What is MS
Demyelination of the nerve occurs resulting in scar tissue formation that affects nerve transmissions in widely scattered areas of the brain and spinal cord
- Starts with an inflammatory process, followed by the loss of
myelin that surrounds the nerve axons.
Scar tissue, known as sclerotic plaques
develops at the sites of demyelination.
These plaques cause a slowing, disruption or blockage of nerve transmissions.
With increased plaque formation, symptoms become more severe.
Who MS affects
- This disease strikes people during a very active time in life.
- Average onset: between 20 and 40 years, however, it can happen as early as
15 and as late as 45. - Women are slightly more affected than men.
MS etiology genetics
⚬ There is a genetic link, but not an inherited disease. Has been found in 25% to 30% of monozygotic twins.
Risk increased if a first degree relative has is (parents, siblings, children)
Etiology - Environmental factor
Higher occurrence of MS the farther you live from the equator, such as North America & Northern Europe
Etiology viral factor
Such as measles, canine distemper, human herpesvirus-6, Epstein-Barr, Chlamydia pneumonia: causes
overactivity of the immune response which results in the demyelination of the axons.
Etiology Immunological factor
Abnormal immune response causes inflammation/ damage to the CNS. T cells & B cells can causes an
autoimmune response - attacking the myelin
Diagnosis
Difficult to diagnose in early stages
- Medical history & neurological examination
- MRIs, Evoked Potentials (EP), Lumbar puncture (LP)
- Doctors look for evidence of damage in at least 2 separate areas of the CNS - brain, spinal cord, & optic nerves
- Evidence that damage occurred at different points in time
- Rule out all other possible diagnoses
Clinically
Isolated
Syndrome (CIS)
- Earliest from
- Refers to a single episode of neurological
symptoms that relate to MS - MRI shows evidence of abnormality in brain or
spinal cord - People who experience this may or may not go on
to develop MS - Having multiple attacks of the symptoms changes
the diagnosis to relapsing-remitting MS
Relapsing-remitting MS (RRMS)
- Most common
- Characterized by unpredictable but defined relapse - aka: attacks, flair ups, exacerbations
- New symptoms appear or existing ones get worse
- In between relapses - recovery can range from
complete, nearly complete to pre-relapse function
or remission
Secondary Progressive MS (SPMS)
- Relapsing-remitting eventually transition to
secondary progressive - This phase has progressive worsening but
fewer relapses - Sometimes there are occasional relapses &
minor remissions/ plateaus
Primary progressive MS (PPMS)
- Characterized by slow accumulation of disability without defined relapses
- Can stabilizes for periods of time
- Can have minor temporary improvement
- No periods of remission
- Approximately 15% of MS patients are
diagnosed with PPMS
Which matter is affected and where are lesions commonly found
Specific S&S depend on location of lesions in the CNS & the extent of the lesions
⚬ White matter is affected
⚬ Lesions are commonly found in the brain stem, cerebellum & spinal cord
- Optic & Trigeminal nerve S&S
⚬ Optic nerve S&S: visual acuity, colour blindness, visual field defects, diplopia
⚬ Total blindness is uncommon
⚬ Trigeminal nerve S&S: trigeminal neuralgia
Signs & Symptoms
- Fatigue
- Spasticity
- Weakness
- Impaired proprioception
- Intention tremors
- Circumducted gait
- Altered posture
- Vertigo
- Bladder dysfunction, UTIs
- Bowel dysfunction
- Compensatory changes of unaffected or
overused limbs - Paresthesia
- Cold extremities or sweating abnormalities
- Edema, may be present
- Speech disturbances i.e. dysarthria and
slurring - Mood swings, depression, euphoria, cognitive
problems i.e. forgetfulness and inattentiveness
Exacerbating
Symptoms
- Vitamin/ mineral and essential fatty acid
deficiencies - Amalgam dental fillings
- Food allergies: dairy produces, increased
intake of polyunsaturated fats - Stressful events, over exertion, heat, fever,
injury, emotional upset
MS Contraindications
- Techniques that can fatigue the patients
⚬ frictions, vigorous work that increases SNS firing - inducing fatigue
- Heat applied over large areas
- Deep techniques in areas of altered sensation
- Decubitus ulcers - local massage
⚬ If you see red, inflamed areas over bony prominences the patient should be
referred to their MD
History/ Intake
- Are other conditions present? infection, cold, flu - potentially increases susceptibility to fatigue
- Last attack? remissions?
- Diminished or loss of sensory perception, limb proprioception?
Assessment/ Special Tests
- ROM
- Sensory testing
- Specific orthopedic tests
Goals
- Decrease SNS, prevent fatigue
- Improve/ maintain tissue health, decrease edema
- Limit contratures, address postural changes/imbalances
- Address secondary conditions/ temporarily decrease spasticity/ maintain joint health, ROM
Homecare/ Therex
- encourage ADLs to the level of their ability
- encourage movement rehab programs if they have difficulties with balance & shifting weight -
yoga, tai chi - swimming or walking - as long as they don’t over fatigue
- modified weight training in a cool environment
⚬ ensure they are taking rest periods up to 5 mins
⚬ submaximal resistance - they’re not using their full strength - resisting against gravity,
gradually increasing to resistance bands - Patient education - tissue health, self lymphatic drainage, cool hydro, signs of gangrene
