Week 13.docx

Week 13 Multiple sclerosis (MS) sclerosis means plarquey outline breakdown down of myelin multiple sites of sclerosis inflammatory process autoimmune – body reacting to its own defences younger adult disease – particularly with females Statistics age of onset from 20-50 years in 85% of cases fema...

Week 13 Multiple sclerosis (MS) sclerosis means plarquey outline breakdown down of myelin multiple sites of sclerosis inflammatory process autoimmune – body reacting to its own defences younger adult disease – particularly with females Statistics age of onset from 20-50 years in 85% of cases female more than male Pathophysiology myelin sheath is attacked by the autoimmune system activated t cells recognise myeline proteins as foreign antigens and attack T cells lock into the myeline, and then release the interleukin and that starts to engulf the myeline as it assumes the myeline is foreign – autoimmune response in protection Antibody production makes this inflammatory response go quicker Relapsing remitting – autoimmune attack followed by periods of partial recovery Progressive MS– continuous, you don’t get the recovery Classification Relapsing – Remitting Most common New and worsening symptoms Can progress overtime Secondary progressive Gradual worsening of the disability overtime Primary progressive Least common and most aggressive Affects 10-15 people with MS Nerve cell structure and function Cell body located in the circular structure Synaptic dendrites Unipolar (direction of the axons) Myelin sheath – think of myeline as insulation around the nerve tissue Saltatory nerve conduction If you remove myeline then the electrical signal becomes impaired and damaged Sign and symptoms All symptoms can be exacerbated by heat (body heat and environmental) Fatigue Coordination, balance and muscle strength leading to difficulty walking Strength and power become reduced Numbness and tingling due to the impairment of the conduction along the nerve Gripping things difficulty (lifting them out of a chair, moving in and out of a car, gripping the steering wheel Spasticity Vision problems – optic nerve – sensitive to bright light – sometime painful Dizziness and vertigo – associated to disturbances with the brainstem Neuropathic pain – in facial and periphery Tremors – secondary tremor Location of lesions Myeline Anywhere there is big white tracks – white matter Optic nerves Heavily myelinated pathway in the brainstem – MLF- coordination of right and left eye Spinal cord – weakness of lower or upper limb or changes in periphery senses Cerebellum disturbances with lesions approximate to this area Clinical outcome instrument of MS Functional system scale – evaluate severity – 8 domains – scores on scale to 0-6 EDSS – questionnaire with 10 questions – 0-10 (10 meaning death by MS) Risk factors Age Gender – more likely in females – ma be associate to hormonal changes Genetics – first degree relative – risk is slightly higher Infections Low vitamin d levels – maintaining adequate sunlight may decrease risk of MS Ethnicity – northern Europe decent more common Geography – higher latitude areas (outside the equator) Smoking Obesity Other autoimmune disorders Summary Pt 1 Chronic, progressive demyelinating disease of CNS Link with low vitamin d level Affects areas of CNS where there is myeline High incidence of optic nerve being impacted causing blurring vision, pain etc Can affect brain stem causing nausea, vertigo etc Diagnosis and Assessment Combination of clinical tests Medical history – progression symptoms, past medical history etc Neuro exam – assess health of nervous system MRI Evoked potential response Cerebrospinal fluid analysis Blood tests McDonalds criteria – guideline to help diagnose MS – regularly updated Clinical course of MS Progressive relapsing – condition worsens over time but has relapses and slowly worsens over time Primary progressive – continuously gets worse over time Comorbidities Depression Anxiety Hypertension Fatigue – can lead to chronic fatigue syndrome and chronic pain Hyperlipidaemia Chronic lung disease Diabetes Ischemic heart disease Fibromyalgia Inflammatory bowel disease Sleep disorders – insomnia and sleep apnoea Cognitive impairments Treatment There is no cure Goal is to reduce / slow the effect of MS and treat symptoms Rehabilitation Immunotherapy with corticosteroids Supportive care Multidisciplinary care Not one shoe fits all Complex integration of many healthcare professionals Be cognitively aware that you are not the only one placing input into this client Benefits of exercise in MS Has no effect on disease progression Can improve overall QOL Cardiorespiratory capacity Muscular strength Flexibility Physical function Balance Mobility Mood Self-report fatigue Cognitive function Aerobic exercise Walking Swimming Cycling Dancing etc RT Weights RT tubes BW Flexibility and stretching Yoga Pilates Balance exercises Balance board Response to exercise Lower vo2 scores Improve mobility Improve strength Keep fatigue ability in mind Not the type of client you want to push through fatigue – it can take days to recover Exercise testing No gold standard test Balance testing such as functional reach, 360 tun, berg balance scale, char sit to stand are appropriate Cardio testing such as cycle ergometer, treadmill if safe etc Muscular strength testing you can complete 1RM but modify if significant weakness Goal for exercise Maximise physical function and reduce disability or at least slow progression of disability Recommendations for balance, mobility and gait training Static, dynamic and balance training during functional activities May include a variety of challenging activities such as bosu ball, large balls and so on Virtual reality usage is effective for therapeutics – younger clients more adaptable to this technology Recommendations for cardiorespiratory exercise programming 3-5 days per week 40-70% HRR or RPE 11-14 Increase time by 10 mins before increasing intensity Increase to 20-60 mins Recommendations for RT 2-3 days per week 40-80% of 1RM Initially 1-2 sets of 8-12 Recommendations for flexibility and joint ROM Long slow sustained stretches 5-7 days per week 1-2 times per day 30-60s hold 2-4 times All muscle groups Specifical considerations for exercise Individualise the assessment – assess symptoms, ability, strength, balance and overall functional capacity Heat sensitivity – ensure exercise environments are temperature controlled Fatigue consideration Safety Cognitive loads Balance and coordination – incorporate stability exercises to assist in making these better Progressive overload Summary Treatment aims to slow progression and reduce symptoms Goal of exercise is to enhance or maintain daily activity levels and/or functional capacity, mobility and QOL/mental health No exercise training specific guidelines for those with MS