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

Multiple Sclerosis (MS) Flashcards

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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

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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

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

Vestibular problems associated with MS

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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

Study These Flashcards
A
  • Timed 25 ft walk: gait speed
  • TUG and TUG Cognitive
  • Riveremead Mobility Index
  • 12 item walking scale: self report
25
Gait and mobility problems associated with MS
- 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
Visual problems associated with MS patients
- Ice pick pain due to optic neuritis - Marcus gunn pupil (RAPD - detected by swinging flashlight test) - Vertical nystagmus - Diplopia - Scotoma
27
Sensation problems associated with MS patients
- Numbness, tingling, parasthesia - Impaired vibration/position sense: more in LEs; Positive Romberg - Outcome measures: Erasmus modifications to the Nottingham sensory assessment (EmNSA)
28
Pain problems associated with MS patients
- 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
Define Uhthoff's phenomenon
- Temporary worsening of neurological symptoms mostly with heat sensitivity
30
Other motor neuron problems associated with MS patients
- Bladder/bowel dysfunction: small/spastic, flaccid/big, or dyssynergic bladder - Scaling dysarthria - Depression & pseudo bulbar effects
31
List the MS specific outcome measures
- MS Impact Scale (MSIS-29) - MS Quality of Life (MS Qol-54) - Dizziness Handicap Inventory
32
What should you do before performing a fatiguing activity
- 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
What are the effects of fatigue on a MS patients gait and mobility
- Gait and functional mobility deteriorates after fatigue
34
MS specific considerations for examination
- 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
Factors that indicate poor prognosis for MS
- 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
Factors that indicate better prognosis for MS
- Relapsing remitting presentation has better prognosis than progressive - Univocal presentation has batter prognosis than multifocal - Afferent pathway involvement has better prognosis than efferent
37
Approach for rehab based on patient's EDSS score
- 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
Evidence for physical rehab for MS patients
- 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
Excessive exercise may cause pseudo-exacerbations/pseudo-attacks which are
- 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
Exercise and physical activity have been associated with
- 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
Describe aerobic endurance training and MS
- 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
Strength recommendations for EDSS ≤2.5 MS patients
-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
Stretching recommendations for MS patients
- 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
Gait training for ataxic gait
- Proprioceptive loading of UB, ex at modified plantigrade posture, weighted vests, weighted walker/cane
45
Gait training for Trendelenburg gait
- SLS ex against wall, proprioceptive touch to improve glut med contraction during affected limb stance phase
46
Gait training for Steppage gait
- Strengthening DF or use of AFOs or Bioness (AFO/FES CPG)
47
Gait training for restoration vs compensation
- Think Forced-use techniques for affected LE for restoration, NDT-based techniques for maintenance - May need AD/walker with disease progression – compensatory approach
48
What is the best type of practice for MS patients
- Distributed practice sessions over massed practice
49
Management of fatigue during daily activities
- 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
Interventions for advanced stags of MS EDSS >7-9.5
- 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
Slide 43-46
Neuro Dev/Control II
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