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PHYSDYS
NEURODEGENERATIVE DISORDERS (MULTIPLE SCLEROSIS)
| Term | Definition |
|---|---|
| MULTIPLE SCLEROSIS | ● Complex, multifactorial, and progressive disease resulting from presence of multifocal lesions of demyelination in cerebral hemispheres, optic nerves, brainstem, and spinal cord. ● Chronic, progressive neurological disorder ● Motor and cognitive |
| MULTIPLE SCLEROSIS AFFECTS THE: | ● central nervous system (CNS) ● communication between the brain and body |
| MULTIPLE SCLEROSIS CHARACTERIZED BY: | demyelination, inflammation, and neurodegeneration |
| MULTIPLE SCLEROSIS SYMPTOMS: | May vary based on location and severity of nerve damage |
| TYPES OF MULTIPLE SCLEROSIS | ● RELAPSING-REMITTING MS (RRMS) ● PRIMARY PROGRESSIVE MS (PPMS) ● SECONDARY PROGRESSIVE MS (SPMS) ● PROGRESSIVE-RELAPSING MS (PPMS) |
| RELAPSING-REMITTING MS (RRMS) | ● Most common type (about 15% of cases at onset) ● Disease progression is relatively slow in early stages ● May lead to SPMS if managed poorly |
| RELAPSING-REMITTING MS (RRMS) CHARACTERIZED BY: | flare-ups (relapses) followed by periods of remission |
| RELAPSING-REMITTING MS (RRMS) SYMPTOMS: | may completely or partially resolve between relapses |
| PRIMARY PROGRESSIVE MS (PPMS) | ● About 10-15% of MS cases ● Gradual worsening of neurological function from the onset w/o distinct relapses/remissions ● More common in individuals diagnosed later in life (over 40 yrs old) ● Leads to steady accumulation of disability |
| SECONDARY PROGRESSIVE MS (SPMS) | ● Follows an initial phase of RRMS ● Progressive worsening of symptoms over time, with or without relapses ● Greater disability accumulation than RRMS ● Transition from RRMS to SPMS typically occurs 10-20 yrs after initial diagnosis |
| PROGRESSIVE-RELAPSING MS (PPMS) | ● Rare form (-5% of cases) ● Progressive decline from the start, but with occasional acute relapses ● No clear periods of remission ● Rapid progression and severe disability |
| SIGNS AND SYMPTOMS OF MULTIPLE SCLEROSIS | ● FATIGUE AND WEAKNESS ● VISION PROBLEMS ● NUMBNESS, TINGLING OR PAIN IN LIMBS ● MUSCLE SPASTICITY AND COORDINATION DIFFICULTIES ● COGNITIVE CHANGES (LATTER CHANGES) ● BOWEL AND BLADDER DYSFUNCTION ● EMOTIONAL AND MOOD CHANGES |
| FATIGUE AND WEAKNESS | ● Has body malaise (discomfort) ● Most common and debilitating symptoms of MS. ● Not relieved by rest. ● Can be d/t secondary deconditioning from reduced activity. ● Can impact daily activities, work performance, and overall quality of life |
| VISION PROBLEMS | ● Optic neuritis ● Diplopia (double vision) ● Nystagmus ● Scotomas (blind spots) |
| Optic neuritis: | Inflammation of the optic nerve causing pain, blurred vision, or even temporary vision loss. |
| Diplopia (double vision): | Due to impaired eye movement control. (Naduduling) |
| Nystagmus: | Involuntary eye movements affecting visual focus. ○ Uncontrolled and lateral movements |
| Scotomas (blind spots): | May develop in some cases. |
| NUMBNESS, TINGLING OR PAIN IN LIMBS | ● Often an early symptom of MS. ● May present as paresthesia or dysesthesia. |
| paresthesia | (tingling, burning sensation) |
| dysesthesia | (painful, uncomfortable sensations) |
| MUSCLE SPASTICITY AND COORDINATION DIFFICULTIES | ● Spasticity ● Can cause pain, difficulty walking, and trouble with balance ● Ataxia |
| Spasticity: | Increased muscle tone leading to stiffness, cramps, or spasms. |
| Ataxia | (lack of coordination) affects voluntary movements, leading to unsteady gait or tremors. |
| COGNITIVE CHANGES (LATTER CHANGES) | ● Affects 50-65% of people with MS. ● Impacts memory, attention, problem-solving, and processing speed |
| BOWEL AND BLADDER DYSFUNCTION | ● Urinary urgency, frequency, or incontinence and Bowel dysfunction (constipation or incontinence) ● Part of ADLs: toileting |
| EMOTIONAL AND MOOD CHANGES | ● Depression and anxiety are common, affecting up to 50% of people with MS d/t other symptoms. ● Mood swings, irritability, and emotional lability can occur. |
| COURSE OF MS | ● Unpredictable course with periods of relapse & remission ● From relapsing-remitting to secondary progressive MS ● Progressive forms lead to steady neurological decline ● Individual experiences vary greatly, with some maintaining function for decades |
| Relapse | - Active symptoms |
| Remission | - Symptoms become absent, resulting into the individual being normal |
| PROGNOSIS OF MS | ● MS is not fatal, but can lead to significant disability overtime. ● Life expectancy is slightly reduced but improving with better treatments. |
| Factors affecting prognosis: | ■ Age of onset ■ Type of MS ■ Frequency and severity of relapses ■ Early treatment with disease-modifying therapies (DMTs) can slow progression. |
| OT EVALUATIONS FOR MS (1) | SKILLS ● Motor and Sensory Function ● Cognitive and Psychosocial Assessment ● Fatigue and Energy Levels |
| OT EVALUATIONS FOR MS (2) | OCCUPATIONS ● Home end Environmental Assessment ● Standardized Assessment Tools |
| Motor and Sensory Function | ○ Evaluate muscle weakness, coordination, and spasticity ○ Assess balance, fine motor skills, and endurance |
| Cognitive and Psychosocial Assessment | ○ Screen for memory deficits, attention, executive function, and problem-solving skills, ○ Assess for anxiety, depression, and emotional well-being. |
| Fatigue and Energy Levels | ○ Use self-report tools to assess fatigue severity ○ Identify triggers and energy-draining activities. ■ Time in doing activities |
| Home end Environmental Assessment | ○ Evaluate home safety, accessibility, and need for modifications. ○ Recommend assistive technology and mobility aids. |
| Standardized Assessment Tools | ○ Canadian Occupational Performance Measure (COPM) ○ Multiple Sclerosis Impact Scale (MSIS-29) ○ Mini-Mental state Examination (MMSE) or Montreal Cognitive Assessment (MOCA) ○ Berg Balance Scale (BBS) |
| Canadian Occupational Performance Measure (COPM) | - Identifies client-centered goals. |
| Multiple Sclerosis Impact Scale (MSIS-29) | - Assesses physical and psychological impact. |
| Mini-Mental state Examination (MMSE) or Montreal Cognitive Assessment (MOCA) | - Evaluate cognitive function |
| Berg Balance Scale (BBS) | - Assesses fall risk and balance |
| OT INTERVENTIONS FOR MS | ● Fatigue Management & Energy Conservation ● Strength, Endurance, and Mobility Training ● Cognitive Strategies & Memory Aids ● Hand Function and Coordination ● Psychosocial Support and Emotional Well-Being |
| Fatigue Management & Energy Conservation | ○ Educate on the "4 P’s" - Planning, Prioritizing, Pacing, and Positioning Recommend assistive devices to reduce energy expenditure ○ Do not bathe Pt with MS with hot water |
| Strength, Endurance, and Mobility Training | ○ Use low impact exercises (eg. yoga, swimming, stretching) ■ To maintain ○ Functional mobility training to prevent falls ○ Provide adaptive equipment (e.g, grab bars, walkers, reachers) |
| Cognitive Strategies & Memory Aids | ○ Teach compensatory strategies (eg, checklists, planers, smartphone reminders) use problem-solving tasks to enhance executive function. ○ Encourage mindfulness and stress management techniques. ○ Biofeedback |
| Biofeedback | - because some have memory loss |
| Hand Function and Coordination | ○ Use task-specific training for fine motor skills (e.g., buttoning and writing). ○ Recommend adaptive tools (eg, built-up handles, weighted utensils). |
| Psychosocial Support and Emotional Well-Being | ○ Provide counseling on role changes and coping strategies ■ Counseling ○ Incorporate relaxation techniques (e.g., deep breathing, guided imagery.) ○ Support caregivers with education and respite strategies. |
| Counseling | - because their goals change |
Created by:
avemaria