Week 2 Neuro Summary PDF

2.4 examination-MS like all pts a thorough examination is required for pts w MS test and measures: cognition and psychosocial fxn outcome measures for cognition 1. (MECFIMS) important to consider: *scheduling -speed and working memory -learning and memory ask pt what type/time of day -executive fxn...

2.4 examination-MS like all pts a thorough examination is required for pts w MS test and measures: cognition and psychosocial fxn outcome measures for cognition 1. (MECFIMS) important to consider: *scheduling -speed and working memory -learning and memory ask pt what type/time of day -executive fxn is best for them to avoid -visual spatial processing fatigue tests and measures: sensation and pain sensation outcome measures nottingham sensory assessment monofilament testing -both not validated but still used for info of sensation -word retrieval be cognizant of presentation and how long your evalv is visual analog scale pain mcgill pain questionnaire neuropathic pain scale brief pain inventory VAS and these 3 pain scales used to quantify pain and sensation *WE NEED to know monofilament test, VAS and Mcgill pain provides 2 specific domains focused on cognitive processing via: fatigue is a BIG factor when working w MS pts minimal examination of cognitive fxn in MS more for speech and language patho and not PT 2. mini-mental state examination (MMSE) comprised of a list of q’s and activities that pts fulfill w points devoted to each q’s comprised of things like: -spelling ‘world’ backwards -completing sentence w no ifs, ands or buts -drawing shapes that intersect results varying levels of cognitive impairment psychosocial fxn 1. MS quality of life scale pts may present w behavioral or depressive symptoms pseudobulbar affect emotional ability- occurs when an individuals are unable to control emotions w symptoms like laughing or crying uncontrollably presentations can also include: euphoria, depression, anxiety questionnaire tests and measures: neuro and msk neuro tests CN integrity: CN 2,3,5,4,6,9,12 for visual, gag reflex (9), dysphasia (12) -vestibular cochlear nerve bc vestib symptoms vision -for accommodation to light, blurred/double vision, saccades and nystagmus modified ashworth scales: tonal abnormalities DTR: babinski reflex vestibular screen; vestibular deficits msk tests ROM strength: MMT or dynamometry -may not be telling bc they can score well on MMT but have weakness during fxnal activities test and measures: fatigue and temperature fatigue modified fatigue impact scale (MFIS): used to measure how fatigue impacts cognitive, psychological and motor abilities in pts fatigue scale for motor and cognitive fxns visual analog scale temperature: pts have sensitivity to heat uhthoffs phenomenon: 60-80% of pts- increases in core body temp can trigger symptoms to worsen -disorder thought to occur due to decreases in conduction velocity of neuronal circuitry related to temp important: facilities of exercise or aquatic environment have to be a good temp so pts dont get too hot -cold can exacerbate symptoms pseudoexacerbation symptoms are transient and last less than 24 hrs measurement w thermometer recommended in cases where pseudo-exacerbation and exacerbation occur test and measures: balance outcome measures clinical test for sensory interaction and balance (CTSIB or M-CTSIB) berg balance score (BBS) tinetti POMA BESTest require testing to provide idea of fxn -helps get idea of fall risk in some outcome measures no outcome measures specific to MS test and measures: mobility gait and mobility time up and go temporal gait parameters 10MWT 6 min walk dynamic gait index (DGI) time 25 foot walk: very useful specifically for pts w MS MS walking scale (MSWS-12): self reported walking index- how much the individuals diagnosis has impacted walking ability t & m: general health and aerobic capacity general health health status questionnaire (SF-36): for ALL pts-info on general health -clinicians have difficult time distinguishing moderate and severe forms of MS w this aerobic capacity BORG rating and perceived exertion (RPE) dyspnea scale ❌ t & m: MS-specific expanded disability status scale (EDSS): gold standard in MS research graded based on 7 systems: pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual and mental -use 1/2 point scale- 0=no impairement to 10=death -ambulation focused on as primary indicator of disability MS quality of life-54 (MS-QOL 54): combine w SF-35 for MS -items ranked separately w subscales related to physical fxn: physical and emotional role limitations, pain, emotional, well being, energy, health perceptions, social fxn, cognitive fxn, health distress, QoL and sexual fxn MS QOL inventory (MSQLI): similar to ^^ goals come up diagnosis, prognosis then establish goals goals are specifically impacting disease itself encompass ABCDEF (what is this again??)- bc of ‘f’ we can write goals related to fxn can write goals for improving WB and alignment meaningful goals for our pts gait and transferability- more impactful for those in early stages impacts of disease dont write goals specific to decreasing relapses, etc QoL outcome measure goals body fxns/structures or impairment specific ROM pain dont write goals for decreasing spasticity activity based/fxnal goals should be emphasized include objective data: asses quality of motor fxn Summary Same general examination procedures MS-specific nuances Goals specific to Activity