Multiple sclerosis problem list

Question 1

Right Lower Limb Weakness and Coordination Difficulties

Answer 1

*Evidence: Difficulty mobilising indoors with a stick; relies on pram for outdoor support; trunk sway during walking.
*Cause: Demyelination of motor pathways (likely corticospinal tract) in the CNS leading to impaired muscle control and proprioception.
*Impact: Increased risk of falls, reduced walking efficiency, limited community mobility.

Question 2

Right Upper Limb Weakness and Reduced Dexterity

Answer 2

*Evidence: Difficulty lifting baby from cot; impaired hand coordination affecting daily tasks.
*Cause: MS lesions affecting upper limb motor pathways and fine motor control (e.g., primary motor cortex, cerebellum, or internal capsule).
*Impact: Reduced independence in infant care and self-care; increased reliance on carer.

Question 3

Sensory Disturbances (Numbness and Burning Sensation)

Answer 3

*Evidence: Patches of numbness and burning over torso and right thigh.
*Cause: Disrupted sensory signal transmission due to demyelination of dorsal columns or spinothalamic tract.
*Impact: Discomfort, reduced body awareness, and impaired safety during mobility and handling tasks.

Question 4

Postural Instability and Poor Sitting Balance

Answer 4

*Evidence: Leans to the right in unsupported sitting; avoids unsupported sitting for fear of falling.
*Cause: Trunk weakness and impaired proprioception from CNS demyelination.
*Impact: Reduced ability to safely sit with baby or perform functional seated activities.

Question 5

Fatigue

Answer 5

*Evidence: Sleeps frequently during the day; cannot resume leisure activities; struggles with basic mobility.
*Cause: Multifactorial – central fatigue due to MS-related inflammation, neural inefficiency, and emotional stress.
*Impact: Limits engagement in parenting, rehabilitation, and daily activities.

Question 6

Dizziness and Unsteadiness on Standing

Answer 6

*Evidence: Reports dizziness on rising; requires support for initial balance in standing.
*Cause: Possible autonomic dysregulation or impaired sensory integration from demyelinating lesions.
*Impact: Increased fall risk, hesitancy with transfers, reliance on assistance.