Multiple Sclerosis Reading Flashcards
(130 cards)
1
Q
What is MS?
A
Multiple Sclerosis is a chronic inflammatory disease of the central nervous system (CNS) that breaks down myelin and inadequately repairs it, resulting in degeneration and involvement of various parts of the immune system. [1]
2
Q
What approach is used to diagnose MS?
A
MS is a clinical diagnosis made by doctors based on the patient’s history and a physical examination
3
Q
What does a doctor look for during the history and physical examination to make an MS diagnosis?
A
Doctors look for a history of clinical relapses and focal neurological changes on the exam
4
Q
What are red flags that can point to a diagnosis of MS?
A
Age: Younger patients are more likely to have MS.
Definitive Symptoms: Symptoms that clearly worsen, plateau, and then get better fit with MS.
Impactful Symptoms: The symptoms really affect the patient’s life.
Heat Sensitivity: Symptoms worsen with exertion and heat.
Specific Neurological
Symptoms: Symptoms like weakness on one side, tingling, or double-vision
5
Q
What other tools, besides the history and physical, help doctors diagnose MS?
A
MRI: Doctors can identify lesions in the brain characteristic of MS.
Cerebrospinal Fluid
Analysis: Doctors can look for oligoclonal banding in the cerebrospinal fluid, which is a sign of CNS inflammation and can help diagnose MS.
6
Q
What are common conditions that can mimic MS?
A
Conditions that can mimic MS include normal aging, hypertension, smoking, and migraine.
7
Q
What are some key things a doctor considers to rule out conditions that mimic MS?
A
Atypical history: The patient’s history does not fit the typical presentation of MS. [5]
Normal Exam: The neurological exam is normal. [5]
Nonspecific White Matter Lesions: MRI findings look more like normal aging than MS. [5]
Normal Spinal Fluid: Cerebrospinal fluid analysis is normal.
8
Q
What is radiologically isolated syndrome (RIS)?
A
Radiologically isolated syndrome (RIS) is when a patient has an MRI that looks like MS, but the patient does not have any MS symptoms. [6] About 10% of RIS patients will convert to MS, meaning they will develop symptoms within 3 years. [4] Some RIS patients are followed for more than 20 years without developing MS. [4]
9
Q
What is clinically isolated syndrome (CIS)?
A
Clinically isolated syndrome (CIS) is when a patient has their first clinical attack of demyelination. [4] If a patient with CIS has an abnormal MRI, they are much more likely to develop MS later in life. [4]
10
Q
What are the new clinical criteria for diagnosing MS that were established in 2017?
A
The new 2017 McDonald criteria allow for earlier and more accurate diagnoses of MS. [2] Some key features of these criteria include:
Lesion Location: The criteria emphasize the presence of specific lesions in characteristic locations in the brain. [2]
Cerebrospinal Fluid Analysis: The criteria incorporate the use of cerebrospinal fluid analysis to demonstrate dissemination in time, meaning there is evidence of the disease process happening at different points in time. [2]
Simplified Criteria: The criteria are designed to be simpler than previous criteria to reduce delays in diagnosis so treatment can begin earlier. [
11
Q
Can MS be diagnosed based on fatigue, depression, anxiety, cognitive issues, or sleep problems alone?
A
No. MS cannot be diagnosed based only on fatigue, depression, anxiety, cognitive issues, or sleep problems. [3] These symptoms are common in MS, but they are not specific to MS and could be due to other conditions. [3] A diagnosis of MS requires other neurological symptoms.
12
Q
What are the 4 standard clinical measures used to monitor MS progression?
A
Clinical exams, using the Expanded Disability Status Scale (EDSS)
MRI
Timed 25-Foot Walk Test
Symbol Digit Modalities Test (SDMT)
13
Q
What is the Expanded Disability Status Scale (EDSS)?
A
A method of quantifying disability in MS, ranging from 0 (normal neurological exam) to 10 (death due to MS). The EDSS is based on the neurological exam and focuses primarily on motor function.
14
Q
How is MRI used to monitor MS progression?
A
Doctors use MRI to look for new areas of inflammation and disease activity over time. They are particularly interested in new or enlarging T2 lesions, and the presence of gadolinium-enhancing lesions, which indicate active inflammation.
15
Q
What does the Timed 25-Foot Walk Test measure?
A
How quickly a person can walk 25 feet. It provides an objective measure of walking ability and can help determine if a person’s MS has progressed
16
Q
What is the Symbol Digit Modalities Test (SDMT)?
A
A brief (92 second) cognitive screening test that can help doctors track changes in cognitive function over time.
17
Q
What does it mean if a person with MS is classified as “not active?”
A
They are stable. There is no evidence of new disease activity on MRI, and they have not had any clinical relapses.
18
Q
What does it mean if a person with MS is classified as “active?”
A
They have ongoing disease activity. This is indicated by new or gadolinium-enhancing lesions on MRI, or the occurrence of new clinical relapses.
19
Q
What is the goal of disease-modifying therapies (DMTs) in MS?
A
To move patients from the “active” category to the “not active” category by reducing disease activity, preventing relapses, and slowing or stopping the progression of disability.
20
Q
Which of the standard clinical measures for monitoring MS is most directly related to classifying MS as “active” or “not active?”
A
MRI. A doctor looks at a patient’s MRI to see if there are new or enlarging lesions, or gadolinium-enhancing lesions, which would indicate active inflammation.
21
Q
How might the other standard clinical measures be used to determine if someone’s MS is active or not active?
A
EDSS: If a patient’s EDSS score worsens, it could be a sign that their MS is active and progressing. However, it is important to note that progression can also occur in the absence of new relapses or new MRI activity. [6, 7]
Timed 25-Foot Walk and SDMT: Changes in these measures may also suggest disease progression, but they do not directly indicate whether the MS is currently “active” in terms of new inflammation. [1]
22
Q
What are the 4 main categories of treatment for MS?
A
Relapse Treatment
Disease-Modifying Therapy (DMT)
Symptomatic Treatment
Lifestyle/Comorbidity Treatment
23
Q
Which categories of MS treatment aim to modify the disease process itself?
A
Disease-Modifying Therapy (DMT)
Lifestyle/Comorbidity Treatment
24
Q
What is the goal of relapse treatment?
A
To reduce the severity and duration of a relapse and to speed up recovery.
25
How does relapse treatment work?
Relapse treatment usually involves high-dose corticosteroids, given intravenously or orally. Corticosteroids suppress the immune system and help to reduce inflammation in the central nervous system.
26
Does relapse treatment alter the long-term course of MS?
No. Relapse treatment only addresses the acute inflammation of a relapse. It does not modify the underlying disease process or prevent future relapses.
27
What is the goal of disease-modifying therapies (DMTs)?
To slow or stop the progression of MS, reduce the frequency and severity of relapses, and limit the accumulation of disability.
28
How do DMTs work?
DMTs work in various ways to modulate or suppress the immune system. Different DMTs have different mechanisms of action, and some are more effective than others
29
Do DMTs alter the long-term course of MS?
Yes. There is evidence that DMTs, particularly the more effective ones, can significantly delay the progression of disability.
30
When is the best time to start DMTs?
As early in the disease course as possible, ideally within 2 years of the first symptoms or diagnosis.
31
What is the goal of symptomatic treatment?
To relieve symptoms of MS and improve quality of life. Symptomatic treatments do not modify the underlying disease process
32
What are some examples of symptomatic treatments?
Medications for pain, fatigue, spasticity, bladder problems, and bowel problems
Physical therapy
Occupational therapy
Speech therapy
Cognitive rehabilitation
Psychotherapy
33
How does lifestyle/comorbidity treatment aim to modify the course of MS?
By addressing modifiable risk factors that can influence the disease process and by promoting overall health and well-being
34
What are some examples of lifestyle and comorbidity treatments that may benefit people with MS?
Smoking cessation
Healthy diet
Regular exercise
Stress management
Treatment of comorbidities such as hypertension, diabetes, and depression
Vitamin D supplementation
Ensuring good sleep hygiene
35
Do lifestyle modifications alter the pathophysiology of MS?
The sources suggest that lifestyle factors and comorbidities can influence the disease course, but they don't provide definitive evidence that these modifications directly alter the underlying pathophysiology. [4, 5] More research is needed in this area
36
What does Dr. Smyth mean by "Red Flags" for MS?
Red Flags" are characteristic signs and symptoms, and patient history details that help a doctor determine the likelihood that a patient's symptoms are caused by MS, rather than another condition
37
What are some "Red Flags" that suggest a patient may have MS?
The patient is younger, in the 20-40 year old age range. [2, 6]
Symptoms came on suddenly and definitively, worsened, plateaued, then improved. [2, 3]
Symptoms worsen with heat or physical exertion. [2, 7]
Symptoms are localized to a particular area, like one side of the body. [2]
38
What are some "Red Flags" that suggest a patient's symptoms are unlikely to be caused by MS?
The patient is older. [2, 6]
Symptoms are vague and ill-defined, or have remained constant for months. [2]
Symptoms are relieved by changing positions. [2]
The patient has a normal neurological exam despite their symptoms. [4]
MRI shows white spots that look like normal aging, or are related to other conditions like hypertension, smoking, or migraine. [4]
Spinal fluid analysis is normal. [4]
39
What conditions can cause "white spots" to appear on an MRI, other than MS?
Normal aging, hypertension, smoking, and migraine can all cause white spots on an MRI that may be mistaken for signs of MS. [
40
What is the most important factor in diagnosing MS?
A clinical diagnosis, based primarily on the patient's history and a neurological exam. MRI and spinal fluid analysis can support a clinical diagnosis, but cannot replace it.
41
What is Clinically Isolated Syndrome (CIS)?
The first episode of neurological symptoms caused by inflammation and demyelination in the central nervous system (CNS).
Symptoms last at least 24 hours.
Most patients experience CIS as the first phase of MS.
Approximately 85% of MS patients initially present with CIS.
42
What is a relapse in Clinically Isolated Syndrome (CIS)?
A single, isolated neurological event. [2, 5] A second clinical attack would lead to a diagnosis of relapsing-remitting MS.
43
What is Relapsing-Remitting MS (RRMS)?
Characterized by clearly defined attacks of new or increasing neurological symptoms (also called relapses or exacerbations). [2, 6]
These are followed by periods of partial or complete recovery (remissions). [2, 6]
Most patients initially diagnosed with RRMS will eventually transition to a secondary progressive course at a rate of about 2-3% per year. [2, 7]
44
What is the relapse frequency in Relapsing-Remitting MS (RRMS)?
The average early relapse frequency is about 1.1 per year, but this tends to decrease with advancing disease, age, and increasing neurological dysfunction
45
What is Secondary Progressive MS (SPMS)?
Follows an initial relapsing-remitting course. [1, 2, 9]
Characterized by a gradual worsening of neurological function over time, independent of relapses. [1, 2, 9]
Disability steadily worsens, with or without the occurrence of relapses and plateaus. [2, 10]
Relapses may or may not occur during the progressive phase. [2, 11]
46
What is Primary Progressive MS (PPMS)?
Characterized by slowly worsening neurological function from the onset of symptoms, without early relapses or remissions. [2, 12]
Patients experience a gradual but steady increase in disability, without periods of remission. [2, 13]
Acute attacks do not typically occur. [2, 14]
47
What is Progressive-Relapsing MS (PRMS)?
A rare form of MS with progressive disease from the onset. [2, 15]
Acute relapses with or without full recovery. [2, 15]
Continued progression between relapses. [2, 15]
A steady decline with superimposed relapses. [2, 16]
Relapses are present, unlike PPMS. [2, 17]
48
How are different MS subtypes classified as active or inactive?
Each subtype is classified as active or inactive based on relapses or new lesions on MRI. [1, 18]
49
How is disability progression classified in PPMS and SPMS?
Progression over a specific time is a key classification factor for PPMS and SPMS.
50
How do lesions differ in the different MS subtypes?
Active demyelinating lesions are more frequent in CIS and RRMS, while inactive lesions are more common in PPMS and SPMS.
51
What is the general trend between latitude and MS prevalence?
Higher latitude is correlated with increased prevalence and incidence of MS, especially in Europe and North America.
52
What is the range of MS prevalence globally?
Estimates range from 2 per 100,000 individuals in Asia to approximately 1 per 1,000 individuals in Western countries. [2] In some high-latitude countries, the prevalence can be as high as 1 per 400 individuals.
53
What is the strongest proposed reason for the latitude effect on MS prevalence?
Low vitamin D levels, resulting from reduced sun exposure at higher latitudes. [4] Vitamin D's active form may modulate immune function, and UV-B radiation, the major determinant of vitamin D levels, decreases with increasing latitude.
54
What is the HLA-DRB1 haplotype and how might it relate to MS prevalence?
The HLA-DRB1 haplotype is a gene that might partially explain the latitudinal gradient in MS prevalence. [7] Some genetic polymorphisms, particularly those in HLA genes, may interact with environmental risk factors like smoking, EBV infection, and adolescent obesity to increase MS risk
55
Besides low vitamin D levels, what are other potential factors that could contribute to the latitude effect on MS prevalence?
EBV infection, although its role in the latitude effect requires further investigation. [9]
Smoking, as its prevalence might vary across latitudes.
56
What is the trend in the female-to-male ratio in MS?
The female-to-male ratio in MS has increased over time, possibly due to environmental and lifestyle factors that disproportionately affect women. [11] However, this ratio seems to decrease with higher latitude.
57
What is an important area for future research related to latitude and MS?
More research is needed to fully understand the interplay of genetic and environmental factors and their influence on MS prevalence across latitudes. [13] It's also important to note that the sources primarily focus on prevalence and do not extensively address the incidence of MS in relation to latitude.
58
What is one of the most well-established environmental risk factors for developing MS?
Epstein-Barr Virus (EBV) infection
59
What percentage of patients with MS are seropositive for EBV?
Up to 100%
60
What does seropositive mean?
It means that a person has been infected with a virus at some point
61
What is one possible mechanism by which EBV might increase MS risk?
Molecular mimicry. EBV shares a molecular sequence with myelin basic protein (MBP), a component of the myelin sheath. This could lead to the generation of cross-reactive T cells and antibodies that attack both EBV and myelin
62
What is myelin basic protein (MBP)?
It is a component of the myelin sheath that is targeted by the immune system in MS.
63
What is myelin basic protein (MBP)?
It is a component of the myelin sheath that is targeted by the immune system in MS.
64
What is another possible mechanism by which EBV might increase MS risk?
B cell activation. EBV is known to transform and activate B cells, which could lead to the production of pro-inflammatory cytokines that further drive the autoimmune attack on myelin.
65
Where have studies found EBV-infected cells in the brains of patients with MS?
In close proximity to cytotoxic CD8+ T cells.
66
Which gene, in combination with EBV, significantly increases the risk of developing MS?
The HLA-DRB1*15:01 allele. Having both this gene and EBV increases the risk of MS 16-fold.
67
Why is EBV considered a major risk factor for MS?
Strong Association: There is a high seropositivity rate for EBV among MS patients. [1]
Potential Biological
Mechanisms: There are plausible biological explanations for how EBV infection could initiate or contribute to the autoimmune processes in MS. [1, 4]
Gene-Environment Interaction: EBV infection interacts with genetic predisposition to MS, increasing the risk of developing the disease.
68
What is the pathological hallmark of MS?
Focal plaques, also called lesions, which are areas of demyelination.
69
Where are MS lesions typically located
Around post-capillary venules. [2] They are characterized by a breakdown of the blood-brain barrier
70
What are the four types of white matter lesions in MS?
Active demyelinating lesions [4]
Inactive lesions [5]
Chronic active plaques [6]
Slow expanding lesions
71
What characterizes active demyelinating lesions?
Heavy lymphocyte infiltration, activated microglia containing myelin debris, macrophages, and reactive astrocytes. More common in early MS stages (CIS and RRMS).
72
What characterizes inactive lesions?
Sharply circumscribed, hypocellular with well-defined demyelination, reduced axonal density, reactive astrocyte gliosis, and lower lymphocyte density than active lesions. More frequent in progressive MS (PPMS and SPMS)
73
What characterizes chronic active plaques?
More frequent in patients with longer disease duration and SPMS. Characterized by macrophages at the lesion edge and fewer in the center.
74
What characterizes slow expanding lesions?
Typically found in SPMS, with an inactive center, activated microglia at the edge, and few macrophages containing myelin debris. Transected axons are also observed, indicating ongoing demyelination and axonal damage.
75
: What is NAWM and what are some characteristics?
Even macroscopically normal white matter can exhibit signs of diffuse inflammation and neuro-axonal damage, called Normal-Appearing White Matter. These abnormalities are more pronounced in progressive MS and include:
Decreased fiber density due to axonal degeneration and demyelination. [9]
Lymphocyte infiltration. [10]
Macrophage infiltration. [10]
Widespread microglia activation. [11]
Gliosis.
76
Does white matter lesion volume correlate with clinical disability?
The total volume of white matter lesions only moderately correlates with overall clinical disability and cognitive impairment. [12] This is likely due to the involvement of other factors like grey matter lesions and damage to normal-appearing brain tissue
77
Describe the prevalence of grey matter lesions in MS.
Extensive cortical demyelination is observed in the forebrain and cerebellum in MS patients. It can occur from the earliest disease stages and is more widespread in PPMS and SPMS. [13] Lesions can also occur within deep grey matter nuclei and the spinal cord. [13]
78
Describe the prevalence of grey matter lesions in MS.
Extensive cortical demyelination is observed in the forebrain and cerebellum in MS patients. It can occur from the earliest disease stages and is more widespread in PPMS and SPMS. [13] Lesions can also occur within deep grey matter nuclei and the spinal cord. [13]
79
How do grey matter lesions differ from white matter lesions? [14-16]
Compared to white matter lesions, cortical lesions typically exhibit:
Less BBB breakdown. [15]
Less oedema. [15]
Lower degree of inflammation. [15]
More efficient myelin repair. [16]
80
What is the impact of cortical lesions?
Varying degrees of transected neurites. [17]
Neuronal apoptosis. [17]
Loss of neurons, neuro-axons, and glial cells. [18]
Substantial loss of synapses. [19]
Decreased synaptic density is also observed in the normal-appearing cortex of MS patients without cortical lesions.
81
What is the impact of cortical lesions?
Varying degrees of transected neurites. [17]
Neuronal apoptosis. [17]
Loss of neurons, neuro-axons, and glial cells. [18]
Substantial loss of synapses. [19]
Decreased synaptic density is also observed in the normal-appearing cortex of MS patients without cortical lesions.
82
Name the four types of cortical lesions based on their location.
Type I: Affect both grey and white matter at the cortico-subcortical border. [21]
Type II: Small perivenous intracortical lesions that do not affect white matter or the pial surface. [22]
Type III (most frequent): Subpial lesions extending inward from the subpial layers, often related to meningeal inflammatory infiltrates. [23]
Type IV: Extend through the whole cortex without passing the border between the cortex and white matter. [24]
83
Can remyelination occur in MS?
Yes, remyelination can occur in MS and may contribute to clinical recovery after a relapse. [25] It is more common in early MS stages and in younger individuals, and less frequent in PPMS and SPMS
84
When does neurodegeneration occur in MS?
It occurs from the earliest phases of MS and may contribute to irreversible clinical disability. [26] Different mechanisms might drive neurodegeneration as a primary and/or secondary phenomenon throughout the course of MS.
85
What is the impact of MRI on the diagnosis of Multiple Sclerosis (MS)?
MRI has revolutionized the diagnosis and monitoring of MS by enabling early detection of lesions, demonstrating dissemination in space and time (DIS and DIT), and distinguishing between active and inactive lesions.
86
How does MRI help in the early detection of MS?
MRI can detect lesions even in the early stages of MS, such as clinically isolated syndrome (CIS), when clinical symptoms might be subtle. Detecting lesions early can lead to earlier diagnosis and treatment initiation, potentially delaying disease progression.
87
How does MRI help in the early detection of MS?
MRI can detect lesions even in the early stages of MS, such as clinically isolated syndrome (CIS), when clinical symptoms might be subtle. Detecting lesions early can lead to earlier diagnosis and treatment initiation, potentially delaying disease progression.
88
How does MRI demonstrate DIS and DIT?
MRI visually demonstrates DIS and DIT by showing lesions in multiple characteristic locations within the central nervous system (CNS) and the appearance of new lesions over time.
89
What are active lesions and how are they identified using MRI?
Active lesions are characterized by ongoing inflammation and increased blood-brain barrier permeability. They enhance on T1-weighted images after gadolinium administration, signifying active inflammation.
90
What are inactive lesions, and how are they identified using MRI?
Inactive lesions do not exhibit active inflammation and represent a more chronic stage of the lesion. They appear hypointense on T1-weighted images and do not enhance with gadolinium.
91
How does MRI help monitor the effectiveness of disease-modifying treatments (DMTs) in MS?
Regular MRI scans allow clinicians to assess treatment response by monitoring:
The reduction in the number of new T2-hyperintense lesions forming over time. [7]
The decrease in the number of gadolinium-enhancing lesions. [8]
Changes in brain atrophy, which can reflect neurodegeneration. [9]
92
What is a limitation of MRI in detecting cortical lesions in MS?
Current MRI techniques can only detect a portion of cortical lesions, particularly type I lesions. Improving the detection of cortical lesions, especially type III subpial lesions, is an area of active research. [10]
93
What is Radiologically Isolated Syndrome (RIS)?
RIS is a condition where individuals show brain MRI abnormalities suggestive of MS but experience no clinical symptoms. Further research is needed to define RIS, understand its natural history, and develop recommendations for monitoring and potential treatment. [11]
94
What is a key component of comprehensive rehabilitation programs for MS, as emphasized in the sources?
Increased physical activity
95
What is a common and debilitating symptom of MS that exercise can help manage?
Fatigue
96
Besides medication like dalfampridine, what do the sources recommend to improve walking ability in MS patients?
Walking aids and mobility devices
97
How can exercise contribute to overall well-being in individuals with MS?
By improving physical function, mood, and mitigating the negative impacts of MS symptoms on daily life.
98
Where might one find more specific information on exercise types and programs for MS?
Sources specializing in exercise and rehabilitation for MS.
99
What did the authors count to assess the safety of exercise therapy for people with MS?
The number of reported MS relapses in people who received exercise therapy and in people who were in a non-exercise group
100
Did the review find that exercise therapy increased the risk of MS relapse?
No, the review did not find a significant difference in relapse rates between the exercise therapy group and the non-exercise group
101
What limitation did the authors acknowledge regarding the studies included in the review?
Most studies did not clearly define or report relapses
102
What suggests that exercise can be performed safely in a controlled environment for people with MS?
Only one fall was reported across all the studies included in the review.
103
What types of exercise were studied in the review of exercise therapy for MS patients?
Endurance training, muscle power training, task-oriented training, mixed training, and "other" trainin
104
What types of exercise interventions showed a statistically significant effect in reducing fatigue?
Endurance, mixed, and "other" training [2]
105
What did the mixed training interventions include?
Both endurance and muscle power training [3]
106
What did the "other" training interventions include?
Yoga, balance training, and hippotherapy
107
What did the "other" training interventions include?
Yoga, balance training, and hippotherapy
108
Which exercise interventions did not show a significant effect on fatigue?
Muscle power training and task-oriented training. However, the authors note that these types of training were not as well-studied
109
Muscle power training and task-oriented training. However, the authors note that these types of training were not as well-studied
110
What might have contributed to the significant effect size of "other" training?
The large number of yoga interventions included in this category
111
What is a limitation of the study related to the types of exercise studied?
The study found that endurance and mixed training interventions were more extensively studied than muscle power and task-oriented training, which may have influenced the results.
112
What is a limitation related to the "other training" category?
This category includes a variety of interventions, such as yoga, balance training, and hippotherapy. This makes it difficult to draw conclusions about the effectiveness of specific interventions.
113
How might yoga have influenced the results of the "other training" category?
The positive outcomes observed in the "other training" group could be partly due to the inclusion of many yoga interventions. [1, 3, 4] A separate review supports the effectiveness of yoga for fatigue management in people with MS. [1] This suggests yoga may have significantly contributed to the positive results in the "other training" group.
114
What types of exercise are recommended for individuals with MS with an EDSS score of 0-4.5?
Aerobic, resistance, flexibility, and neuromotor exercises
115
What is emphasized in the exercise recommendations for individuals with MS with an EDSS score of 5.0-6.5?
Adaptations to exercises and environments to reduce fall risk, and the importance of guidance from specialists
116
What is the focus of exercise recommendations for individuals with MS with an EDSS score of 7.0-9.0?
Maintaining function and reducing morbidity/mortality risks
117
Provide some examples of exercises recommended for individuals with MS with an EDSS score of 7.0-9.0.
Breathing exercises, flexibility training, upper and lower extremity exercises, core work, and functional electrical stimulation
118
What is a key principle highlighted in the Kalb (2020) recommendations for exercise in individuals with MS?
Tailoring exercise programs to individual needs and abilities, particularly for those with higher EDSS scores
119
What role do healthcare providers play in exercise for individuals with MS, according to Kalb (2020)?
They are important in promoting exercise and physical activity among individuals with MS [2, 5]
120
What role do healthcare providers play in exercise for individuals with MS, according to Kalb (2020)?
They are important in promoting exercise and physical activity among individuals with MS [2, 5]
121
What are the CSEP guidelines for aerobic activity for individuals with MS experiencing mild to moderate disability? [1, 2]
At least 30 minutes of moderate-intensity aerobic activity, 2 times per week
122
What are the CSEP guidelines for strength training for individuals with MS experiencing mild to moderate disability?
Strength training exercises for major muscle groups, 2 times per week
123
How do the Kalb (2020) recommendations for aerobic exercise compare to the CSEP guidelines?
Both recommend moderate-intensity aerobic exercise. [6]
CSEP: Twice a week for at least 30 minutes. [3, 6]
Kalb: 2-3 times per week for 10-30 minutes. [6]
124
What are the Kalb (2020) recommendations for strength training?
Strength training twice a week, 1-3 sets of 8-15 repetitions for each exercise, incorporating 5-10 different exercises.
125
What types of exercise are included in the Kalb (2020) recommendations but not the CSEP guidelines?
Flexibility exercises: Performed daily, holding each stretch for 30-60 seconds, with 2-3 sets per stretch. [9]
Neuromotor exercises: Performed 3-6 times per week for 20-60 minutes, individualized for intensity and duration, and focused on improving balance, coordination, and agility to prevent falls. [10]
126
What is the first step in facilitating client engagement in exercise, according to the sources?
Identify and Address Barriers: [11]
Have an open conversation to understand the client’s individual barriers. [11]
Explore potential physical, social, health-related, cognitive/behavioral, financial, and time-related obstacles.
127
What is the first step in facilitating client engagement in exercise, according to the sources?
Identify and Address Barriers: [11]
Have an open conversation to understand the client’s individual barriers. [11]
Explore potential physical, social, health-related, cognitive/behavioral, financial, and time-related obstacles.
128
Once barriers to exercise are identified, what is the next step in facilitating client engagement?
Work collaboratively with the client to develop practical solutions
129
What are some examples of facilitators that can support client engagement in exercise? [13]
Physical Environment:
Choosing an accessible and comfortable exercise space. [14]
Ensuring appropriate temperature regulation. [14]
Social Environment:
Engaging with supportive healthcare providers. [15]
Support from family members.
Joining exercise groups.
Health Condition:
Setting realistic goals that accommodate current disability level and symptom fluctuations. [16]
Cognitive/Behavioral: Encouraging self-monitoring through activity logs or wearable devices. [17]
Celebrating milestones. [17]
Focusing on the positive experiences associated with exercise. [17]
Cost: Taking advantage of resources offered by MS advocacy organizations. [18]
Exploring cost-effective exercise options. [18]
Time: Helping the client identify windows of time in their schedule that can be dedicated to physical activity. [19]
130
What are some key principles to emphasize when developing a personalized exercise plan for a client?
The plan should be tailored to the client's individual needs, abilities, and preferences. [20]
It should incorporate activities they find enjoyable and motivating. [22]
Safety is paramount. [22]
Encourage gradual progression in terms of frequency, duration, and intensity of activities.
Emphasize the importance of listening to their body.
Taking rest days when needed.
Adjusting the plan based on individual responses to exercise
