Neuromuscular Conditions (2)

Question 1

What is multiple sclerosis?

Answer 1

Destruction of the myelin sheath on the nerve fibres of the central nervous system & brain lesion in the cerebellum.

Question 2

How does MS affect the nerves

Answer 2

Affects the nerve conduction velocity and quality of signal. Also leads to changes in muscle recruitment patterns.

Question 3

Prevalence of MS

Answer 3

0.1%

Question 4

Symptoms of MS

Answer 4

Numbness, pain, onset of dementia, spasticity and fatigue.

Question 5

Onset of MS

Answer 5

20-40 years

Question 6

What other condition is MS related to?

Answer 6

Rheumatoid arthritis (immune function)

Question 7

What is Parkinson’s

Answer 7

Degenerative disorder of the CNS affects neurotransmitters. Reduction in motor cortex stimulation.

Question 8

How does Parkinson’s affect the Basal Ganglia?

Answer 8

Insufficient dopamine formation

Question 9

Potential causes

Answer 9

No specific causes have been identified.

Potential causes
- Loss of the type of nerve cells (neurons) that produce dopamine in an area of the brain responsible for regulating movement
- Excess proteins in the same area of the brain as well as the presence of excess proteins in nerve fibres. May interfer with the transmission of nerve cells (Lewy bodies)

Question 10

Parkinsons Symptoms

Answer 10

Slowing of the movement, tremors, muscle rigidity, postural instability

Question 11

MS Medications

Answer 11

Corticosteroids & interferon beta 1a and 1b (anti-autoimmune reaction)

Question 12

MS considerations & goals

Answer 12

• Reduced strength and endurance
• No assistance from SSC in spastic muscles
• Muscle atrophy an impaired activation patterns
• Exercise is limited by peripheral factors rather than central
• Excessive fatigue post-exercise

Goals
- ensure typical motor unit recruitment continues, maintenance/improve ROM, improve aerobic capacity, monitor post-exercise fatigue

Question 13

MS Assessment & Prescription

Answer 13

Assessment
- standard exercise and strength assessment
- assess balance and flexibility
- can compare to general population norms however it has been previously reported that 75% of MS patients have “low fitness”
- later stages of disease include functional testing

Prescription
- general guidelines
- endurance 3x/wk (65-70% MHR) 30 mins/day
- 3 x week (functional focus) - circuits and therabands useful.
- Heavy lifting with sensory deficit on agonist is a contraindicator

Question 14

Parkinsons Medication

Answer 14

Levodopa and dopamine agonists

Question 15

Parkinsons Exercise Goals & Considerations

Answer 15

Attempt to overcome poor posture and slow movements. Functional performance takes precedence.

Question 16

Parkinsons Physical Assessment

Answer 16

• General physical testing - STS, TUG, single leg balance, ROM, etc
• ## If aerobic testing is considered must consider precautions eg ECG

Question 17

Parkinson’s Exercise Prescription

Answer 17

Flexibility
- Focus on shoulders and spine (has direct relationship to posture).
- 3-5x/week at max strength tolerance capacity

Strength
- Poor evidence -> rely on general conditioning with a view to modifying ROM and intensity. Must assess RPE.

Endurance
- Poor evidence –> rely on general conditioning guidelines with a view to modifying intensity and duration. RPE = 10-12/20. Area of least importance.