How is MS often similar to stroke?
Contracture, weakness, loss of function
Who does MS usually affect?
Young white adults
Describe the pathophysiology of MS
Immunologically mediated inflammatory response in the CNS causing demyelination of neurons in the CNS
= disrupted neural transmission
= neurological signs and symptoms
Describe the 4 stages of inflammation in MS
1) Accumulation of inflammatory cells at the lesion, causing blockage
2) Active destruction of oligodendricytes and myelin sheath
3) Depletion of oligodendricytes
4) Healing of lesion by scar formation (sclerotic plaques)
= decreased nerve conduction
Where can plaques occur?
Anywhere in CNS (e.g. cerebellar white matter, optic nerve)
What are the 4 identifiable patterns of MS?
1) Benign
= little or no progression after the initial attack
= no or limited loss of function
2) Relapsing remitting (80%)
= most common
= neurological deficits but rate and progression varies
3) Secondary progressive
= about 60% of RR type MS results in this
4) Primary progressive
= about 10% of MS cases
= symptoms progress from the onset of the disease
How is MS diagnosed? (methods, after??)
Diagnosis
- Clinical assessment
- Lumbar puncture (used to rule out tumor, GBS, etc)
- MRI = most sensitive
Made after either 2 episodes or evidence of 2 separate lesions
Medical management of MS (3 + example)
- Disease modifying (Interferon - RR)
- Anti-inflammatories (steroids)
- Symptom alleviation (Baclofen - spasticity)
What are the main types of impairments in MS?
Impairments
- cognitive (memory, info processing)
- personality (distractable, emotional)
- vision, hearing, vestibular
- sensorimotor (stroke-like)
- autonomic
- fatigue
What is often the most disabling impairment in MS and why?
Fatigue - exacerbated by heat and leads to further deconditioning
What should be included in a subjective for MS? (5)
Subjective
- Current fn (mobility, ADLs)
- SHx (family support, care package)
- Meds
- Previous exacerbations and function before
- Previous PT
MS objective (impairments, activity)
Impairments
- as for stroke
Activity
- relevant to level
- environment specific
- meaningful
MS measures (5)
Measures
- Expanded Disability Status Scale (impairments)
- MS functional composite scale
- MS Impact Scale (physical and psychological impact)
- MS self efficacy scale
- Fatigue Severity Scale
What are the 3 aims of PT in MS?
Physiotherapy Aims
- optimize performance in everyday activities
- prevent unnecessary disability
- improve QOL
How can fatigue be managed?
Fatigue management
- rest
- simplify tasks
- time management
- low impact aerobic
- other factors (e.g. sleep, diet)
- pharmacological agents
Spasticity in MS (3)
Spasticity
- common
- associated with painful cramps and spasms
- medically managed
How should activity training for MS occur?
Like stroke but consider if degenerative condition or not
What are advantages of using a walking aid?
Adv
- Stability/falls
- increased walking distance and speed
- efficient/less fatigue
What are DISadvantages of using a walking aid?
Disadv
- Less LL strength use
- Less trunk/head movement
- less balance stimuli
- posture
What should carers be educated about in MS?
Carer education
- disease progression/impact
- manual handling
- motor training strategies
- assistive devices
MS strength training research? (2)
Progressive resistance with theraband 3x/wk and aerobic 1x/wk
= MSFC better and no deterioration
= LL and mobility best
= no QoL change
PRE 3x/wk for 6 months
= better walking speed and upper limb endurance
= 59% compliance
MS aerobic training research? (3)
5x30min bike riding for 4 wks = better
Low-mod endurance exercise = well tolerated
Treadmill 30mins, 3x/wk for 4wks = BETTER
