44 Questions
What percentage of people with RRMS transition to secondary progressive MS (SPMS)?
90%
What is a characteristic of secondary progressive MS (SPMS)?
Relapses may occur early but gradually lessen over time
What is a feature of primary progressive MS (PPMS)?
Progression results in a gradual worsening of symptoms without relapses
What is radiologically isolated syndrome (RIS)?
A group of individuals with no clinical manifestations of MS but with abnormal MRI findings
What is the age range when people are typically diagnosed with primary progressive MS (PPMS)?
Late 30s to early 40s
What is a feature of brain tissue in people with secondary progressive MS (SPMS)?
There is a greater amount of brain atrophy
What is the natural history of relapsing-remitting MS (RRMS)?
Attacks normally occur with a frequency of one or two per year
What is the approximate percentage of people with radiologically isolated syndrome (RIS) who develop MS within 5 years?
30%
Where can lesions affect the vestibular system in people with MS?
All of the above
What is used to assess dynamic balance in people with MS?
Functional Reach Test
Which test is used to assess static balance in people with MS?
Single-leg stance test
What is assessed in the daily pattern of fatigue in people with MS?
All of the above
What is used to formally assess fatigue in people with MS?
Fatigue Severity Scale (FSS)
What is measured when assessing gait in people with MS?
All of the above
What was Mrs H's major concern after being diagnosed with MS?
Fatigue and anxiety about caring for her children
What is benign paroxysmal positional vertigo (BPPV) related to?
Peripheral vestibular dysfunction
What can cause overall excessive tiredness in people with MS?
Central fatigue
What was the purpose of the 3-day diary given to Mrs H?
To self-assess her fatigue
Who was involved in planning Mrs H's treatment and daily routine?
Mrs H, her husband, and the professional care team
What was the result of Mrs H's self-assessment of fatigue?
A distinct pattern of fatigue
What was the time of day when Mrs H was most active?
Morning
What was the role of the health visitor in Mrs H's treatment plan?
Helping to plan her daily routine
Why was Mrs H's physician informed about her neurological management program?
To keep them informed of her progress and address any queries
What tests were used to assess Mrs H's balance and mobility?
BBS and TUG tests
What is the primary goal of physical therapy treatment for the patient in the case study?
To improve mobility and balance
What is the typical age range for the peak incidence of MS?
20-40 years
What is the name of the disease that the patient in the case study is diagnosed with?
Secondary Progressive MS
What is the role of the physical therapist in managing MS?
To assess, treat, support, and educate patients and their families
What is the characteristic of MS symptom presentation?
Inconsistent within an individual and from one attack to another
What is the term used to describe the formation of sclerotic plaques in the brain and spinal cord in MS?
Sclerosis
What is the impact of MS on the patient's quality of life?
It decreases the patient's quality of life
What is the primary cause of neurological disability in young and middle-aged adults?
Multiple sclerosis
What is the focus of the physical therapist's approach to managing MS?
On the whole person and their context of personal and family life
What is the characteristic of the disease course in MS?
Unpredictable and variable
What is the most common symptom of Multiple Sclerosis?
Fatigue
What is the characteristic abnormality caused by a lesion of the medial longitudinal fasciculus?
Internuclear ophthalmoplegia
What is the effect of heat on fatigue in Multiple Sclerosis?
Worsens fatigue
What is the term for the worsening of symptoms with exercise and increased temperature in Multiple Sclerosis?
Uhthoff's phenomenon
What is the criteria for a clinically definitive diagnosis of Multiple Sclerosis?
History of two attacks and clinically evidence of two separate lesions
What is the most disabling symptom of Multiple Sclerosis?
Fatigue
What is the common presenting complaint of visual symptoms in Multiple Sclerosis?
Diplopia
What is the effect of a lesion in the brain stem on Multiple Sclerosis symptoms?
Diplopia, trigeminal neuralgia, nausea, and nystagmus
What is the characteristic of Uhthoff's phenomenon?
It is a temporary worsening of symptoms that resolves after returning body temperature to normal
What is the prognosis of Multiple Sclerosis related to?
Greater number of relapses in the first 2 years postdiagnosis
Study Notes
Case Study: Mrs. H
- Mrs. H, a 30-year-old woman, experienced a relapse of her multiple sclerosis (MS) 11 years after diagnosis, resulting in flaccid paralysis, urinary incontinence, and sensory deficits.
- She was referred to a neurological rehabilitation team with expertise in MS.
- Mr. and Mrs. H were seen together as a team, and they were willing to work with the professional staff to participate in decisions and planning of treatment.
Initial Assessment
- Mrs. H was judged to have mild disability due to her MS.
- Her major concerns focused on her fatigue, loss of sensation, and anxiety about being able to care for her new baby and meet the demands of her 3-year-old child.
- Mrs. H was provided with information booklets and given the contact address and telephone number of the MS Society.
- She was given a simple 3-day diary to use as a self-assessment of her fatigue (FSS).
Initial Treatment Program
- A distinct pattern emerged from her self-management of fatigue.
- The physiotherapist, together with Mrs. H and her health visitor, worked out a daily routine where most activity occurred in the morning.
- Mrs. H received outpatient physiotherapy (PT) twice a week, focusing on balance and functional activities, lower limb (LL) range of motion (ROM) exercise, and gait re-education.
Important Points
- 11 years after diagnosis, Mrs. H experienced a relapse of her MS.
- Relapses are unpredictable and can have a significant impact on patients and their families.
- Assessment revealed severe ROM loss and hypertonicity in LL extensor groups.
- Assessment also revealed abnormal posture and balance transfer problems.
- Treatment focused on exercise, stretching, and gait re-education to improve mobility and balance.
What PTs Should Know About MS
- Definition: A chronic, debilitating, demyelinating disease of the central nervous system (CNS).
- Pathology: Autoimmune disease resulting from dysregulation of the immune system.
- Etiology: Unknown, but peak incidence is between 25 and 35 years of age.
- Clinical manifestations: Heterogeneous, depending on plaque location, and can include fatigue, weakness, spasticity, sensory impairments, pain, bladder or bowel dysfunction, tremor, incoordination or ataxia, sexual dysfunction, and disorders of emotion.
- Diagnosis: Clinically definitive diagnosis requires a history of two attacks and clinical evidence of two separate lesions.
- Prognosis: More aggressive forms of MS are related to a greater number of relapses in the first 2 years postdiagnosis, short intervals between first and second relapses, and incomplete recovery from first attack and poor recovery from relapses.
Assessing Impairments and Activity
- Balance: Can be assessed using the Berg Balance Scale, Functional Reach Test, and other tests that focus on stationary or static tasks.
- Fatigue: Can be assessed using the Fatigue Severity Scale (FSS), which measures the daily pattern of fatigue, times of the day when energy is high, and the functional impact of fatigue on everyday activities.
- Gait: Can be assessed by measuring gait speed and velocity, and by having the patient walk a given distance while being timed.
A case study of a patient with Multiple Sclerosis (MS) undergoing neurological rehabilitation. The patient, Mrs H, has residual loss of sensation and movement in her lower limbs. The study highlights the importance of teamwork and participation in treatment planning.
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