Multiple Sclerosis Flashcards by Owen Honroth

explain the etiology of MS

specific causes are unknown
can be due genetic susceptibility
can be associated with Vitamin D deficiency / smoking

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incidence of MS in relation to
- gender
- age
- race
- proximity to equator

women > men
young adult onset (20-40)
caucasian
increased frequency further from equator

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what is the pathophysiology of MS

chronic inflammatory demyelination of CNS via autoimmune disorder

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what is the result of demyelination

slowed/blocked neural signals

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when axons are demyelinated, what occurs

fibrous astrocytes fill the space and undergo gliosis

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what is gliosis

glial scarring causing plaques

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MS is marked by

hardened plaques throughout CNS white matter and optic nerve

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the CNS white matter that plaques form in affect the _____ and _____ tracts

motor and sensory

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what qualifies an MS diagnosis

damage that is present in 2 or more separate CNS areas

damage that has occurred at 2 separate points in time with one month in between

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what methods are used to diagnose MS

MRI
visual evoked potential tests
lumbar puncture for CSF analysis

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what are visual evoked potential tests

measures of nerve conduction along the visual pathway

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T1 MRI characteristics

better for anatomical detail
FAT = white
FLUID = black

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T2 MRI characteristics

better for pathology
FAT = bright white
FLUID = bright white

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what is a T2 FLAIR

T2 image where CSF and vitreous fluids are suppressed

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what are T2 FLAIR MRIs for

identification of MS plaques near ventricles

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what is clinically isolated syndrome

1st episode of CNS inflammatory demyelination

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what causes clinically isolated syndrome to become relapsing remitting MS

2nd episode of CNS inflammatory demyelination after MRI confirmation

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if CIS is not active, what does that mean for relapses

not active = no relapses

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what is the most common form of MS? what is the % of cases associated?

relapsing remitting MS

85%

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what are relapses defined as? what about remission?

relapse = acute inflammatory attack with worsening neurological function

remission = full or partial recovery

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what is secondary progressive MS? what does it start as

steady decline in neurologic function w/ accumulation of disability

RRMS

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explain relapses associated with secondary progressive MS

can be with or without them

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how is primary progressive MS described? what is the incidence of it?

continuous worsening without distinct attacks

15% of patients with MS

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what is the timeframe associated with MS relapses/exacerbations

more than 24 hours

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what can cause relapses

overall deterioration in health viral/bacterial infections stress

what are psuedoexacerbations

temporary worsening of symptoms for less than 24 hours

what can cause psuedoexacerbations

heat or increased body temp - fever, prolonged exercise, change in climate

sensory disturbances associated with MS

paresthesia (pins and needles) hypothesia (numbness) heat intolerance altered prop and vibration sensation

explain altered prop/vibration sensation in regards to peripheral receptors and CNS pathways

DCML pathway into CNS is damaged rather than peripheral receptors

pain associated with MS

acute / chronic pain headaches migraines sharp shooting electric shock like pain (lhermitte's sign) trigeminal neuralgia

visual changes associated with MS

diplopia diminished acuity nystagmus gaze palsy optic neuritis internuclear ophthalmoplegia

what is internuclear ophthalmoplegia

lateral gaze palsy

what motor abnormalities are associated with MS

UMN S/S ataxia asthenia disuse weakness

what is asthenia? is this common in MS

complete sensation loss no, it is rare

what time of the day is best to complete therapeutic intervention

mornings > nights

what causative factors can affect one's level of fatigue with MS

inflammation axonal conduction velo imbalance of NT levels decreased glucose metabolism

what psychological factors can affect one's level of fatigue with MS

self efficacy motivation cognitive dysfunction

what coordination/balance abnormalities are associated with MS

cerebellar or sensory ataxia postural/intention tremor hypotonia dizziness/vertigo disequilibrium

what systemic deficits lead to gait/mobility deficits in those with MS

weakness fatigue spasticity vision changes

what DME / ADs are used to fix gait deficits

AFOs custom wheelchairs

what speech/swallowing deficits are associated with MS

dysarthria dysphonia dysphagia aspiration pneumonia

what is dysphonia

change in vocal quality leading to abnormal sounding voice

what cognitive deficits are associated with MS

decreased processing speed short-term memory loss decreased attention/concentration executive function impaired

what cognitive functions are maintained in those with MS

reading conversing long term memory

how is pt affect changed by MS

increased: depression anxiety psuedobulbar effect apathy

bowel and bladder deficits associated with MS

reduced control spastic or flaccid bowel/bladder dyssynergic bladder constipation

what bladder symptoms are associated with MS

urgency frequency nocturia incontinence/leaking

why can constipation occur

inactivity poor diet medication depression

male and sexual deficits associated with MS

decreased sensation erectile dysfunction / vaginal dryness decreased libido

medical management of MS

corticosteroids synthetic interferon drugs

what do corticosteroids treat

acute relapses, shortening the duration of them

how do corticosteroids work

exert powerful anti-inflammatory / immunosuppressive effects

side effects of corticosteroids

HTN mood changes fluid retention hyperglycemia insomnia

how do synthetic interferon drugs treat MS

disease modifying therapy that decrease immune system response by reducing inflammation

corticosteroids vs interferon drugs in treatment of disease progression

cortico = do not modify disease course inter = reduce disease activity

when should PT referral be implemented for those with MS

at time of diagnosis for baseline assessments and education

what cognitive screens should be done on inital MS eval

MMSE -- may determine need for referral

what affect screening can be done in acute assessment of MS

beck depression inventory

what is the screen used for fatigue

modified fatigue impact scale

what screenings need to be done in acute MS patients

cognitive affect fatigue visual acuity / oculomotor function

what are impairment specific interventions most often performed in MS population

pain management ROM - flexibility strengthening muscles due to disuse endurance

what is the goal of restorative interventions? in MS population, what are examples of this?

hoping to complete the movement in the way it was previously performed task-oriented training postural control

will strengthening muscles due to disuse change chronic UMN weakness? if not, what do we need to focus on?

no, focus on task specific movements that use multiple muscle groups that are weak

compensatory interventions in MS populations

AD to reduce falls adaptive equipment for ADLs wheelchairs / AFOs training in new (adapted) movement patterns

preventative interventions

skin integrity home safety postural deformities maintenance exercise program education

what education needs to be provided to patients with MS

fatigue management lifestyle modifications exercise disease progression

fatigue management strategies

cooling agents simplified work/ADLs sleep regulation stress management nutrition education

exercise guidelines for those with RRMS

avoid exercise/exertion during an exacerbation, but may resume when remission is evident

exercise guidelines for those with PPMS

exercise within limits of capabilities

resistance exercise guidelines for MS (generally) in regards to - frequency - resistance training - circuit training - form of work

alternate days of any variety of resistance - discontinuous work that alternates between UE and LEs

exercise precautions for those with MS associated with intensity level equipment mode of instruction and exertion

moderate intensity equipment / environment appropriate for level of impairments/ataxia balance monitor with Borg RPE

is exercising to the point of fatigue indicated in those with MS?

no, contraindicated actually SILLY

if doing aquatherapy, what temperature does the water need to not exceed

84°F

how long should muscle fatigue post exercise last?

should not be present for more than 24 hours

Multiple Sclerosis Flashcards

(74 cards)