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Flashcards in Overweakness and Fatigue Deck (18):
1

Describe Buchner's curve and it's relevance

- Buchner's curve relates function - walking speed (y axis) to strength (x-axis)
- slope looks like a cliff edge
- past a certain threshold of strength, further increases in strength yield no increases in function
- but BELOW that threshold, drops in strength - even small ones - can result in precipitous drops in function
- this can mean the difference between walking VERY slowly - losing strength and not being able to walk at all

2

Define overwork weakness

PROLONGED reduction in strength and endurance due to EXCESSIVE activity especially ECCENTRIC activity

3

What are symptoms of overwork weakness?

1. DOMS
2. Temporary reduction in max force

4

Do strengthening execises cause overwork weakness?

NO - unless high intensity performed 4x/week - this is based on Kilmer's study that increased subjects from 3 to 4x/week
- might be due to less recovery between sessions

5

What effect do strengthening exercises have on activity and strength?

- improves activity
- effect on strength is inconclusive

6

How to strengthen without causing overwork weakness?

- no more than 3x/week
- change only 1 training parameter at a time
- monitor for fatigue/exertion/mm soreness
- start SLOW - mod intensity

7

Define fatigue (in MS)

- a subjective lack of physical + mental energy perceived by the individual or caregiver to interfere with activities of daily living

8

Characteristics of fatigue in MS

- may be physical/mental
- worse in PM
- agg by heat, depression, pain, excessive exertion
- interferes with physical/social function

9

Causes of fatigue in MS

- depression
- sleep
- pain
- bladder dysfunction

10

What are 1º causes of fatigue in MS?

- demyelination
- cortical reorganization

- higher levels of immune markers?

11

What are 2º causes of fatigue in MS?

- reduced PA causing reduced strength and cardiorespiratory fitness
- heat (0.5º C rise in body temp = heat fatigue)
- anti spasticity meds (reduces force generation of mm's)
- low sense of control or environment mastery (?)

12

How is fatigue managed? (list 2 basic ways)

1. Acknowledge it as a genuine symptom d/t nervous system damage resulting from the disease
- medications - amantadine (anti viral agent) benefits people with MILD fatigue but has a few SEs (dizziness, nausea, dry mouth, constipation,loss of balance)
- emotional support

2. Multidisciplinary approach (OT/physio/dietician/psychologist/social worker/pain+sleep clinic etc)

13

How does the following help to manage fatigue?
- diet
- psychologist
- OT

Diet - low fat/low chol diet = reduction in fatigue impact

Psychologist - mindfullness based training "non-judgemental awareness of experiences" = reduction in fatigue impact and reduces depression and increases QoL

OT - energy conservation course (2hrs/week for 6 wks) = increased self efficacy and reduces fatigue impact

14

How can physiotherapy help with fatigue?

FITNESS! - address 2º causes of fatigue and increase strength, PA levels, and fitness

15

What is the effect of exercise on fatigue? On fitness?

Heine et al (2015) (Cochrane SR) - favors exercise training group for reducing fatigue in MS

No evidence that one exercise protocol is superior to another to pick based on patient preference

Platta et al (2016) - exercise improves fitness

16

Examples of aerobic training protocols

Ahmadi et al(2013):
- treadmill training
- 8 wks, 3x/week for 30mins
- 40-75% MHR
- 20 mins stretch

Skerbjaek et al (2014)
- arm ergo
- 10 wks, 5 min warmup, 6x3min intervals (65-75% VO2)

Petajan et al (1996)
- arm/leg cycle ergo
- 15 wks, 3x/week, 5 min warmup, 30 mins @ 60% VO2, 5 min cool down, 5-10 mins stretchin

17

Can telephone counselling/telehealth help with fatigue?

Turner et al (2016)
- motivational interviewing - 1x/week for 6 wks 60-90min sessions
- tracked PA, phone calls for problem solving + counselling
- REDUCED fatigue and depression, INCREASED self reported PA

18

What are some exercise guidelines for the management of fatigue?

C.H.A.T.T.I
C - clothing (loose and breathable)
H - hydration
A - aquatic physio 25-30ºC
T - time of day (not in the evenings since more likely to be tired)*
T - temperature (not in hot part of day)*
I - intensity (start light intenisty and progress)

* to address heat - try pre-exercise cooling? 30mins LL immersion in 16-17º water - reduces RPE during and fatigue post exercise