Multiple Sclerosis (MS) Overview

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Questions and Answers

Which pathological process is central to the development of multiple sclerosis (MS)?

  • Gradual loss of dopamine-producing neurons in the substantia nigra.
  • Demyelination of nerve fibers in the central nervous system, leading to scar tissue formation. (correct)
  • The build-up of beta-amyloid plaques and neurofibrillary tangles within the brain.
  • Progressive weakening of skeletal muscle fibers due to reduced acetylcholine receptors.

Which of the following age ranges represents the typical onset of multiple sclerosis (MS)?

  • 5-10 years old
  • 20-40 years old (correct)
  • 60-80 years old
  • 70-90 years old

Which of the following factors is NOT generally considered to contribute to the development of multiple sclerosis (MS)?

  • Immunological factors
  • Environmental factors
  • Specific bacterial infection (correct)
  • Genetic predisposition

A patient presents with a single episode of neurological symptoms suggestive of MS. This is MOST consistent with which type of MS?

<p>Clinically Isolated Syndrome (CIS) (B)</p> Signup and view all the answers

Which of the following statements accurately describes Primary Progressive MS (PPMS)?

<p>It involves a slow accumulation of disability from the onset, without distinct relapses or remissions. (A)</p> Signup and view all the answers

Secondary Progressive MS (SPMS) is characterized by which of the following?

<p>A progressive worsening of symptoms with fewer relapses, often evolving from RRMS. (A)</p> Signup and view all the answers

Lesions associated with MS commonly affect which area of the central nervous system?

<p>The brain stem, cerebellum, and spinal cord (D)</p> Signup and view all the answers

Damage to which cranial nerve(s) is most likely to cause trigeminal neuralgia in a person with MS?

<p>CN V (D)</p> Signup and view all the answers

Which of the following symptoms is MOST characteristic of cerebellar involvement in MS?

<p>Intention Tremors (D)</p> Signup and view all the answers

Which gait pattern is commonly observed in individuals with multiple sclerosis (MS) due to muscle weakness and spasticity?

<p>Circumducted gait (A)</p> Signup and view all the answers

Which of the following is an exacerbating factor that individuals with MS should be educated to avoid?

<p>Exposure to heat (C)</p> Signup and view all the answers

During a massage for a client with MS, which technique should be approached with CAUTION?

<p>Deep techniques in areas of altered sensation (B)</p> Signup and view all the answers

A massage therapist observes a reddened, inflamed area over a bony prominence on a client with MS. What is the MOST appropriate course of action?

<p>Refer the client to their physician for evaluation. (C)</p> Signup and view all the answers

What is the MOST appropriate goal of massage therapy for a client experiencing spasticity due to MS?

<p>Decrease spasticity (B)</p> Signup and view all the answers

Which of the following homecare recommendations is MOST suitable for a client with MS experiencing balance and coordination issues?

<p>Movement rehabilitation programs like yoga or tai chi (D)</p> Signup and view all the answers

What is the recommended minimum duration of moderate-intensity aerobic activity per session for adults with multiple sclerosis?

<p>30 minutes (B)</p> Signup and view all the answers

According to the Canadian Physical Activity Guidelines, how many times per week should adults with multiple sclerosis engage in strength training exercises?

<p>Two times per week (C)</p> Signup and view all the answers

Why is resting at least one day between strength training sessions important, according to the guidelines?

<p>To allow muscles to recover (B)</p> Signup and view all the answers

Which perceived exertion rating on a scale of 1 to 10 best represents 'moderate intensity' for aerobic activities?

<p>5 or 6 (D)</p> Signup and view all the answers

Aside from weight machines, which of the following is a suggested option for strength training activities?

<p>Cable pulleys (B)</p> Signup and view all the answers

What recommendation is provided in the guidelines regarding the progression of physical activity for individuals with MS?

<p>Gradually increase duration, frequency, and intensity (C)</p> Signup and view all the answers

What is the primary objective of the Canadian physical activity guidelines for adults with multiple sclerosis?

<p>To achieve important fitness benefits (D)</p> Signup and view all the answers

According to the physical activity guidelines, which of the following activities would be considered an aerobic exercise option?

<p>Arm cycling (A)</p> Signup and view all the answers

Which statement reflects a key recommendation regarding the intensity of strength training exercises?

<p>The weight should allow barely finishing 10-15 repetitions safely. (C)</p> Signup and view all the answers

Which age group are these physical activity guidelines primarily designed for?

<p>Adults aged 18-64 years (B)</p> Signup and view all the answers

Flashcards

Multiple Sclerosis (MS)

Demyelination of nerves in the brain and spinal cord leads to scar tissue formation, disrupting nerve transmissions.

Relapsing-Remitting MS (RRMS)

The most common type of MS, characterized by unpredictable relapses (attacks) with new or worsening symptoms, followed by periods of remission.

Primary Progressive MS (PPMS)

Type of MS characterized by slow accumulation of disability without distinct relapses or remissions.

Secondary Progressive MS (SPMS)

Type of MS that begins as RRMS and transitions into a progressive worsening of symptoms with fewer relapses.

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Common lesion locations in MS

Inflammation and demyelination in the brainstem, cerebellum, and spinal cord.

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Optic Nerve (CN II) Symptoms in MS

Visual disturbances such as blurred vision, color blindness, visual field defects, and double vision.

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Trigeminal Neuralgia in MS

Severe facial pain due to lesions affecting the trigeminal nerve.

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Intention Tremors

Uncontrollable shaking movements that occur when trying to perform a task.

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Circumducted Gait

A gait pattern characterized by swinging the leg in a wide arc to clear the ground due to weakness or spasticity.

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MS - Exacerbating factors

Exacerbating factors include deficiencies, allergies, stress, overexertion, heat, fever, injury and emotional upset.

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Massage Contraindications for MS

Avoid prolonged or vigorous techniques, heat over large areas, and deep techniques in areas of altered sensation.

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Massage Treatment Goals for MS

Goals include increasing relaxation, decreasing pain and edema, maintaining tissue and joint health, addressing muscle imbalances, and reducing spasticity.

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Homecare Recommendations for MS

Diaphragmatic breathing, ADLs, movement rehab programs (yoga, tai chi), aerobic activities (swimming, walking), and modified weight training in a cool environment.

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Patient Education for MS

Patient education on tissue health, self-lymphatic drainage, cool hydrotherapy, and signs of gangrene.

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MS - Techniques to avoid

Techniques that can fatigue and vigorous work that increases SNS firing should be avoided.

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Aerobic activity recommendation. (MS)

Adults aged 18-64 years with multiple sclerosis should perform 30 minutes of moderate intensity aerobic activity, two times per week.

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Strength training recommendation. (MS)

Adults aged 18-64 years with multiple sclerosis should perform strength training exercises for major muscle groups, two times per week.

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Moderate-intensity physical activity

Activities performed at a level where you can talk, but not sing, during the activity.

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Gradual progression in aerobic activity

Gradually increase your activity to reach at least 30 minutes of aerobic exercise per session.

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Repetitions in strength training

Number of times you lift and lower a weight during a strength training exercise.

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Resistance in Strength Training

Aim for 10-15 repetitions in the last set, using a weight that challenges you safely.

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Rest between sets.

Take a break of 1-2 minutes between each set of strength training exercise.

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Rest between strength training sessions

Space workouts to allow at least one day of rest between strength training sessions, for muscle recovery.

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Study Notes

  • Canadian Physical Activity Guidelines for adults with multiple sclerosis.

Guidelines

  • Adults aged 18-64 with multiple sclerosis who have mild to moderate disability require at least 30 minutes of moderate intensity aerobic activity, twice per week to achieve important fitness benefits
  • Strength training exercises for major muscle groups are also needed, 2 times per week
  • Meeting these guidelines alleviates fatigue, improves mobility, and enhances elements of health-related quality of life.

Aerobic Activity Recommendations

  • Frequency: Two times per week
  • Can be combined with strength training activities on the same day
  • Rest muscles for at least one day between strength training sessions.
  • Intensity: Gradually increase activity to at least 30 minutes of aerobic activity per workout session.
  • Effort: Moderate intensity; a 5 or 6 on a scale of 10
  • Heart rate should increase
  • Should be able to talk, but not sing.
  • Examples:
    • Upper Body Exercises: arm cycling
    • Lower Body Exercises: walking, leg cycling
    • Combined Upper and Lower body exercises: elliptical trainer.
  • Other beneficial exercises: elastic resistance bands, aquatic exercise, calisthenics.

Strength Training Activity Recommendations

  • Frequency: Two times per week
  • Repetitions: Number of times you lift and lower a weight.
  • Aim for 10-15 repetitions of each exercise for one set, gradually increasing to 2 sets.
  • Resistance: Use a resistance (free weights, cable pulleys, bands, etc.) heavy enough to barely finish 10-15 repetitions of the last set safely
  • Rest for 1-2 minutes between each set and exercise.
  • Strength training activities for the upper and lower body using weight machines, free weights, and cable pulleys can be done.

Who are the Guidelines for?

  • Appropriate for adults (aged 18-64 years) with minimal to moderate disability from relapsing remitting or progressive forms of multiple sclerosis.

Getting Started

  • Consider consulting a health professional to determine appropriate physical activity types and amounts. Professionals include doctors, physiotherapists, and qualified exercise professionals.
  • For those physically inactive, performing activities at a lower intensity, frequency, and duration than recommended may still bring some benefit.
  • Gradually increase duration, frequency, and intensity to meet the guidelines.

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