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211 exam 1
Multiple Sclerosis
| Question | Answer |
|---|---|
| MS | Autoimmune disease that effects the CNS (brain, spinal cord, optic nerves) Demyelinating disease of the central nervous system Sclerotic plaques disseminated throughout the CNS |
| Charcot's triad | intention tremor, scanning speech (pause after each syllable), nystagmus |
| what is MS characterized by? | exacerbation and remissions |
| what may MS exacerbations be triggered by? | Viral or bacterial infections (colds) Trauma, Pregnancy, stress Increase in External heat and Internal heat (fever, increase body temp.) Sleep deprivation |
| what are the demyelinating lesions in MS? | plaques, appear in the white matter first, then can affect gray matter in later stages |
| what do plaques cause in MS | impaired neural transmission, fatigue quickly #1 symptom |
| initial acute phase of MS | inflammation + decrease in number of myelin- producing cells |
| what causes MS? | unknown, may be immunologic, viral, environmental, climate, genetic, or auto-immune related |
| immunologic causes of MS | immune-mediated - the body attacks the myelin “Friendly Fire” |
| viral infection causes of MS | Epstein-Barr, Herpes (HHV-6) |
| environmental causes of MS | Possibly link to lack of Vit D, smoking |
| climate causes of MS | more common in countries with temperate temperatures and certain latitude |
| genetic causes of MS | higher risk with certain genes (on chromosome 6 P21) Certain auto-immune diseases (Pernicious anemia, thyroid dz, DM I, IBD) |
| pernicious anemia | lack of vit B12 |
| who is more often affected by MS? | Women, Caucasian, 20-40y/o North U.S., Scandinavian, North Europe, South Canada, New Zealand and South Australia |
| diagnostics for MS | Lumbar puncture- Cerebral Spinal Fluid analysis- elevated immunoglobulin Evoked Potentials (EP) MRI- 95% of pts with clinical signs have a (+) MRI |
| 4 types of MS | Relapsing Remitting MS (RRMS) Secondary Progressive MS (SPMS) Primary-Progressive MS (PPMS) Progressive-Relapsing MS (PRMS) |
| how many plaques must be found on MRI to be diagnosed with MS? | 2 or more |
| relapsing remitting MS | 85%,(most common) Sudden onset with partial or complete remissions, remains stable a long time |
| secondary progressive MS | Progression of RRMS move to steady and irreversible decline. 40-50% |
| primary progressive MS | 10%, progresses without remitting, severe disability no distinct attacks |
| progressive relapsing MS | 5% gradual neurologic deterioration from onset with relapses |
| Benign MS | Mild symptoms, little disease progression 10-20% of all pts with MS |
| malignant/Aggressive MS | Rapid progression Significant disability or death within short time after onset |
| clinical presentation of MS | Great variability amongst individuals Hx of vague fxl limitations may precede definite symptoms Symptoms may develop quickly (within hours) or slowly (over days or weeks) Psychosocial considerations |
| prodromal period | time when pt doesn't feel quite "right" but not definite symptoms or positive labs, long prodromal period with MS |
| sensory changes with MS | Paresthesia, numbness Decrease Proprioception Hyperpathia paresis |
| Lhermitte's sign | Flex neck-> electric shock running down spine and into limbs |
| hyperpathia | hypersensitivity to minor sensory stimuli |
| areas of paresis from MS | 1) weak hip flexors 2) weak hams and ankle dflexors 3) weak quads 4) increased lumbar lordosis 5) Trendelenburg gait Agonist/antagonist disturbed Synergistic Patterns |
| how often is spasticity found with MS | 90% (Ankle clonus, Babinski, spasms, hyperreflexive) |
| how many MS pts have pain? | 80% have pain, 50% have Chronic pain |
| what happens when plaques get to the cerebellum? | movement disorders |
| movement disorders that occur with demyelination of cerebellum | Dysmetria Dysdiadochokinesia Ataxia |
| dysmetria | -rapid movements are made with more force than necessary |
| dysdiachokinesia | -inability to produce rapid alternating movements |
| ataxia | - uncoordinated movements |
| what makes vestibular dysfunction worse? | movement of head or eyes |
| when is fatigue least with MS? | pts wake refreshed and tired by afternoon |
| cerebellar symptoms from MS | generalized weakness –Do not Exer for endurance more than 15-20 beats/min above resting HR |
| visual disturbances in MS | Diplopia Blurred vision Optic Neuritis is typically the first sign of MS |
| optic neuritis | eye pain and temporary vision loss |
| what % of MS pts have visual disturbances | 80% |
| scotoma | blind spot- pt relies on peripheral vision |
| what % MS pts have cognitive deficits | 60% |
| behavioral disturbances from MS | lability, bipolar affective disorders (manic-depressive), lack of closure to illness (doesn't always get better) |
| lability | Euphoria, pathologic laughing and weeping, anger, aggression |
| communication disturbances with MS | dysphagia (swallowing disorder) |
| prognosis for MS | 22-25 years after diagnosis |
| coordination and balance test for MS | Romberg test (pt stands w/EO, (+) loss of balance w/EC. Gait/Posture) |
| standardized tests common with MS pts | Expanded Disability Status Scale EDSS Functional Examination of MS FAMS |
| Expanded Disability Status Scale EDSS | Based on a 0-10 scale 0=Normal function 7 or greater=unable to ambulate Focuses on ambulation as the primary indicator of disability |
| Functional Examination of MS FAMS | 59 item Measures quality of life in 6 areas: mobility, emotional well being, general contentment, thinking/fatigue, family & social wellbeing. |
| 3 treatment activities for sensory impairments and skin care for MS | Hyperpathia tapping, rubbing proprioception loss --> compensate use vision to substitute pressure sores --> schedule pressure releases |
| rules of skin care | Keep skin clean and dry Inspect skin regularly (at least once a day) Wear breathable clothing Provide regular pressure relief -every 2hrs in bed/15 minutes in sitting Pressure relieving devices |
| If non blanchable erythema occurs after___minutes, stay off area until redness disappears, if it doesn’t see Doctor ASAP | 30 |
| pain tx for MS | Treat Muscle imbalances – strengthening/stretching Chronic pain TENs, Aquatics-cool |
| why is ice and ice baths good for MS? | Slows clonus by decreasing the tendon reflex excitability and slowing nerve impulses to the muscle. |
| how long do effects of ice help MS pts? | effects may last up to an hour |
| exercise for MS pts | begin early in the course of the MS (with baclofen or Botox) need to start stretching ASAP after baclofen or botox |
| LE stretching for MS | HS, quads, adductors, and plantarflexors |
| Emphasize ___ and ___ ___ movement control | Trunk, proximal joint |
| other tx's for MS | Positioning including bracing FES-reciprocal inhibition Cryotherapy |
| how often should immobile joints be mobilized with MS? | several times a day -usually by family and nursing Capsular restriction - joint mobs |
| precautions for exercise with MS | Improve strength and endurance slowly Progressive resistive exercise – as able When Spasticity is present- use functional exercises Timing of exercise program- AM usually better Cool environment Teach Energy conservation-pacing |
| when is ataxia present with MS? | when there are cerebellar lesions |
| what helps with ataxia? | Wt bearing helps - all fours, put wts on pts ankles, kneeling rhythmic stabilization joint approximation slow reversal-hold exercises static balance->dynamic balance activities Ball exercises if high enough level Stationary Bike, UBE pool- slows |
| purpose of Frenkel's exercises for ataxia | Designed primarily for coordination; not for strengthening. |
| how to give commands for Frenkel's exercises | event, slow voice; the exercises should be done to counting. |
| set up for Frenkel's exercises | important that the area is well lit and that you are positioned so that you can watch the movement of your legs. |
| avoid ___ with Frenkel's exercises | fatigue |
| sets/ reps/ rest for Frenkel's exercises | Perform each exercise not more than four times. Rest between each exercise. The exercise routine takes about ½ hour and should be done 2 times daily. |
| what ROM should Frenkel's exercises be done within? | normal range of motion to avoid over-stretching of muscles. |
| Frenkel's exercise progression | The first simple exercises should be adequately performed before progressing to more difficult patterns |
| Gait considerations with MS | prevent hyperextension of the knees – brace, tape, educ. Trunk Bracing technique for lordosis Trendelenburg gait Assistive devices |
| goals for functional mobility with MS | Compensate as necessary energy conservation decrease dependency and passivity |
| Majority of MS pts use multiple devices for mobility. ____, ____, ____, | Over head trapeze, bath aids, long handle reachers |
| ___of MS pts need assistance from someone else | 1/2 |
| respiratory tx for MS | Diaphragmatic breathing Resistive breathing Postural training |
| tx of psychosocial issues in MS | Flexibility by the PTA, Therapy in groups |
| = |
Created by:
bdavis53102
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