what is MS
is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Multiple Sclerosis occurs when blood brain barrier malfunctions and allows B cells to pass into the brain, which destroys healthy tissue and myelin
diagnosis of MS
The only way to diagnose MS is to rule out other
diseases and disorders. There are no symptoms or tests that, by themselves, can determine if someone has MS.
diagnosis criteria
● Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves
● Find evidence that the damage occurred at different points in time (can be done by MRI)
● Rule out all other possible conditions
making a diagnosis
- neurologic exam, which includes tests of cranial nerves (vision, hearing, facial sensation, strength, swallowing), sensation, reflexes, coordination, walking and balance
- Cerebrospinal fluid analysis
- MRI
- Blood tests
incidence
-2014-2015 data on adults (20+ years old) diagnosed with MS estimates that over 77,000 Canadian adults are living with MS. An estimated 1 in every 385 Canadians.
-Women are three times more likely to be diagnosed with MS than men
-On average, 11 Canadians are diagnosed with MS every day
-60% of adults diagnosed with MS are between the ages of 20 and 49 years old
-MS is more common in a temperate climate, more prevalent in higher altitudes
-family history/genetics, you are more likely to develop
MS if you have a family member with the disease
other incidence
- Vitamin D deficiency is a risk factor for MS
- Multiple concussions, especially between the ages of 11 and 20 can increase risk
-smoking increases MS risk as well as the risk of disease
severity and progressions
-the Epstein-Barr virus, type 1 diabetes, thyroid disease, and inflammatory bowel disease all slightly increase your risk
how to decrease your risk
- getting your recommended daily dosage of Vitamin D
- drinking at least 30 oz (4 cups) of coffee per day
- meeting recommended physical activity guidelines
symptoms of MS
- Numbness and weakness in one or more limbs, usually occurs on one side of the body of the legs and trunk
- Electric-shock sensations (occurs with certain neck movements)
- Lack of coordination, tremor
- Slurred speech
- Fatigue
- Burning, stabbing, sharp and squeezing sensations
- Heat intolerance
- Vision Problems
- Partial or complete loss of vision, usually in one eye at a time
- Prolonged double vision
- Blurry vision
- Often with pain during eye movement
- Tingling or pain in parts of your body
- Problems with bowel function, and bladder function
- Dizziness
ranges of severity scales
- Expanded Disability Status Scale (EDSS
- Functional System Score (FSS)
Expanded Disability Status Scale (EDSS)
- Focuses mainly on the ability to walk
- Scored 1-10, lower the number less severe the disability is.
- EDSS scale is used with reference to the FSS scale.
Functional System Score (FSS)
-Each Functional system(FS) scored 0 (no disability) to 6 (severe disability) -pyramidal (muscle and limb movement) -cerebellar (balance coordination) -Brainstem (speech and swallowing) -Sensory (Sensation) -Bowel and Bladder Function -Visual Function -Cerebral Functions (Thinking and Memory)
ranges of severity
- 1.0 no disability minimal signs in one FS
- 1.5 No disability, minimal signs in more than one FS
- 2.0 Minimal disability in one FS
- 2.5 Mild disability in one FS or minimal in two FS
- 3 Moderate disability in one FS, or mild in three or four. No impairment in walking
- 3.5 Moderate in one and more than minimal in several others. No impairment in walking
- 4.0 Significant disability, but can walk for 500 metres without aid or rest and does not affect daily activities.
- 4.5 Significant disability, but can walk for 300 metres without aid or rest and does not affect daily activities.
- 5 Severe enough to affect daily activities, able to walk 200 metres without rest
- 5.5 Avoid some daily activities, can walk 100m without rest
- 6 Requires a walking aid (cane, crutch, walker) to walk 100m without rest
- 6.5 Requires two walking aids (canes, crutches) to walk 20m without rest
- 7 Unable to walk 5m with aid. Essentially restricted to wheelchair but can transfer alone
- 7.5 Unable to take five steps, may need aid in transferring,may require motorized wheelchair
- 8 In bed, chair or pushed in wheelchair, retains self care function, generally effective use of arms
- 8.5 Restricted to bed, effective use of arms retains some self care functions
- 9 Confined to bed, can still eat and communicate
- 9.5 Confined to bed and totally dependent. can not communicate, eat or swallow
- 10 Death due to MS
types of MS
There are 4 different types of MS ◼ Relapsing-remitting ◼ Primary progressive ◼ Secondary progressive ◼ Progressive-relapsing
Relapsing-remitting MS (RRMS)
is the most common form of MS. About 85% of people with MS are initially diagnosed with RRMS. People with RRMS have temporary periods called relapses, flareups
or exacerbations, when new symptoms appear. Followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent.
Secondary-Progressive MS (SPMS)
In SPMS, symptoms worsen more steadily over time, with or without the occurrence of relapses and remissions. Most people who are diagnosed with RRMS will
transition to SPMS at some point
primary progressive MS (PPMS)
This type of MS is not very common, occurs in about 10% of people with MS. PPMS is characterized by slowly worsening symptoms from the beginning, with no
relapses or remissions
progressive relapsing MS ( PPMS)
A rare form of MS (5%), PRMS is characterized by a steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without
recovery
a day in the life of someone with MS
- whether your able to work or not
- not being able to play sports or enjoy your hobbies
- it impacts the whole family
- it suddenly can change your day
- Flare Ups can happen at anytime from many triggers such as: the weather(too hot or cold), stress, etc (varies person to person)
- all individuals are affected differently
treatments
◼ Physical therapy can help with stretching and strengthening exercises.
- ex for leg weakness or gait problems
◼ Muscle relaxants for uncontrollable muscle spasms or stiffness
◼ Medications to reduce fatigue
- ex. Amantadine, Ritalin
◼ Medications to increase walking speed
- ex. Ampyra
◼ Medications to deplete levels of B cells:
- ex. Ocrevus, Arzerra
◼ Medications specific towards other problems associated with MS
- ex. for depression, bowel control
- ex. Cannabis can help with easing the pain of symptoms
◼ Mobility aids
- ex. wheelchair, walker, cane
men are more prone to
- diabetes (type 2)
- epilepsy
- depression
- anxiety
- airway infections
women are more prone to
- chronic lung disease
- airway infections
teaching/coaching considerations
◼ Know the student - what are their symptoms?
◼ Only modify when necessary to the extent necessary
◼ IEP
◼ Memory - instructions on a whiteboard or an info card on each station
◼ Overheating- fans and/or drinking water
- there are also a number of cooling devices such as a cooling vest
◼ Increased fatigue - activities should include frequent rest breaks as well as substitutions for games like soccer
◼ Wheelchair, walker or crutch
◼ Be aware that symptoms and ability level may change very quickly, activities may need to be adapted with little to no notice
other considerations
◼ Warm-up and cool down are very important; especially stretching
◼ Rhythmic activities, active lead-up games, obstacle courses
◼ Activity options provided
◼ If functional strength has not returned after 12 hours then exercise was too intense
flare up triggers & treatment
- heat
- fatigue
- stress
- infection
When to Treat MS Flares: - severe weakness
- balance problems
- loss of vision
