• Body weight supported treadmill training

Question 9

MS Outcome Measures

Answer 9

• HR and BP are only effective in early stages (first 2 years) because it is ineffective when cardiovascular dysautonomia is present
• RPE is gold standard (13-15 is where we want these patients to be kept)

Question 10

MS Spasticity

Answer 10

• Excessive extensor tone
• Avoid contractures — position out of synergy, PNF stretching techniques (contract relax and hold relax)
• Reduce spasticity — flexion and rotational based exercises, aquatics, tai chi, and yoga