MS + ALS + GBS + CNS Tumor

Question 1

What is the most common kind of MS?

Answer 1

Relapsing Remittent

Question 2

What are “clinically isolated symptoms” in MS?

How long must they happen for?

Answer 2

The first episode of demyelination in CNS , not yet confirmed to be MS

Must be atleast 24 hours

Note: It’s called exacerbation if its new and recurrent MS symptoms lasting over 24 hours

Question 3

Exacerbation vs pseudo-exacerbation in MS

Answer 3

Exacerbation: New or recurrent MS symptoms over 24 hours

Psuedo exacerbation- Temporary worsening of MS under 24 hours

Question 4

Primary vs secondary fatigue in MS

Answer 4

Primary fatigue- due to hypometabolism and location of plaques in CNS

Secondary fatigue- due to increased energy needed to perform activities

Question 5

What is Uhthoff’s phenomenon in MS?

Answer 5

Excessive heat causes temporary worsening of symptoms

Question 6

What is lhermittes phenomenon in MS?

Answer 6

Neck flexion cuases electric-shock sensation down spine

Question 7

What is charcot’s triad in MS?

Answer 7

When the cerebellum is affected

scanning speech

intention tremor

nystagmus

Question 8

What visual dysfunction occurs with MS?

Answer 8

Diplopia, Marcus-gunn pupil, vision loss, lateral gaze palsy

Question 9

What are the most common symptoms of MS

Answer 9

Fatigue 83%
Heat Sensitivity 80 %

DIfficulty walking and imbalance 67%

Stiffness Spasms 63%

Question 10

What do you want to know in your subjective on an MS patient

Answer 10

Fatigue level

Exacerbations

Previous education and insight into MS

PATIENT GOALS

Question 11

Modified fatigue impact scale MFIS vs Fatigue Severity scale

Answer 11

The one with the longer name (MFIS) asks about fatigue in 4 weeks, other one asks for only 1 week

Question 12

what gait impairments will someone with MS present with

Answer 12

Extensor spasticity, scissoring, ataxia, uneven steps

Question 13

The expanded disability scale requires examination by _______

Answer 13

A neurologist

Question 14

Movement pattern coordination deficit has what kind of prognosis for MS

Answer 14

Good prognosis for recovery

Question 15

Force production deficit has what kind of prognosis for MS

Answer 15

Poor for chronic progressive

Good for relapsing remittent

Question 16

What are the 4 PT diagnoses associated with MS

Answer 16

Movement pattern coordination deficit

Force production deficit

Fractionated movement deficit

Hypermetria

Question 17

Normal life expectancy with ALS

Answer 17

5 years

Question 18

ALS only affects ____ neurons

Answer 18

MOTOR

Question 19

Typical ALS presentation:

Answer 19

UMN and LMN without sensory loss

It’s a diagnosis of exclusion that requires both UMN and LMN symptoms with decline in physical function not attributable to other disorders

Question 20

ALS can start in what 2 places

Answer 20

Can start in limbs, spinal onset

Or in cranial nerves, bulbar onset

Question 21

What are the most important things in subjective for ALS

Answer 21

Known code status

Question 22

What are the most important functional activity limitations to assess for ALS

Answer 22

Communication

Swallowing

Breathing

Question 23

What muscles become especially weak due to ALS

Answer 23

Neck extensors

Question 24

What is the nutritional goal of ALS patients

Answer 24

Promote weight gain

Question 25

Should ALS patients perform vigorous exercise

Answer 25

False

Question 26

Is moderate intensity exercise safe during early ALS

Answer 26

Yes

Question 27

Guillain barre syndrome onset?

Answer 27

Rapid onset

Question 28

Guillain barre syndrome affects what gender more

Answer 28

Males more than females

Question 29

Guillain barre paralysis follows what pattern

Answer 29

Symmetrical Distal to proximal

Question 30

how will reflexes present during guillane barre

Answer 30

areflexic or decreased

Question 31

PT considerations for Guillain Barre

Answer 31

Avoid working to exhaustion check vitals to avoid BP instability, Cardiac arrythmias, and orthostatic hypo

Question 32

Important question to ask Guillane Barre patients during subjective

Answer 32

Do they require ventilation Family support

Question 33

Guillane Barre prognosis

Answer 33

Acute stage 1-10 days Peak motor 2-8 weeks Improvement can begin approximately 2-3 months post onset 33% fully back to normal after 8 months

Question 34

How will PT be involved in the ascending stage of guillane barre

Answer 34

education on positioning and respiration

Question 35

Exercise considerations for Guillain Barre patients (MMT)

Answer 35

If less than or equal to 3/5 strength avoid eccentric contraction exercises and avoid overloading muscles

Question 36

What age groups have CNS tumors at the highest rate Gender?

Answer 36

0-14 40-70 Males more than females

Question 37

How do headaches relate to brain tumors

Answer 37

Headache present in 50% of cases, but rarely is the sole complaint

Question 38

Headache redflags

Answer 38

Interupts sleep or is worse when waking up elicited by posture changes, cough, or exercise recent onset is more severe than typical headaches new onset of headache occurs in older person associated with nausea, vomiting, papilledema, and focal neurological signs

Question 39

Important subjective questions for CNS tumor

Answer 39

Family support What do they know/ understand?

Question 40

What kind of PT goals should be made for patients with CNS tumors

Answer 40

patient/family focused goals

Question 41

When recommending equipment and treating pts with CNS tumors, what should we do?

Answer 41

determine what is needed now and plan for the future

Question 42

How variable is CNS tumor presentation between patients

Answer 42

All CNS tumor patients have completely different presentation

Question 43

Exercise guidelines for people with CNS tumors

Answer 43

they should be as physically active as possible

Question 44

How will clinically isolated symptom of MS present?

Answer 44

One lesion in the brain w/ * Increase in tone * Lhermitte’s sign * Uthoffs sign

Question 45

The ANPT suggests student learn what MS outcome measure?

Answer 45

12 item MS walking scale

Question 46

A single breath count test of ____ might indicate a GB patient needs ventilation

Answer 46

Under 19

Question 47

For GBS patients we want to avoid exercise when??

Answer 47

During acute and progressive stages Limit to only AROM/AAROM