Evaluation and Intervention in Neurodegenerative Conditions Pt. 2 – MS, GBS, HD

What does “Multiple” refer to in Multiple Sclerosis?

Dissemination across time and location of lesions and relapses.

What does “Sclerosis” mean in Multiple Sclerosis?

Scar tissue or plaques on axons and myelin that disrupt nerve conduction.

What happens when axons are transected in MS?

Permanent functional loss occurs.

What is demyelination?

Loss of myelin sheath causing impaired nerve signal transmission.

What is the most common neurological disease causing disability in young adults?

Multiple Sclerosis (MS).

How many people are affected by MS in the U.S.?

About 1 million people.

Who is more likely to have MS?

Women are 2–3 times more likely than men.

What is the mean age of MS diagnosis?

Around 32 years old.

What causes MS?

An autoimmune response triggered by environmental, genetic, or infectious factors.

What are the three primary clinical types of MS?

Relapsing-Remitting, Secondary Progressive, and Primary Progressive.

What is Relapsing-Remitting MS?

Periods of worsening symptoms followed by improvement and remission.

What is Secondary Progressive MS?

Starts as relapsing-remitting, then becomes continuous worsening.

What is Primary Progressive MS?

Continuous decline from onset without remission.

What is the most common symptom of MS?

Fatigue.

When is MS fatigue typically worse?

In the afternoon or with increased body temperature.

What is the most effective approach to manage MS fatigue?

Education and energy conservation programs.

What are the six types of fatigue in MS?

Primary, Secondary, Physical, Cognitive, Local/Focal, Generalized.

What factors contribute to MS fatigue?

Sleep disturbance, pain, stress, depression, deconditioning, medications, nutrition, or ambulation difficulty.

What causes weakness in MS?

Nerve fiber fatigue after repeated contractions.

What percent of people with MS experience cognitive impairments?

Up to 60%.

What are common cognitive deficits in MS?

Memory, attention, executive function, word-finding, and slowed processing.

What percent of people with MS report pain?

About 48%.

What is the difference between primary and secondary pain in MS?

Primary pain comes from the disease itself; secondary pain is due to posture, positioning, or gait.

How common is spasticity in MS?

84% experience it, usually in lower extremities.

What are medications used to manage MS spasticity?

Baclofen, Tizanidine, Botox, and Cannabis.

What is an intention tremor?

A tremor that worsens as the body part approaches a target.

What is ataxia?

Loss of coordination and balance during movement.

What causes dysphagia in MS?

Cerebellar or brainstem lesions.

What visual problem is common in MS?

Optic neuritis (blurred or double vision, eye pain).

What percentage of people with MS experience bladder or bowel issues?

Over 50%.

What percentage of people with MS experience sexual dysfunction?

About 60%.

What percentage of people with MS experience depression or anxiety?

Up to 50%.

How is MS diagnosed?

Through history, neurological exam, MRI, and cerebrospinal fluid analysis.

What are typical neurological findings in MS?

Weakness, hyperreflexia, positive Babinski, dysmetria, nystagmus, and impaired vibration sense.

What are Disease Modifying Therapies (DMTs)?

Medications that slow progression, reduce relapses, and decrease lesion formation.

What is the OT’s role in MS medical management?

Reinforce medication adherence, provide accurate information, and promote realistic hope.

When does MS typically occur in life?

During productive adult years, impacting work and family roles.

What are common OT assessments for MS fatigue?

Modified Fatigue Impact Scale and Fatigue Severity Scale.

What assessment evaluates endurance in MS?

6-Minute Walk Test.

What assessments measure mobility in MS?

MS Walking Scale and FIM mobility section.

What assessment screens for sleep issues in MS?

Pittsburgh Sleep Quality Index.

What assessment screens mood in MS?

Beck Depression Inventory–Fast Screen.

What cognitive assessments are used in MS?

MS Neuropsychological Screening and BICAMS.

What assessments test dexterity in MS?

Nine-Hole Peg Test and Purdue Pegboard.

What assessment tests sensation in MS?

Semmes-Weinstein Monofilaments.

What comprehensive measure is used in MS?

MS Functional Composite Measure.

What is the Comprehensive Fatigue Assessment Battery (CFAB-MS) used for?

Analyzing fatigue patterns in MS.

What are examples of OT interventions for MS self-maintenance roles?

Home safety, stretching, strengthening, time management, and technology use.

How does OT promote self-advancement roles in MS?

Support continued employment and adapt job expectations and environment.

What are examples of self-enhancement roles in MS OT?

Encouraging leisure and social participation using modifications and assistive tech.

What is a key education topic for managing MS fatigue?

Energy conservation and activity modification.

How can exercise help in MS?

Reduces fatigue and spasticity through aerobic and rhythmic movement.

What are cognitive compensation strategies in MS?

Using planners, digital aids, and stress management to address fatigue-related cognitive issues.

What are OT approaches to MS pain management?

Posture training, ergonomics, splinting, stretching, and workstation modification.

How does OT address tremor and ataxia in MS?

Proximal stabilization, adaptive tools, and orthoses.

What is emphasized in employment modifications for MS?

Flexible hours, telework, and rest areas.

What is the benefit of early OT referral in MS?

Maximizes adaptation and self-management.

What is Guillain-Barré Syndrome (GBS)?

An acute inflammatory demyelinating polyneuropathy causing muscle weakness and sensory loss.

What is the typical cause of GBS?

An immune response following infection (e.g., Campylobacter, Zika, flu).

What are the common onset peaks for GBS?

Ages 20–24 and 70–74.

Who is more likely to develop GBS?

Men (1.5× more likely).

What are early symptoms of GBS?

Rapidly ascending paralysis, pain, sensory loss, and absent reflexes.

What remains intact in GBS?

Cognition.

What is the mortality rate range for GBS?

1–10%.

How is GBS diagnosed?

Based on history, exam, nerve conduction studies, and CSF analysis.

What treatments are used for GBS?

IV immunoglobulin, plasma exchange, steroids, and mechanical ventilation.

What are the three phases of GBS?

Acute Inflammatory, Plateau, and Progressive Recovery.

What happens during the Acute Inflammatory phase of GBS?

Tingling/weakness progresses to paralysis; may need respirator.

What happens during the Plateau phase of GBS?

Max weakness, no change for days to weeks; monitor cardiac/respiratory issues.

What happens during the Progressive Recovery phase of GBS?

Recovery starts proximally and moves distally; may last 12 weeks or longer.

What are major functional effects of GBS?

Sudden paralysis, emotional distress, and loss of independence.

What is the long-term OT goal for GBS?

Return to pre-GBS functional level.

What is the short-term OT goal for GBS?

Optimize function within tolerance and prevent complications.

What are OT interventions in the acute and plateau phases of GBS?

Positioning, comfort, anxiety reduction, and communication modification.

What are OT interventions in the recovery phase of GBS?

Gradual ADL engagement, dynamic splints, transfers, desensitization, and fatigue management.

What is Huntington’s Disease (HD)?

A genetic neurodegenerative disorder causing motor, cognitive, and psychiatric decline.

What causes HD?

Mutation in the HTT gene leading to toxic huntingtin protein accumulation.

What is the inheritance pattern of HD?

Autosomal dominant with 50% chance of inheritance.

What brain areas are affected in HD?

Basal ganglia and cerebral cortex.

What are the main stages of HD?

Preclinical, Stage 1–2 (mild), Stage 3 (IADL loss), Stage 4–5 (dependent).

What are cognitive symptoms of HD?

Impaired memory, planning, and organization.

What are psychiatric symptoms of HD?

Depression, impulsivity, mania, and social withdrawal.

What are motor symptoms of HD?

Chorea, dystonia, bradykinesia, falls, fatigue, and seizures.

What tool is used to assess HD?

Unified Huntington’s Disease Rating Scale (UHDRS).

What are OT intervention priorities in HD?

Adaptive equipment, energy conservation, compensation for memory, and long-term planning.