Types of MS
Relapsing-remittent MS, Secondary-progressive MS, Primary-progressive MS
Relapsing-remittent MS
Relapsing-remitting MS (RRMS) is the most common subtype, affecting 85% of people with MS and is characterised by short attacks to the CNS followed by a complete or partial return to normal functioning
On/off phases
Secondary-progressive MS
Secondary-progressive MS (SPMS) is a subgroup that begins as a relapsing-remitting course accompanied by a steady decline in function and is often developed by the patient.
Progressive-relapsing MS
Steady decline since onset with super-imposed attacks
Primary-progressive MS
Primary-Progressive MS (PPMS) is a progression of the disease where a steady decline in function is experienced from the onset of the disease. Progressive-relapsing MS (PRMS) is similar to PPMS but has the additional characteristic of acute attacks.
What happens in MS?
Autoimmune disease of the CNS, characterized by chronic inflammation and demyelination. Leads to primary demyelination and then generation of white and grey matter of brain and spinal cord. Multifocal lesions known as plaques develop within the CNS.
Medical treatment for MS
Disease Modifying Therapies (DMT’s)
* Majory of DMT’s treat RRMS
* As disease progresses so does response to DMT’s
Deep Brain Stimulation (DBS)
Manage relapses
* Corticosteroids
Treat symptoms
* oral medication
* botox for spasticity
Motor impairments of MS and structure
UMN weakness (paresis)
* PMC, corticospinal tract
Reduced fractionation
* PMC, corticospinal tract
Spasticity
* PMC, corticospinal tract
Ataxia
* PMC, corticospinal tract
Increased tone
* Corticospinal tract and reticulospinal pathways
Reduced proprioception
* Dorsal column medial lemniscus pathways
Health promotion - why exercise matters
Promotion of a ‘brain-healthy’ lifestyle to optomize brain volume and cognitive reserve is a priority to minimize the effects of MS pathology.
Cerebellar impairments
Cerebellar ataxia
Dysmetria
Dysdiadochokinesia
Intention tremor
Visual impairments
Diplopia (double vision) - more common
* Brainstem
Homonymous hemianopia
* Occipital lobe
Sensory impairments
Reduced light touch
* Spinothalamic tract
Other main impairment of MS
Fatigue
Primary
* CNS demyelination
Secondary
* Deconditioning
Cognitive and behavioural impairments
- Cognitive dysfunction
Attention, processing speed, executive function - Emotional changes
Depression, motivation
Speech and swallowing in MS
Dysarthria & Dysphagia
* Cerebellum / brainstem
Interventions for MS at diagnosis
Diagnosis - DMT’s, education
Health promotion - emphasis on health promotion to maintain current levels of activities by managing fatigue, regular exercise and a healthy lifestyle.
Interventions for MS at moderate disability
Restorative rehabilitation and symptom management
Interventions for MS at severe disability
Maintenance rehabilitation
Evidence based interventions in MS
Strong evidence for both resistance, aerobic and mind-body exercise for fatigue, balance and strength.
Education on pacing is beneficial for fatigue.
Exercise guidelines for MS
Minimum:
2 x 30 mins moderate intensity aerobic per week
2 x mod intensity strength with 8-10 exercises, 3 sets, 8-12 reps
Advanced:
5 x 30-40 mins mod-vigerous intensity per week
2 x mod intensity “ “
More severe mobility or non-ambulatory
20 minutes/day 3-7 days/week focused on breathing, flexibility, upper extremities, lower extremies, core.
Very severe or confined to wheelchair
10-15 mins 3-7 days/week to include “ “
