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Neuro Dev/Control II > Multiple Sclerosis (MS) > Flashcards

Multiple Sclerosis (MS) Flashcards

1
Q

Describe the presentation of MS

A
  • No stereotypical presentation: any part of the CNS could be a target
  • UMN disease
  • Can vary by signs and symptoms, location, intensities, timeframes, & prognosis
  • Cann also vary depending on age
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2
Q

What is a sig of MS when looking at imaging

A
  • Demyelinating plaques will show in neuroimages
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3
Q

Describe MS

A
  • Progressive demyelinating disease
  • Working with MS patients is a lifelong commitment with the patient’s needs changing as disease progresses
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4
Q

What are the 4 types of MS progression in order

A
  • Relapsing remitting MS (RRMS)
  • Secondary progressive MS (SPMS)
  • Primary progressive MS (PPMS)
  • Progressive relapsing MS (PRMS)
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5
Q

How long should true relapses last and how far apart from other relates should they be

A
  • Should last at least 24hrs
  • Should be separated from other relates by at least 30 days
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6
Q

Define pseudoexacerbations

A
  • Last less than 2hrs due to stressors like heat, fatigue, and/or infections
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7
Q

Describe the McDonald criteria for diagnosis of MS

A

Slide 6

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8
Q

Describe the Kurtzke EDSS

A
  • Quantifies disability and documents disease progression
  • Defines function systems into: pyramidal, cerebellar, brainstem, sensory, bowel/bladder, visual, cerebral, & other
  • Each functions system is scored from 0-9 (zero being normal)
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9
Q

Describe the categorization of MS per the EDSS scores

A
  • EDSS 0-3.5 = mild disability, fully ambulatory w/o assistive device
  • EDSS 4-6.5 = moderate disability, ambulatory to specific distances w/o or w/ assistive device
  • EDSS 7-9.5 = severe disability, very limited ambulation even w/ aid, W/C or bed bound
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10
Q

Epidemiology of MS

A
  • Age of onset is 20-50yrs
  • Females affect more than men
  • Most commonly Dx b/w 30-35yrs, uncommon after 60yrs, disease could be very mild until 60yrs, the MS symptoms+geriatric processes can lead to progression
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11
Q

What are the top three most common symptom of MS in order from most prevalent to least prevalent

A
  • Fatigue
  • Heat sensitivity
  • Difficulty with walking & balance
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12
Q

What is the most common reason for disability & limitations in mobility for MS patients

A
  • Fatigue
  • Also the earliest symptom
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13
Q

Define fatigue

A
  • Subjective feeling of tiredness
  • Recognized by patients avoidance of exercise/physical activity
  • Reported by caregivers
  • Decreased scores win self-report fatigue measures (MFIS, FSMC)
  • Depression/anxiety
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14
Q

Define fatigabiliity

A
  • Objective measure of how fast someone gets tired with a specific repetitive task
  • Observed by progressive slowing of gait speed/distance, progressive weakening of specific contractions, worsening of sensation/speech/vision with a repetitive task
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15
Q

Describe central type fatigue

A
  • Comes abruptly with or without exertion
  • Triggering factors: exertion, heat, humidity, reduced sleep
  • Occurs along with mental confusion/dullness: brain fog/brain fatigue/Cog Fog
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16
Q

Describe the modified fatigue impact scale

A
  • Assessment for impact of fatigue on physical, cognitive, & psychosocial function
  • Recommended best for comprehensive assessment by a recent systematic review
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17
Q

Describe the fatigue severity scale

A
  • Assessment for impact of fatigue on daily activities
  • Recommended best for quick screening by a recent systematic review
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18
Q

List the assessments for fatigue

A
  • Modified fatigue impact scale
  • Fatigue severity scale
  • Fatigue scale for motor & cognitive functions
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19
Q

List the assessments for fatiguability

A
  • Visual analog scale
  • # of steeps in the last minute of 6MWT
  • # of hip flex reps in supine
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20
Q

UMN signs associated with MS

A
  • Weakness (paresis): MMT of ≤3/5 min once or more muscle groups
  • Spasticity
  • Brisk DTRs
  • Clonus
  • Babinski’s sign (toes flare up/out)
  • ROM limitations
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21
Q

Coordination problems associated with MS

A
  • Mainly from cerebellar & posterior column lesions
  • Cerebellar: ataxia, intention tremor, dysdiiadokokinesia, dysmetria, dyssynergia
  • Tests: finger to nose, RAM
  • Outcome measures: 9 hole peg test, Box and Blocks test
22
Q

What balance outcome measures can be used for MS patients

A
  • Berg balance scale (BBS)
  • Dynamic gait index (DGI)
  • ABC (activities specific balance confidence)
23
Q

Vestibular problems associated with MS

A
  • Presence of dizziness, vertigo, nystagmus, imbalance with head movements
  • Careful exam required: large number of new vestibular symptoms ion MS are found to be BPPV or other peripheral problems
24
Q

Functional mobility assessment outcome measures that can be used for MS patients

A
  • Timed 25 ft walk: gait speed
  • TUG and TUG Cognitive
  • Riveremead Mobility Index
  • 12 item walking scale: self report
25
Q

Gait and mobility problems associated with MS

A
  • Reduced stride length
  • Prolonged double support time
  • Slow gait speed
  • Hip flexor & DF weakness (steppage gait)
  • Hip ABD weakness (Trendelenburg gait)
  • Hip ADD tightness (Scissoring)
  • Cerebellar lesion (Ataxia)
26
Q

Visual problems associated with MS patients

A
  • Ice pick pain due to optic neuritis
  • Marcus gunn pupil (RAPD - detected by swinging flashlight test)
  • Vertical nystagmus
  • Diplopia
  • Scotoma
27
Q

Sensation problems associated with MS patients

A
  • Numbness, tingling, parasthesia
  • Impaired vibration/position sense: more in LEs; Positive Romberg
  • Outcome measures: Erasmus modifications to the Nottingham sensory assessment (EmNSA)
28
Q

Pain problems associated with MS patients

A
  • Parathesia/Dysesthesia: pins and needles, hypersensitivity, burning, neuropathic type
  • Trigeminal neuralgia
  • Lhermitte’s sign
  • MSK strain/joint malalignment from chronic muscle imbalance
  • Pain scales: DN4, PainDETECT
29
Q

Define Uhthoff’s phenomenon

A
  • Temporary worsening of neurological symptoms mostly with heat sensitivity
30
Q

Other motor neuron problems associated with MS patients

A
  • Bladder/bowel dysfunction: small/spastic, flaccid/big, or dyssynergic bladder
  • Scaling dysarthria
  • Depression & pseudo bulbar effects
31
Q

List the MS specific outcome measures

A
  • MS Impact Scale (MSIS-29)
  • MS Quality of Life (MS Qol-54)
  • Dizziness Handicap Inventory
32
Q

What should you do before performing a fatiguing activity

A
  • Assess strength before & after
  • Assess muscle endurance before & after
  • Assess balance before & after
  • Assess gait and mobility before & after
  • Assess somatosensation and vision before & after
  • Assess vestibular function before & after
33
Q

What are the effects of fatigue on a MS patients gait and mobility

A
  • Gait and functional mobility deteriorates after fatigue
34
Q

MS specific considerations for examination

A
  • May need to assess w/o fatigue & after fatigue specifically in mild cases/initial stages
  • Good idea to assess during relapse & remission
  • May need observation over days to get good baseline functional level
  • May need to identify factors that exacerbate patient’s symptoms
35
Q

Factors that indicate poor prognosis for MS

A
  • Male
  • Onset of Sx after age 40
  • Initial Sx involving cerebellum, mental function, or urinary control
  • Initial Sx that affect multiple regions of the body
  • In the first years after onset, attacks that are frequent or a short time b/w the first 2 attacks
  • Incomplete remissions
36
Q

Factors that indicate better prognosis for MS

A
  • Relapsing remitting presentation has better prognosis than progressive
  • Univocal presentation has batter prognosis than multifocal
  • Afferent pathway involvement has better prognosis than efferent
37
Q

Approach for rehab based on patient’s EDSS score

A
  • EDSS 0-3.5 (mild disability): restorative/preventative rehab
  • EDSS 4-6.5 (moderate disability): restorative/compensatory rehab
  • EEDSS 7-9.5 (severe disability): compensatory/maintenance rehab
38
Q

Evidence for physical rehab for MS patients

A
  • Strong evidence for rehab to prevent or slow down disability
  • Improvements at impairment, activity, & participation levels
  • Refer for therapy when there is abrupt/gradual worsening that affects mobility, safety, QOL
39
Q

Excessive exercise may cause pseudo-exacerbations/pseudo-attacks which are

A
  • Transient worsening of symptoms due to fatigue, rise in body temperature, stress and patients may complain after exercise but exercise does not cause exacerbations/attacks/relapes
40
Q

Exercise and physical activity have been associated with

A
  • Reduced relapse rates
  • Decreased mobility-related disability and its progression
  • Decreased lesion volume, improved neuroperformance
  • Improved gait outcomes
  • Exercising is safe for MS population and does not cause relapse
41
Q

Describe aerobic endurance training and MS

A
  • Pts show normal CV responses to submit exercise: HR, VO2, BP increase
  • CV response may be blunted if autonomic system is affected then need to use RPE
  • Need to monitor for fatigue by observing s/s of overexertion
  • Use of cooling fans/vests to maintain body temp.
  • No exercise during relapse
  • PPMS types also benefit from exercise
  • EEDSS ≤2.5: 3-5days/wk; 60-85% HRpeak or 50-70% VO2peak; 30 min total in 10 min sessions with rest breaks; recumbent cycle/walking/swimming
42
Q

Strength recommendations for EDSS ≤2.5 MS patients

A

-Weight machine, free weights, therabands
- 2days/wk
- 60-80% 1RM, 1-2 sets of 8-15 reps; increased rest time b/w sets (2-5min) to avoid fatigue
- Progression slower use cooling fans/vests to maintain body temp.

43
Q

Stretching recommendations for MS patients

A
  • Daily
  • Static stretches with 30-60sec holds
    -Needs volume, use of orthoses/night splints as needed to prevent contractures
  • Stretching only his net enough so combine with strengthening thee antagonists & progress to functional use
    -Identify if decreased ROM is due to actual weakness or secondary disuse
44
Q

Gait training for ataxic gait

A
  • Proprioceptive loading of UB, ex at modified plantigrade posture, weighted vests, weighted walker/cane
45
Q

Gait training for Trendelenburg gait

A
  • SLS ex against wall, proprioceptive touch to improve glut med contraction during affected limb stance phase
46
Q

Gait training for Steppage gait

A
  • Strengthening DF or use of AFOs or Bioness (AFO/FES CPG)
47
Q

Gait training for restoration vs compensation

A
  • Think Forced-use techniques for affected LE for restoration, NDT-based techniques for maintenance
  • May need AD/walker with disease progression – compensatory approach
48
Q

What is the best type of practice for MS patients

A
  • Distributed practice sessions over massed practice
49
Q

Management of fatigue during daily activities

A
  • Energy effectiveness strategies (EES)
  • Maintain daily activity diary: comment on temp, MS symptoms during activity
  • Rate each activity by fatigue (F), value(V), satisfaction (S): Look for higher rated V and S, prioritize by high F values
  • Use energy conservation techniques: modify task (task analysis), modify home/environment, activity scheduling/pacing (doing laundry throughout the day), Preplanned rest-activity ratios
50
Q

Interventions for advanced stags of MS EDSS >7-9.5

A
  • Teach compensatory techniques for maintaining functional mobility
  • Wheeled mobility devices: scooter, powered chair
  • ADL training: transfer training to/from wheeled mobility devices
  • With disease progression: positioning, will need trunk supports for correct alignment in wheel chair, belt for safety (extensor spasms, pelvis tend to rotate posteriorly and slip)
  • Contracture management: continued stretching, splinting
  • Maintaining skin integrity: pressure relieving techniques
  • Caregiver training
51
Q

Slide 43-46

A

Neuro Dev/Control II (19 decks)

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