Neuro - MS

Question 1

Explain the pathology of MS

Answer 1

• An autoimmune response, attacking myelin resulting ineither areduction or complete loss ofnerve conduction
• Lymphocytescross the blood-brain barrierand targetmyelin leading to inflammatory response

Question 2

Describe the classification of MS

Answer 2

RelapseRemitting: around 90% of patients initially have relapsing-remitting disease, most of them ultimately developing secondary progression.
Around 10% of patients have primary progressive multiple sclerosis, for which there is currently no disease-modifying treatment.

Question 3

Name some symptoms of MS

Answer 3

Numbness and tingling (63.5%)
Fatigue (40.1%)
Walking difficulty (48.9%)
Depression (14.7%)
Weakness (25.3%)

Question 4

How can physios help those with MS?

Answer 4

Falls and Fractures
Balance
Functional practice
Fatigue
Weakness

Question 5

What is included in a subjective assessment for someone with MS?

Answer 5

1. Expectations, priorities
2. HPC
   - RRMS, PPMS, SPMS. Previous treatments,(pain, stiffness, weakness, bladder/bowel,cognition, swallow) body function/structures, activities, participation.
3. SH
   - support, carers, environment, employment
4. PMH
   - previous relapses, THREADS
5. DH
   - DMT medicationand timings

Question 6

What is included in an objective assessment for someone with MS?

Answer 6

1. Observation during functional activities
   - tremor, stiffness, cognition, balance, vision, speech
2. Range of movement and activity/power
   - AROM and PROM
3. Coordination
   - finger to nose
4. Sensation and proprioception
   - light touch
5. Balance
   - sitting balance, standing balance, outside of BoS
6. Gait
   - stride, technique
7. Functional- on/off floor,rolling, ly-sit

Question 7

What are some different types of treatment that can be offered to those with MS?

Answer 7

• Stretching program
• Strengthening
• Aerobictraining - 30 minutes mod- intensity aerobic exercise2 days a week
• Upper Limb-gaming, dexterity,task specific practice
• Painmanagement
• Balance re-education, fallsstrategies

Question 8

What is tone?

Answer 8

Tone is the resistance of muscles to passive stretch.
It is the amount of tension a muscle has at rest
Tone is the internal state of muscle-fibre tension within individual muscles and muscle groups
It is a continuum from low (floppy or flaccid) to high (hypertonus or spasticity)

Question 9

What 3 strategies are there to maintain balance?

Answer 9

Postural Adjustments

1. Ankle strategy
2. Hip strategy
3. Stepping mechanism

Question 10

How can goals be set in a neuro setting?

Answer 10

Goals should be SMART where possible (specific, measurable, achievable, realistic and time framed)
Goals can be short, medium or long term

Question 11

What headings should you use for a problem list?

Answer 11

1. Body functions and structures
2. Activities
3. Participation

Question 12

What should the exercises be based on for neuro patients?

Answer 12

Exercises should be aimed at functional tasks and rebuilding movement skills

Question 13

What does motor learning require?

Answer 13

• Task specificity
• Practice/ intensity (1000 reps)
• Feedback
• Transferability
• Modeling
• Mental practice

Question 14

What do the guidelines for exercise prescription for MS patients say?

Answer 14

Physio treatments should be aimed at improving gait

Progressive resistance training and aerobic exercise for those with motor weakness

Question 15

How can muscles change with disuse?

Answer 15

• Reduced cross-sectional area
• Atrophy (muscle wastage) in antigravity muscles - postural muscles
• Changes in length-tension relationship
• Increased tendon stiffness

Question 16

Explain what MS is and who it is most common in

Answer 16

Multiple Sclerosis is a progressive long-term neurologicaldisorder of theCNS
Higher levels of incidencein North America and Europe.