RehabII Multiple Sclerosis

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RehabII Multiple Sclerosis
2014-03-03 10:31:22
Multiple Sclerosis

Multiple Sclerosis
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  1. Intention tremors, scanning speech, nystagmus are all symptoms of what disease and make up what triad
    Multiple Sclerosis

    Charcot's Triad
  2. The t-lymphocytes damage what portion of the CNS
    the myelin sheath
  3. Multiple Sclerosis typically involves what structures of the CNS
    • brain
    • spinal cord
    • optic nerves
  4. Gliosis, selective demyelination, inflammation hardened plaque and gliosis are all characteristics of what pathology
  5. During relapse of MS what must be avoided during PT rehab
    aggresive exercises
  6. What are the predictors for a good outcome for MS
    • onset with only 1 symptom (strong indicator)
    • benign, RRMS
    • complete recovery after attacks
    • onset<40 years
    • MRI findings low active lesions, mild axonal loss 
    • neurological findings at 5 yrs is good predictor
  7. What are predictors of bad outcome
    • progressive course
    • onset >40 yrs
    • significant pyramidal, cerebellar signs at 5 yrs
    • (nystagmus, tremor, ataxia, dysarthria)
    • high frequency of attacks
  8. What are the most common symptoms of MS
    • fatigue                             88%
    • gait problems                    87%
    • bowel/bladder problems     65%
    • pain & other sensations     60%
    • visual disturbance             58%
    • cognitive                          44%
    • tremors                            41%
  9. What are some general info/stats for MS
    • 20-40 Yrs rare in children and >50yrs
    • females>male, cauacasians
    • life expectancy not reduced
    • death secondary infection
  10. What are areas of the globe that have a higher frequency of MS diagnoses
    • Northern US/Southern Canada
    • Scandinavia
    • Northern Europe
    • New Zealand/Southern Australia
  11. What are the risk factors for MS
    • 0.1% no other family member
    • 1% father has MS and baby is boy
    • 2% mother has MS and baby is girl
    • 3% if sibling has MS
    • 5% if fraternal twin has MS
    • 25% if identical twin has MS
  12. What are some other risk factors for MS
    • smoking, vitamin d deficiency
    • viral agents such as (Epstein-Barr virus, measles, canine distemper, human herpevirus-6 chlamydia pneumoniae
  13. What percentage of viral infection triggers MS
  14. What areas of the CNS are more greatly affected by demyelination
    • optic nerves
    • periventricular white matter
    • spinal cord (corticospinal tract, posterior white columns)
    • cerebellar peduncles
  15. What are the percentages of axonal loss with mild and severe MS
    • mild 10-20%
    • severe 80%
  16. How is MS diagnosed
    There is no specific test, an MRI of the CNS showing evidence of at least 2 damaged areas, damage occurs  in 2 seperate points in time that are at least 1 month apart
  17. What is looked for in the CSF for MS
    increased immunoglobulin and oligoclonal bands
  18. Which subtype of MS accounts for less than 20% of all MS cases in which the patient remains fully functional in all neurological systems 15 years after onset
  19. This subtype of MS is very rare is also known as Marburg disease. It has a rapid onset with continuous progression leading to significant disability and/or death in a short time
  20. This subtype of MS has clearly defined exacerbations of neurological deficits, followed by partial or complete recovery in subsequent weeks to months. Remission time periods ar characterized by lack of disease progression and is the most common at time of diagnosis
  21. This subtype of MS is slow with continuous worsening symptoms, no distinct relapses or remission which is associated with a later onset and is least common
    Primary progressive
  22. This subtype of MS initially starts as RRMS has a cahnge of clinical course from steady progressive and irreversible decline, which may be due to progressive axonal loss rather than new lesions
  23. This subtype of MS has a steady deterioration from onset, it has occasional clear acute relapse, in between relapses disease progression continues and is the least common form
  24. An Pseudoexacerbation such as heat is also known as
    Uthoffs Syndrome
  25. What is optic neuritis
    Inflammation of the optic nerve. It may cause sudden, reduced vision in the affected eye
  26. What Diminished acuity
    acuteness or clearness of vision, which is dependent on optical and neural factors
  27. What is Marcus Gunn pupil
    Its a medical sign observed during the swinging-flashlight test whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye.
  28. What is internuclear ophthalmoplegia
    is a specific gaze abnormality characterized by impaired horizontal eye movement with weak adduction of the affected eye and abduction nystagmus of the contralateral eye
  29. What is diplopia
    double vision, is the simultaneous perception of two images of a single object that may be displaced horizontally, vertically, or diagonally (i.e., both vertically and horizontally) in relation to each other.
  30. What is Dysdiadochokinesia
    an impaired ability to perform rapid, alternating movements
  31. What is dysarthria
    difficulty saying words because of problems with the muscles that help you talk.
  32. What is dysphonia
    difficulty speaking because of dystonia (muscle spasms)
  33. What is dysphagia
    difficulty swallowing
  34. interferon beta 1b & 1a are indicated for which type of MS
  35. Novatrone is indicated for what form of MS
    SPMS, PRMS and worsening RRMS
  36. Baclofen, tizanidine, diazepam, tegretol and botulin toxin are all forms of what type of medications for MS to treat
    spasticity and spasms
  37. What are some surgical interventions for MS
    • tendon release
    • neurectomy
    • rhizotomy
    • nerve blocks
  38. What are some PT interventions for MS
    • Strength trng & Cardio conditioning
    • Flexibility exer.
    • fatigue and spasticity mgmt
    • balance & coordination trng.
    • gait trng.
    • functional mobility trng.
    • H2O therapy
    • pain treatment
    • safety trng
    • compensatory strategies for sensory deficits
    • adaptive equip,ent trng.
  39. What are some Short Term Goals for MS patients
    • Increasing/maitaining ROM, strength, endurance, functional mobility improving ADL's
    • energy conservation, compensatory training, increasing activity level with tolerance
    • educate on skin care due to sensory loss
    • fit & educate on proper equipment
    • educate patient, family, friends on disease process, exacerbating factors, realistic expectations, community resources, promote emotional and social adjustments
  40. What are some Long Term Goals for MS
    • Maximize functional status & independence
    • prevent/slow development of 2° impairments
    • promote emotional/social adjustments for patient and family
    • minimize complications 2° to decreased mobility
    • compensate for loss function
    • Ed. energy conservation techniques especially during exacerbations
    • maintain employment as long as possible
    • Ed. psychosocial adjustments, vocational trng.,
    • family issues maximize rehab gains