MS Exam & Intervention

Where can plaques occur in the body when someone has MS?

• Myelinated areas of the CNS like…

  • Cerebral white matter

  • Brain stem

  • Cerebellar tracts

  • Optic nerves

  • Spinal cord

What impact may sensory dysfunction have on someone with MS?

• Increase likelihood of falls

• Increase chance of burns

• Increase wounds

What is the primary kind of pain in people with MS?

Neuropathic

What is Lhermitte’s sign?

A brief electric shock-like sensation down the spine that occurs with neck flexion toward the chest

What percentage of people with MS experience spasticity?

80%

What percentage of people with MS engage in the recommended amount of moderate-to-vigorous PA?

20%

What are some factors that can affect the presentation of spasticity on someone with MS?

• Sex

• Age

• Duration of MS

• Type of MS

• Disability due to underlying conditions

• Other MS symptoms

What are some things that can trigger spasticity in someone with MS?

• Temp/humidity

• Excessive PA

• Fatigue

• Stress

• Loud sounds

• Tight clothing

• Pain

• Physical dysfunction

• Infection

• Menstruation

What percentage of people with MS experience fatigue?

80%

The Modified Fatigue Impact Scale is part of what larger scale?

MS-QOL

What are the three types of fatigue looked at in the Modified Fatigue Impact Scale?

• Physical

• Cognitive

• Psychosocial

The higher someone’s score on the Modified Fatigue Impact Scale, the less of an impact fatigue has on function. True or false?

False! The higher the score, the more impact fatigue has on function

What is the primary reason someone with MS struggles with dizziness and impaired balance?

Demyelination of cerebellum or central vestibular pathways

In what direction do people with MS typically have the worse reactive stepping?

backward

What percentage of people with MS have a cognitive dysfunction?

35-65%

What phenotypes of MS typically have cognitive dysfunction?

All of em

What areas of cognitive function are most commonly impact in someone with MS?

• Information processing speed

• Episodic and working memory

• Executive functions

• Sustained and divided attention

• Visuospatial processing

Is explicit or implicit learning more commonly affected in someone with MS?

Explicit

What are some emotional/behavioral dysfunctions someone with MS could have?

• Depression

• Aggression

• Apathy

• Euphoria

• Lack of insight

• Adjustment disorders

• Compulsive disorders

What is the most common neuropsych symptom in MS?

Depression

In what types of MS is autonomic dysfunction more commonly seen?

• Progressive types

• When someone has more severe disability

What percentage of people with MS have bowel/bladder dysfunction?

80%

People with MS typically feel that their symptoms improve during pregnancy. True or false?

True

Do people with MS typically do worse in the heat or cold?

The heat

What is Uhthoff’s sign?

When someone gets warm, they experience a worsening of neurological symptoms

The twelve item MS walking scale looks at the impact of MS over how many weeks?

2 weeks

What are the 12 items on the twelve item MS walking scale?

• Walk

• Run

• Climb up/down stairs

• Standing

• Balance stand/walk

• How far able to walk

• Support use when walking indoors

• Support use when walking outdoors

• Slowed down walking

• Smoothness of walking

• Concentration when walking

MS is a fatal disease. True or false?

False!

The majority of people with MS become severely disabled. True or false?

False!

List some favorable factors for MS PT prognosis

• Female

• Onset before 40

• Initial symptoms are sensory only

• Only 1 CNS system involved at onset

• Fully recovery between exacerbations

• Absence or later onset of cerebellar symptoms

What are some unfavorable factors for a MS PT prognosis?

• Male

• Onset after 40

• Initial symptoms involve the cerebellum, mental functions, or urinary control

• Initial symptoms affect multiple body regions

• Frequent exacerbations or incomplete remissions

• Rapid progression

What are the different types of MS?

• Clinically isolated syndrome (CIS)

• Relapsing remitting MS (RRMS)

• Secondary progressive MS (SPMS)

• Primary progressive MS (PPMS)

What is clinically isolated syndrome (CIS)?

When someone has 1 episode of demyelination with symptoms and then they recover. Don’t go on to have anything else

What is the most common phenotype of MS? What percentage of people with MS have this kind?

Relapsing remitting MS (RRMS), 85%

Describe RRMS

When someone has an exacerbations of symptoms for a period of time that go away to a degree, come back, and go away to a degree again but not as much as the first time and on and on

What is secondary progressive MS (SPMS)?

RRMS that turns intro progressive MS

What percentage of people with MS have primary progressive MS (PPMS)?

10%

Describe PPMS

When someone’s MS symptoms continue to worsen overtime with no regression or plateau

What is the purpose of the Kurtzke Expanded Disability Status Scale (EDSS) and Functional Systems Score (FSS)?

Quantify the level of disability of someone with MS

What EDSS scores could someone have if they were fully ambulatory?

1-4.5

What EDSS scores could someone have if they had impaired ambulation?

5-9.5

What is the Disease Steps (DS) test?

Test that classifies a patient’s disability based on their performance on the 25 foot walk test

What can you do with someone in PT who is experiencing an acute exacerbation of MS?

Work on functional tasks (transfers, gait, stairs)

What are some benefits of doing exercise with someone with MS?

• Helps reduce symptoms (tertiary prevention)

• Has disease modifying effects (secondary prevention)

• Reduce the risk of developing MS (primary prevention)

Exercise can trigger MS exacerbations. True or false?

False

When it comes to PA and exercise, what should you try to get your patient to do every week?

150+ min/wk of exercise and/or 150+ min/wk of lifestyle PA

What is lifestyle PA? How much does someone need in a day at minimum?

Planned or unplanned leisure, occupational, or household activities that last at least 30 minutes that are moderate to vigorous in intensity

What is exercise?

Form of leisure-time PA with specific external objectives that is performed repeatedly over an extended period of time

Regular exercise can help manage someone with MS’ fatigue. True or false?

True!

What are some ways we can help reduce spasticity with PT?

• Active exercises (with spastic muscles as primary mover)

• Stretching

What are some ways we can help reduce ataxia in someone with MS with PT?

• Focus on relating controlled and coordinated movements

• Weighting limbs/trunk

• Incorporate coordination during balance/gait

• Extremity coordination tasks

What CN are purely sensory?

• CN I

• CN II

• CN VIII

What CN are purely motor?

• CN III

• CN IV

• CN VI

• CN XI

• CN XII

What cranial nerves are both motor and sensory?

• CN V

• CN VII

• CN IX

• CN X

What CN have no peripheral component, are CNS?

• CN I

• CN II

What CN are part of the PNS?

• CN III - XII

A cerebellar lesion could impact what CN?

• CN III

• CN IV

• CN VI

What is the function of CN I (olfactory)?

Smell

What is the function of CN II (optic)?

Vision

What is the function of CN III (oculomotor)?

• Eye movement

• Pupillary reflexes

What is the function of CN IV (trochlear)?

Superior oblique eye muscle innervation

What is the function of CN V (trigeminal)?

• Innervate muscles of mastication

• Sensation of the face

What is the function of CN VI (abducens)?

Innervate lateral rectus eye muscle

What is the function of CN VII (facial)?

• Tase for the anterior 2/3 of tongue

• Innervate muscles of facial expression

What is the function of CN VIII (vestibulococchlear)?

• Hearing

• Vestibular

What is the function of CN X (vagus)?

• Epiglottis innervation

• larynx innervation

• Parasympathetic innervation of internal organs

What is the function of CN XI (accessory)?

• Trap innervation

• SCM innervation

What is the function of CN XII (hypoglossal)?

• Innervation of tongue muscles

If an UMN innervating the face had a lesion, where would you see damage?

Contralateral lower face

If CN III is damaged, how would the eye look at rest?

Slightly depressed and rotated medially

If CN IV is damaged, how would the eye look at rest?

• Elevated

How can you screen CN I?

Ask if they’ve had any changes in smell

How can you screen CN II?

• Have them reading some close and far

• Ask how many fingers ya got holding up (one eye at a time)

• Eye light thingy

How can you screen CN III, IV, and VI?

H test

How can you screen CN V?

• Palpate masseter

• Light touch of 3 branches

How can you screen CN VII?

Look for facial asymmetries with smile, frown, eyes closed, raised eyebrows, etc.

How can you screen CN VIII?

Rub test

How can you test CN X?

See if they have any voice hoarseness

How can you screen CN XI?

Have em shrug their shoulders

How can you screen CN XII?

Have em stick out their tongue