Week 3 - MS, GBS and ALS

Question 1

what is the focus in the neuro conditions MS, GBS and ALS?

Answer 1

weakness and fatigue

Question 2

what are the three clinical types of MS?

Answer 2

benign:
- 1-2 initial attacks with complete/near complete remission
-mostly symptom free

exacerbating- remitting
- sudden symptoms onset with partial-complete remissions
- stable for long periods

remitting progressive
- leads to severe disability
-slow to rapid

Question 3

What are the clinical signs and symptoms of MS?

Answer 3

1. SENSORY DISTURBANCES
   – Tingling parasthesias, numbness
   – Lhermitte’s Sign- electric shocklike sensation down
   LE’s produced by neck flexion
   – Disturbed position sense, vibratory sense
   – Pain: burning, spasms/spasticity, headache
   **Note: complete sensory loss of any sense is rare
2. WEAKNESS
   – Mild to total; ++ variability
   – Secondary to disuse atrophy, inactivity
3. SPASTICITY:
   – Very common
   – Increased tone, hyperactive stretch reflexes
   – Clonus, spontaneous spasms
4. FATIGUE:
   – Increased neuro symptoms, physical dysfunction
   – Brought on by:
   * excessive physical activity
   * Weakness
   * Depression
   * Increased body temperature
5. CEREBELLAR DISTURBANCES:
   – Tremor (e.g. intention/action)
   – Dysmetria, dysdiadochokinesia, ataxia
   – Vertigo
6. VISUAL DISTURBANCES
   – Decreased/ blurred vision
   – Field deficits
   – Diplopia (double vision)
   – Optic neuritis (pain with eye movement)
   – Nystagmus
   – Problems with reading, visual tracking
7. COMMUNICATION DISTURBANCES:
   – Dysarthria (slurred speech)
   – Decreased volume
   – Dysphagia (swallowing problems
8. BOWEL / BLADDER
   – Urinary frequency, urgency, retention, hesitancy,
   incontinence
   – Neurogenic issues: incontinence, constipation
   – Sexual dysfunction
9. COGNITIVE + BEHAVIORAL
   – Decreased:
   * Memory, conceptual thinking, abstract reasoning
   – Emotional/psychotic: anger, aggression
   – Depression, anxiety
   – Emotional instability / lability; euphoria

Question 4

MS -secondary issues

Answer 4

• Psychological
• Neuromuscular
• Renal
• Digestive
• Cardiovascular
• Respiratory
• integumentary

Question 5

MS - exacerbating factors

Answer 5

• heat: increases symptoms, induces
• fatigue
  -stress
  -trauma

Question 6

MS: PT management - goals

Answer 6

• improve neuro symptoms
  -improve/maintain optimal level of physical functioning
  -prevent or slow development of secondary complications

Question 7

MS PT management - treatment

Answer 7

• ROM
• improve sensory feedback
  -skin care education

Question 8

What is GBS?

Answer 8

reactive self limiting autoimmune disorder

Question 9

what part does the immune system attack in GBS?

Answer 9

immune system attacks part of PNS

presents as acute generalized weakness

Question 10

how is nerve conduction affected in GBS?

Answer 10

slowed
after 2-3 weeks of demyelination, inflammation subsides, re-myelination begins

Question 11

what are the 3 types of GBS?

Answer 11

1)acute inflammatory demyelinating polyneuropathy (AIDP)

2 )axonal: acute motor neuropathy, acute motor sensory axonal neuropathy

3) miller fisher syndrome

Question 12

what are the typical presentation of GBS?

Answer 12

• motor neuropathy
  -distal limb parasthesias
  -symmetric leg weakness
  -gait ataxia

Question 13

what are the clinical presentations of GBS?

Answer 13

1. WEAKNESS:
   – Bilateral
   – Proximal with subsequent distal
2. REDUCED / ABSENT REFLEXES
3. SENSORY DISTURBANCE
   – Symmetric distal limb parasthesias
4. AUTONOMIC DISTURBANCE
   – Cardiac dysfunction, B/B issues, altered sweating
   5.CRANIAL NERVE INVOLVEMENT
5. PAIN

Question 14

what is the symptom progression of GBS?

Answer 14

mean time to peak symptoms: 12 days

98% reach peak by 4 weeks

recovery begins 2-4 weeks after progression ceases

mean time to clinical recovery: 200 days

Question 15

what is the plateau phase in GBS?

Answer 15

persistent unchanging symptoms followed by gradual improvement

Question 16

Medical management of GBS?

Answer 16

• plasmapheresis
• intravenous immunoglobulins (IVIG)
  -supportive care
  -ventilatory support
  -prevention of secondary issues: infection, dvt, pressure sores, pain management

Question 17

GBS - PT management

Answer 17

• maintain clear airways and prevent lung infection: chest therapy techniques, breathing exs
• maintain ROM: passive –> active assisted –> active
• prevent pressure sores: positioning

Question 18

What are early signs of amyotrophic lateral sclerosis (ALS)?

Answer 18

• tripping
• dropping things
  -slurred or thick speech
• difficulty swallowing

Question 19

what are early symptoms of ALS?

Answer 19

• feeling weak
• fatigue
• muscle cramping or twitching
• muscle stiffness or rigidity

Question 20

what is affected by ALS?

Answer 20

• muscle weakening will spread throughout the body which will cause difficulty with breathing, chewing, swallowing, and speaking
• the 5 senses are not affected
• muscles of eyes and bladder remain functional until very late in disease

Question 21

what are some PT management of ALS?

Answer 21

• chest therapy techniques and breathing exs
• rom exs and stretches
• positioning
• functional strengthening exs
  -transfers and mobility training

Question 22

what is the functional strengthening / training for ALS?

Answer 22

• train body for daily life activities: meaningful to pt, occurs within a pattern of movement
• incorporate task and context - specific practice
• considerations:
  condition, pt goals, ensuring goals are realistic and achievable

Question 23

what are the components of functional training program?

Answer 23

• individualized
  -progressive
• directed towards everyday life activities