Unit 8: MS Flashcards by Lexi Vitale

What is MS?

-Most commonly diagnosed neurological disease that can cause disability in young adults
-Chronic, immune-mediated disease in which the bodys immune system attacks the CNS
-Specifically the myelin (fatty substance that surrounds and insulates the nerve fibers) and nerve fibers themselves are affected
-When the myelin or nerve fibers are damages, nerve impulses are distorted or interrupted producing a variety of potential symptoms

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Epidemiology and Etiology of MS

400,000 people are diagnosed
-2.5 million people worldwide
-Typically btw 15-50 when diagnosed
-Peak age of onset is 20-30 years
-Women are 2-3x more likely than men
-Most common amongst Caucasians of Northern European ancestry
-Epidemiological evidences support that there are both genetic and environmental risk factors for MS
-Precise cause remains unknown

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Four Categories of MS

-Progressive Relapsing
-Secondary-Progressive
-Primary-Progressive
-Relapsing-Remitting

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Progressive Relapsing (Categories of MS)

~5% of individuals diagnosed with MS
-Steady decline since onset with superimposed
attacks

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Secondary-Progressive (Categories of MS)

~50% of people with RRMS develop SPMS *usuallly within 15 years of diagnosis
-Initial course of RRMS, followed by transition to progressive MS and steady worsening of symptoms

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Primary-Progressive (Categories of MS)

-Approximately 10% of individuals diagnosed with MS
-Gradual worsening of neurologic function from onset
-No distinct relapses or remission
-Rate of progression may vary over time

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Relapsing-Remitting (Categories of MS)

~85% of people are initially diagnosed with RRMS
-Produces clearly defined relapses (referred to as: flare-ups, or exacerbations) of acute worsening of neurological function followed by partial or complete improvement and then stable periods (remission) between attacks
-May or may not leave permanent deficits

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Symptoms of MS

Central
-Fatigue
-Cognitive Impairment
-Depression
-Unstable mood
Visual
-Nystagmus
-Optic neuritis
-Diploplia
Speech
-Dysarthria
Throat
-Dysphagia
Musculoskeletal
-Weakness
-Spasms
-Ataxia
Sensation
-Pain
-Hypoesthesia
-Paraesthesia
Bowel/Urinary
-Incontinence
-Diarrhea or Constipation
-Frequency/retention

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Common areas impacted by MS

-Communication
-Domestic Life
-Employment
-Leisure Activities
-Mobility
-Physical Activity
-Self care
-Social Interactions

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MS Rehab Team

-Neurologist
-Speech
-OT
-PT
-Psychologist
-Nurse

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Neurologist (MS Rehab Team)

Assists with the medical diagnosis and treatment of MS. This includes medication, symptom management, and monitoring disease progression.

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Speech Therapist (MS Rehab Team)

Specializes in evaluation and treatment of swallowing, speech, and/or cognition limitations.

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Occupational Therapist (MS Rehab Team)

-Provides techniques and strategies to help a person with MS manage symptoms in order to continue to perform meaningful daily activities and improve independence in daily life.
* This can include ADL/IADL training, compensatory techniques, memory aides, home modification, fatigue management.

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Physical Therapist (MS Rehab Team)

Focuses on strengthening, coordination, balance, ROM, managing spasticity, and optimizing mobility for people with a decline in function.

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Psychologist (MS Rehab Team)

Focuses on the evaluation and treatment of cognitive and emotional problems.

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Nurses (MS Rehab Team)

Focuses on administering medication, following doctor’s orders and vitals

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Goals of MS Rehab

-Maximize QoL
-Self-management of symptoms to minimize medical, role, and emotional impact on daily life
-Maintain current abilities, regain lost abilities, and maximize independence in daily activities
-Prevent deterioration and emergence of new restrictions or secondary conditions
-Enhance participation and independence in life roles
-Self-advocate for necessary services and supports
-Promote overall health, well-being, and life balance
-Educate and train caregivers for continued care in the home

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What Settings do OT’s treat MS?

-Inpatient: Acute relapse or exacerbations
-Sub-Acute: Acute relapse or exacerbation or transitioning to a more advanced supportive care setting
-Outpatient: Mild relapse, discharged from hospital or subacute
-Home Health: Discharged from hospital or subacute setting, may need equipment and home modification recommendations

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Assessments/Screens/Tests Used with MS for Fatigue

-Fatigue Severity Scale
-Modified Fatigue Impact Scale
-Rochester Fatigue Diary Scale
-The Comprehensive Fatigue Assessment Battery for MS (CFAB-MS)

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Assessments/Screens Used with MS for Cognition?

-Mini-Mental State Exam
-Minimal Assessment of Cognitive Function in MS (MACFIMS)
-MS Neuropsychological Screening Questionnaire
-Paced Auditory Serial Addition Test
-Symbol Digit Modalities Test (SDMT)

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Assessments/Screens Used with MS for Pain, Tremors, Ataxia and Dysphagia?

-Pain Scale
-Multidimensional Assessment of Tremor (MAT)
-Canadian Occupational Performance Measure (COPM)
-Modified Barium Swallow Study (MBSS): SLP’s perform
-6 Minute Walk Test

Additional MS Assessments

-Multiple Sclerosis Walking Scale
-Sleep History Questionnaire or dairy
-Home Assessment
-Beck Depression Inventory – Fast Screen
-Mobility section of the Functional Independent Measure (FIM)
-ADL, IADL, and dysphagia assessments
-Nine-Hole Peg Test/Purdue Pegboard
-Semmes-Weinstein Monofilaments
-Manual Muscle Testing (MMT)
-Range of Motion testing (ROM)
-Grip Strength (dynamometry)
-Vestibular Evaluation

Challenges Reported by Caregivers

-Use of formal supports
-Emotional aspects of caregiving
-Physical aspects of caregiving
-Availability of other informal supports
-Obtaining and using assistive technology or home modifications
-Caregivers personal health
-MS knowledge
-Planning for the future

Practical & Logistical Challenges Facing MS Patients & Caregivers

-Managing varying, unpredictable,
and declining symptoms
-Assisting with mobility & functional transfers
-Planning for the future or hesitancy
to make long term plans
-Using technology, assistive devices, or medical equipment
-Time management
-Maintaining Employment
-Making or altering plans for retirement
-Managing finances
-Paying for assistive equipment
-Identifying and accessing services or managing care
-Education about MS as a disease
-How to help someone up after a fall
-Maintain control in one’s own life
-Information about home modifications
-Decision making
-Impaired home maintenance and management
-Navigating insurance companies & claims.

Emotional & Physical Challenges Facing MS patients & their Caregivers

-Depression/ Anxiety -Injuries related to lifting/moving -Stress/ emotional strain -Low mental health or quality of life -Difficulty coping with unpredictability -Fear of the unknown -Anxiety -Helplessness -Arthritis & Lower back pain -Fatigue/ tiredness -Sleep disturbance -Reduced life satisfaction -Loss of vitality -General health problems & bodily pain -Caregiver physical decline due to carer activities

Social and Relational Challenges Facing MS patients & Caregivers

-Lack of social supports from family or friends -Feelings of social isolation -Limited time for leisure activities -Impaired social interaction -Loss of intimacy with care partner/sexual relationship -Lack of emotional support -Impaired role performance

AOTA & Caregivers (AOTA’s statement on Family Caregivers)

“Caregivers (unpaid family and friends who are assisting loved ones) often experience negative health effects as a result of their efforts. This not only affects their own well-being but can affect their ability to continue to provide care. Many areas of caregiver concern have been identified, including issues of life imbalance, stress, depression, and the need for training in task performance. OT's can help ensure a healthy balance and support caregivers who experience sudden or long-term changes in their lifestyle and priorities and assist caregivers who may be at risk for negative health consequences.”

Initial Evaluation for MS

-Help build skills for success -Promote advocacy -Assist in planning for the future -Teach caregivers to incorporate task analysis -Educate about and refer to outside services. -Teach tools to deal with unpredict- ability

What are the most commonly used impairment rating instruments for MS clinical and research settings?

The Expanded Disability Status Scale and the MS Functional Composite

What is the most common and pervasive MS symptom and a primary reason for referral?

Fatigue -Affects 60-80% of people with MS and is a significant contributor to unemployment and overall disability

Primary MS Fatigue

Caused by MS disease process, the cause is poorly understood

Secondary MS Fatigue

Resulting from untreated MS problems such as walking difficulties

Physical Fatigue

Experienced in the limbs, torso, head, and neck such that the body is tired

Cognitive Fatigue

AFFECTS THINKING, PLANNING, MEMOry, word-finding, and decision making, such that the brain feels exhausted

Local/Focal Fatigue

Motor fatigue caused by inefficient nerve conduction to a selected area of the body

Generalized Fatigue

An entire body experience; A complete exhaustion that is physical and cognitive

Normal Fatigue

Experienced by humans after excessive energy output or several hours of being awake (a normal day) that benefits from rest or sleep

Weakness

May occur in all parts of the body -Repeated muscle contractions or fatigue of same muscle(s) is known as nerve fiber fatigue

Cognition

Up to 65% of people with MS -Loss of brain volume particularly gray matter -Memory (acquiring and retaining new information -Word Finding -Attention -Concentration -Executive function -Slowed information process speed -Perceptial problems: visual spatial

Cognition

Best test for MS Cognition

Minimal Assessment of Cognition Function in MS -The MS Neurophysiological Screening Questionnaire -The Paced Auditory Serial Addition test -Symbol Digit Modalities tes

PAIN

-40-60% -48% report chronic -Can be localized as in trigeminal neuralgia, lhermittes sign (a stabbing, electric shock along spine when neck flexes forward), or pain asa result of spasticity -

Spasticity

-Usually greater in lower extremities and may be source of pain, interrupted sleep, and activity limitations

Factors that may precipitate or augment Spactisity include

Infections, distended bladder, stress, or disease progression

Factors that may precipitate or augment Spactisity include

Infections, distended bladder, stress, or disease progression

What is the most common type of tremor in MS

-Intention tremor -Multidimension assessment of tremor (severity and functional impact_

Ataxia

-Presents in the trunk and UE where postural responses tend to occur before UE movements

Dysphagia

-Videofluoroscopy

Techniques used during relapse or remission

-Relapse: Emotion-focused coping techniques -Remission: Problem Solving and use of social network

Self Management

Critical for those living with MS