DPTD 862 - multiple sclerosis

immunologic etiology

• theorized that triggers (viral infection) induces delayed autoimmune attack in those w/ genetic susceptibility

• WBC (T-lymphocytes) → inflammation targeting myelin & oligodendrocytes

acute plaques contain…

immune cells/compounds & microglia

chronic plaques contain…

more extensive demyelination & some demyelination

infectious agents that can contribute to MS

• Epstein-Barr virus

• measles

• human herpes virus-6

• chlamydia

• pneumonia

diagnosis criteria

• evidence of damage in at least 2 separate areas of the CNS

• AND evidence the damage occurred at least a month apart

• AND rule out other diagnoses

motor symptoms

• paresis or paralysis

• spasticity

• fatigue

• impaired gait & balance

• ataxia

MS & spasticity

• caused by abnormal firing of the ascending & descending excitatory & inhibitory pathways in the CNS

• pain can exacerbate spasticity

• antigravity LE muscles are most commonly effected

visual symptoms

• diploid

• vision loss

• nystagmus

• dizziness

• lateral gaze palsy

speech & swallowing symptoms

dysarthria, dysphasia, & dysphasia

MS & fatigue

• reported by 75% of pt

• often precedes diagnosis

• can occur without warning

• physical, social, cognitive, emotional

MS & sleep dysfunction

• related to fatigue

• excessive limb movements, nocturnal, & pain are main symptoms that lead to disruption

• insomnia is a common compliant

MS & bowel/bladder dysfunction

• diarrhea & bowel incontinence

• urinary incontinence (due to spastic, flaccid, or dyssynergic bladder)

  • >50% of pts

clinically isolated syndrome

first episode of neurological symptoms, lasting at least 24 hours and are caused by inflammation or demyelination

does NOT need diagnosis criteria

relapsing remitting

• attacks of worsening neurological function followed by complete recovery or partial recovery with residual symptoms and a new baseline

• no progression between relapses

what qualifies a “new attack”

symptoms must last at least 24 hours & be separated from other symptoms by at least 30 days

secondary progressive

• disease will progress more steadily (not necessarily more quickly)

• periods of relapse may or may not occur

• median time between onset of progression to this type of- 11-19 years

primary progressive

• near continuous disease progression from onset

• may or may not be a period of plateaus of temporary improvements

• no distinct remission phases

active

with relapses and/or evidence of new MRI activity

worsening

confirmed increase in disability over a specified period of time following a relapse

with progression

evidence of disease worsening on an objective measure of change over time, with or without relapses

without progression

no progression over the past year

better prognosis

• younger age of onset

• complete recovery after first onset

• optic neuritis

worse prognosis

pyramidal & cerebellar signs at onset

medical management of acute relapses

• corticosteroids & ACTH - 3-5 day intravenous

• solution-medrol, decadron, deltasone, IVIG, HP acthar gel

disease modifying therapies

• reduce frequency & severity of exacerbations, MRI lesions, & progression of disability

• recommended to start early

• some have severe side effects

PT during an exacerbation

pt should NOT exercise until remission is evident

resistance training recommendations

• 15-8RM, 1-3 sets (progressing 3-4), 2-4 minute rest between sets, 2-3x/week

• whole body working from large to small muscle groups & multi to single joint movements

• prioritize LE

• circuit training alternating between UE & LE

• do NOT go until point of fatigue

aerobics exercise recommendations

• 3-5x per week on alternating days for 30-40 minutes

• low to moderate intensity (60-85% HR or 50-70% VO2max) & interval training are well tolerated

• 1 minute of work followed by 2-4 minutes of light work or rest

• can HIGT!

individuals with balance problems or sensory loss will require…

non-weight bearing activities

pain management

• depends on source

• treat MSK impairments w MSK interventions

• pressure stockings or gloves

• referral to pain clinic

respiratory muscle raining

• inspiratory muscle training - 3×15 per day

• significant improvement in max inspiratory pressure, FEV, FVC - but no change in fatigue

fatigue management

• MS related fatigue during exercise is often related to core-body overheating/thermal stress → cooling techniques

• activity & fatigue diary