MS Flashcards
what is MS?
lesions (plaques) in primary white matter throughout the CNS- demyelinating
destruction of oligodendrocytes- cell bodies and axons tend to be spared
common sites
impairs neural transmission causing nerves to fatigue rapidly (not efficient when moving from node to node)
myelin sheath is replaced by fibrous scarring produced by glial cells (gliosis)
who gets MS? when?
onset of MS typically occurs between 15-50 years old.
peak age=30
2:1 more women
predominately white
geographical pattern with areas of high, medium and low frequencies. Best linked to vitamin D deficiency
High = temperate zones of northern US, scandinavian countries, northern Europe, southern Canada, New Zealand, and southern Australia.
Medium= closer to the equator
Low= tropical areas
what is the etiology of MS?
unknown
theory- autoimmune disease induced by a viral or other infectious agent (herpes and chlamydial pneumonia)
what is the clinical course of MS?
relapsing remitting (RRMS)
primary progressive (PPMS)
secondary progressive (SPMS)
progressive-relapsing (PRMS)
what is RRMS?
relapsing remitting MS
80%
usually early diagnosed, mostly women
clearly defined disease relapses, periods of acute worsening of neurological function, followed by remissions (periods without disease progression and partial or complete abatement not S&S)
~80% of RRMS cases go on to develop SPMS
what is SPMS?
begins with a relapsing remitting course followed by progression with or without occasional relapses, minor remissions and plateaus
what is PPMS?
rare form occurring in about 10& of cases.
Characterized by a nearly continuous worsening of the disease from the onset without distinct relapses.
some do have occasional plateaus or temporary minor improvements.
typically has a later onset, usually after 40.
what is PRMS?
progressive relapsing MS
characterized by progressive disease from onset but without clear acute relapses that may or may not have some recovery or remission
commonly seen in people who develop the disease after 40
what is benign MS?
characterized by mild disease in which patients remain fully functional in all neurological systems 15 years after onset.
what is malignant MS?
“Marburg’s variant”
characterized by rapid progression leading to significant disability or death within a relatively short time after onset
what are exacerbating factors?
defined by new and recurrent MS symptoms that last at least 24 hours and are unrelated to another etiology.
avoiding these aggravating factors is important in ensuring the patient’s optimal function
pseudoexacerbation= temporary worsening of MS symptoms. episode typically comes and god quickly, usually within 24 hours.
what is Uthoff’s symptom?
adverse reaction to heat
anything that raises the body temp can bring on a pseudo-attack
what are clinical S&S of MS?
1= fatigue
weakness
sensory disturbances
spasticity
dizziness/vertigo
sexual dysfunction
cerebellar disturbances:
- poor balance
- intention tremors
- ataxia
- dysmetria
- dysdiodochokinesia
- dyssynergia
visual disturbances:
- diplopia
- nystagmus
- blurred vision
- optic neuritis
- scotoma (blind spot)
communication/swallowing:
- dysarthria
- dysphagia
bladder/bowel disturbances:
- decrease frequency
- urgency
- incontinence
- retention
- hesitancy
cognitive/behavior disturbances:
- memory
- attention/concentration
- learning
- visuospatial skills
- emotional changes
- depression
what are tests and measures for body structure and function?
aerobic capacity and endurance
ataxia
cardiovascular/pulmonary status
dizziness/vestibular
fatigue
flexibility
muscle performance
pain
posture
sensory integrity
somatosensation
what are tests and measures for activity?
balance/falls
bed mobility
gait
reach and grasp
transfers
wheelchair skills
what are OM for participation?
health and wellness
home management
leisure
QOL
role function
shopping
social function
work
outcome measurement rating scale:
4: highly recommend:
- excellent psychometric in MS population
- excellent clinical utility in an MS population (administration <20 min, requires equipment typically found in the clinic, no copyright payment required, easy to score)
3: recommend:
- good psychometrics in MS pop
- good clinical utility
2: unable to recommend at this time:
- insufficient info to support a recommendation for individuals w/ MS
1: do not recommend
- poor psychometrics, poor clinical utility , or both in an MS population (time, equipment, cost)
what does an EDSS range of 0.0-3.5 on the expanded disability status scale mean?
low end of range= normal
upper end of range=
- moderate disability in 1 FS or mild disability in 3-4 FS
- fully ambulatory
what does an EDSS range of 4.0-5.5 on the expanded disability status scale mean?
low end of range=
- fully ambulatory w/o aid or rest at least 500m
- self sufficient, but relatively severe disability
Upper end of range=
- ambulatory w/o aid 100m
- disability precludes full daily activities
what does an EDSS range of 6.0-7.5 on the expanded disability status scale mean?
Low end of range=
-intermittent or unilateral assist for walking 100m
Upper end of range=
- unable to take more than a few steps; restricted to w/c
- may need assistance for transfers
what does an EDSS range of 8.0-9.5 on the expanded disability status scale mean?
Low end of range:
- restricted to bed/chair/w/c
- retains self-care; effective UE use
Upper range:
- restricted to bed
- dependent
- unable to communicate and swallow
what are recommendations for practice setting?
acute care inpatient rehab home health skilled nursing outpatient
what are meds used for an acute attack?
1- corticosteroids
2- plasmapheresis
what do corticosteroids do?
used for acute MS attacks
used to reduce the inflammation that spikes during a relapse.
ex:
- oral prednisone (Deltasone)
- intravenous methylprednisolone (Solu-medrol)
side effects may include mood swings, seizures, weight gain and increased risk of infections
