DPT 860 – Neurological Physical Therapy II Guided Notes – Multiple Sclerosis

This set of flashcards covers key concepts, facts, and details about multiple sclerosis based on lecture notes from DPT 860 – Neurological Physical Therapy II. It includes aspects of pathology, diagnosis, symptoms, treatment, and management relevant to the condition.

What type of disease is multiple sclerosis (MS)?

MS is a progressive autoimmune disease that affects the central nervous system.

What processes are involved in multiple sclerosis?

Neuroinflammation and neurodegeneration.

What is the result of neuroinflammation in MS?

Destruction of myelin sheath and axonal damage, with possible repair and restored function.

What is gliosis?

Infiltration of demyelinated areas by fibrous astrocytes.

True or False: Neuroinflammation and neurodegeneration occur at discrete timepoints without overlap.

False; they can occur at the same time.

Where do MS lesions primarily affect early in the disease process?

White matter.

What is the typical age of onset for multiple sclerosis?

20-50 years old.

List three factors that increase the predisposition for developing multiple sclerosis.

Women are more affected than men, genetic predisposition, and higher incidence in Caucasians.

True or False: There are definitive tests to diagnose MS.

False; it is a diagnosis of exclusion.

What two laboratory tests can support a diagnosis of multiple sclerosis?

MRI with Gadolinium or Flair image and CSF oligoclonal bands.

What does dissemination in space mean for MS diagnosis?

More than one area of the CNS is affected, excluding the optic nerve.

What is Clinically Isolated Syndrome (CIS)?

One symptom associated with MS indicating the first episode of inflammatory demyelination.

What is the most common form of multiple sclerosis?

Relapsing-remitting MS (RRMS).

What characterizes Secondary Progressive MS (SPMS)?

It begins with a relapsing-remitting course followed by progression to steady and irreversible worsening.

Name a common sensory symptom experienced in MS.

Diminished sensation or paresthesia.

List three examination techniques a PT can use to assess sensory status in MS.

Dermatomes, Joint position sense, and Tuning fork assessment.

What is Lhermitte’s sign associated with?

Demyelination in the dorsal column medial lemniscus (DCML) pathway.

True or False: Visual symptoms in MS usually lead to permanent disability.

False; they typically resolve.

List two visual symptoms commonly reported in MS.

Optic neuritis and eye movement abnormalities.

What cranial nerves can be screened to assess deficits in speech/swallowing?

Cranial nerves 9 and 10 (glossopharyngeal, vagus).

List five psychosocial or emotional symptoms frequently experienced by people with MS.

Depression, anxiety, pseudobulbar affect, apathy, and denial/aggression.

What is the most frequently reported bowel symptom in people with MS?

Constipation.

True or False: MS rarely affects sexual function.

False; sexual dysfunction occurs in a high percentage of men and women with MS.

What is a defining characteristic of fatigue in MS compared to fatigability?

Fatigue is a subjective feeling of being tired, while fatigability is an objective measure of how quickly someone gets tired.

Which medication is used to treat acute relapses of MS?

High dose corticosteroids (methylprednisolone).

What is the purpose of disease-modifying therapeutic agents in MS?

To prevent future disease activity by reducing relapses and new lesions.

List the methods of administration for disease-modifying medications in MS.

Injection, oral, and IV infusion.

What should physical therapists monitor regarding medications used in MS?

Adverse drug reactions and signs of ineffective response to current medication.

What are the recommended precautions when implementing an exercise program for people with MS?

Avoid overwork fatigue, manage core temperature, and avoid moderate/vigorous intensities during active RRMS.

True or False: Exercise training has been shown to increase the risk for relapses in people with MS.

False; exercise training is beneficial.

Which gender is more commonly affected by multiple sclerosis?

Women.

Aside from gender, what biological factor increases the risk of developing MS?

Genetic predisposition.

What ethnic group has a higher incidence of multiple sclerosis?

Caucasians.

What neurological imaging technique is commonly used to support an MS diagnosis, often with contrast?

MRI with Gadolinium or Flair image.

What specific finding in cerebrospinal fluid (CSF) can support an MS diagnosis?

Oligoclonal bands.

Which sensory assessment technique involves examining specific nerve distributions on the skin?

Dermatomes.

What assessment technique is used by physical therapists to evaluate proprioception in people with MS?

Joint position sense testing.

How can a physical therapist assess vibratory sensation in a person with MS?

Using a tuning fork assessment.

What vision problem in MS is characterized by inflammation of the optic nerve?

Optic neuritis.

Besides optic neuritis, what other visual issues are commonly reported in MS?

Eye movement abnormalities (e.g., nystagmus, internuclear ophthalmoplegia).

What common emotional symptom in MS is characterized by uncontrollable, inappropriate laughing or crying?

Pseudobulbar affect.

What is a frequently reported psychological symptom in people with MS that involves a persistent feeling of sadness or loss of interest?

Depression.

What method of administering disease-modifying medications in MS involves self-injection?

Injection.

Which administration route for disease-modifying medications in MS involves taking pills?

Oral.

What method of administering disease-modifying medications in MS involves a medical professional delivering the drug directly into a vein?

IV infusion.

What type of fatigue should be specifically avoided when implementing an exercise program for people with MS?

Overwork fatigue.

What physiological factor needs to be carefully managed during exercise for individuals with MS?

Core temperature.

When should individuals with active relapsing-remitting MS avoid moderate to vigorous exercise intensities?

During active relapses (or active RRMS).

What is the primary characteristic of neurodegeneration in the context of MS?

Irreversible neuronal damage and loss.

Which cranial nerve, when screened, helps assess speech and swallowing deficits in MS and is known as the glossopharyngeal nerve?

Cranial nerve 9.

Which cranial nerve, when screened, helps assess speech and swallowing deficits in MS and is known as the vagus nerve?

Cranial nerve 10.

How do high-dose corticosteroids primarily act to treat acute MS relapses?

They reduce inflammation in the central nervous system to lessen the severity and duration of the relapse.

What benefits can individuals with MS gain from regular exercise training?

Improved strength, endurance, balance, gait, functional mobility, and quality of life.

List two key strategies physical therapists use to help manage fatigue in people with MS.

Energy conservation techniques and activity pacing.

What are some practical interventions to help manage core temperature during exercise for individuals with MS?

Utilizing cooling vests, performing exercise in cooler environments, and ensuring proper hydration.

What common balance deficit is characterized by incoordination of voluntary movements in people with MS?

Ataxia.

List two types of balance exercises beneficial for individuals with MS.

Static balance activities (e.g., standing unsupported) and dynamic balance activities (e.g., walking on uneven surfaces, Tai Chi).

What are common gait deviations observed in people with MS due to weakness or spasticity?

Foot drop, scissoring gait, or ataxia.

Name two physical therapy interventions specifically aimed at improving locomotor function in MS.

Gait training with assistive devices or body-weight supported treadmill training and functional electrical stimulation (FES) for foot drop.

What is a primary benefit of regular aerobic exercise for individuals with MS, beyond cardiovascular health?

Reduction in fatigue.

What method can be used to monitor aerobic exercise intensity for people with MS, particularly when heart rate response may be blunted?

The Borg Rating of Perceived Exertion (RPE) scale or the Talk Test.

What types of pain are commonly experienced by individuals with MS?

Neuropathic pain, musculoskeletal pain, and spasticity-related pain.

Describe how neuropathic pain related to MS is often characterized.

Burning, tingling, sharp, stabbing, or electric-shock-like sensations.

What common facial pain condition is associated with MS?

Trigeminal neuralgia, often caused by demyelination of the trigeminal nerve pathway.

What are common types of bladder dysfunction experienced by individuals with MS?

Urgency, frequency, nocturia, and incomplete bladder emptying (retention).

What is the primary cause of bladder dysfunction in MS?

Demyelination of nerve pathways that control bladder function.

What is a common strategy for managing bladder urgency and frequency in MS?

Timed voiding schedules and fluid management.

Besides constipation, what other bowel issues can be experienced by individuals with MS?

Fecal incontinence and diarrhea.