MS Interventions

Question 1

treament focus with MS

Answer 1

1. Prevention
2. Remediation
3. Compensation

Question 2

EDSS 0-2.5 Mild Disability treatment focus

Answer 2

Mostly on Prevention and some remediation

1. minimal mobility deficits
2. standard tests may not be sensitive enough to detect disease progression or disability
3. assessment of pts when symptomatic is extremely helpful
4. focus on edu and maximizing fitness levels

Question 3

EDSS 3-6 Moderate Disability treatment focus

Answer 3

Mostly Remediation with some prevention

1. Impairments are more readily apparent
2. may or may not begin to impact activity and participation
3. secondary impairments develop

Question 4

treatment considerations for EDSS 3-6

Answer 4

1. intermittent versus continuous activity
2. can improve tolerance by increasing rest periods
3. this is where we spend the most time with patients

Question 5

treatment focus with EDSS 6.5-9 Severe Disability

Answer 5

Mostly Compensation and some prevention

1. sig mobility and functional limitations
2. more pronounced comorbidities
3. longer remission periods

Question 6

treatment considerations for EDSS 6.5-9.5

Answer 6

1. despite focus being largely compensatory and preventative, it can still be very meaningful
2. major goal is to improve safety and efficiency with mobility

Question 7

EDSS 0 description

Answer 7

normal neuro exam

Question 8

EDSS 1 description

Answer 8

no disability, minimal signs in one FS

Question 9

EDSS 1.5 description

Answer 9

no disability, minimal signs in more than one FS

Question 10

EDSS 2 description

Answer 10

minimal disability in one FS

Question 11

EDSS 2.5 description

Answer 11

minimal disability in 2 FS

Question 12

EDSS 3 description

Answer 12

fully ambulatory, moderate disability in one FS

or

mild disability in three or four FS

Question 13

EDSS 3.5 description

Answer 13

fully ambulatory but with moderate disability in one FS and minimal or more disability in several other FS

Question 14

EDSS 4 description

Answer 14

fully ambulatory without aid, self-sufficient, up and about some 12 hours a day, able to walk without aid or rest at least 500m without aid/rest

Question 15

EDSS 4.5 description

Answer 15

1. fully ambulatory without aid,
2. up and about much of the day,
3. able to work a full day, may otherwise have some limitation of full activity or require min A
4. able to walk without aid or rest at least 300m

Question 16

EDSS 5 description

Answer 16

1. ambulatory without aid/rest for about 200m
2. disability sig enough to impair full daily activities
   
   • e.g to work a full day without special provisions

Question 17

EDSS 5.5 description

Answer 17

ambulatory without aid for about 100m

disability sig enough to preclude full daily activities

Question 18

EDSS 6 description

Answer 18

intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100m with or without resting

Question 19

EDSS 6.5 description

Answer 19

constant bilateral assistance (canes, crutches, braces) required to walk about 20m without resting

Question 20

EDSS 7 description

Answer 20

unable to walk beyond ~5m even with aid, essentially to wheelchair

wheels self in standard wheelchair and transfers alone, up and about in wheelchair some 12 hours a day

Question 21

EDSS 7.5 description

Answer 21

unable to take more than a few steps, restricted to wheelchair

may need aid in transfer, wheels self but cannot carry on in standard wheelchair in a full day

may require motorized wheelchair

Question 22

EDSS 8 description

Answer 22

1. essentially restricted to bed or chair or perambulated in wheelchair, but may be out of bed itself much of the days
2. retains many self-care functions
3. generally has effective use of arms

Question 23

EDSS 8.5 description

Answer 23

essentially restricted to bed much of day; has some effective use of arm(s); retains some self-care functions

Question 24

EDSS 9 description

Answer 24

helpless bed pt, can communicate and eat

Question 25

EDSS 9.5 description

Answer 25

totally helpless bed pt; unable to communicate effectively or eat/swallow

Question 26

EDSS 10 description

Answer 26

death

Question 27

intervention components

Answer 27

1. gait training and device management 2. aerobic training 3. balance retraining 4. vestibular retraining 5. fatigue management 6. falls prevention 7. **comorbidity management**

Question 28

MS-specific rehab goals

Answer 28

1. promote independence in functional mobility skills and ADLs 2. facilitate max mobility in home and community 3. energy conservation techniques 4. Vision * EOM exercises, vestibular rehab, may need patching for diplopia 5. improve sensory awareness as impairment progress 6. avoid precipitating exacerbations 7. patient and family edu

Question 29

how to avoid precipitating exacerbations

Answer 29

1. schedule therapy sessions during optimal times for function 2. minimize fatigue 3. establish schedule of rest and moderate exercise 4. avoid stressors and overheating

Question 30

Benefits of exercise

Answer 30

1. exercise has now been proven to have positive improvements on all of the following for pts with MS * gait speed, fall risk * time until AD prescription * VO2 max * UE/LE strength * BMI, triglyceride and VLDL levels * Depression, anger, anxiety * fatigue * cognition * neuroprotective responses

Question 31

T/F: benefits of exercise is only for RRMS subtype

Answer 31

FALSE benefits found with all subtypes and across the majority of progressive stages of the disease

Question 32

Fatigue and exercise

Answer 32

1. research supports use of moderate exercises to modulate fatigue symptoms 2. encourage aerobic exercise 3. encourage exercise at times of day when fatigue symptoms are minimal and body temperature is lowest 4. use fatigue scale to monitor effect of exercise program on QOL 5. teach energy conservation techniques

Question 33

Patient and Family Education

Answer 33

1. disease process, clinical manifestations, signs of progression 2. prevention of secondary complications 3. medication aherence, monitoring effects of meds 4. rationale behind prescriptions for assistive devices 5. general health and stress management 6. depression S/S 7. Community resources