MS Slides (Tuininga et al, 2024) PDF

SPECIFIC HEALTH CONDITION PRESENTATION: MULTIPLE SCLEROSIS PRESENTATION OUTLINE GENERAL OVERVIEW SYMPTOMS ETIOLOGY + INCIDENCE  TYPES OF MS Attack/Relapse: “the appearance of new symptoms, or the return of old symptoms, for a period of 24 hours or more...

SPECIFIC HEALTH CONDITION PRESENTATION: MULTIPLE SCLEROSIS PRESENTATION OUTLINE GENERAL OVERVIEW SYMPTOMS ETIOLOGY + INCIDENCE  TYPES OF MS Attack/Relapse: “the appearance of new symptoms, or the return of old symptoms, for a period of 24 hours or more” “Symptoms come over hours or days, stay for a number of weeks, and are usually over within a month. Can vary, from very short periods of only a few days, to many months.” (MS Society UK) Multiple Sclerosis - Scientific Figure on ResearchGate. CASE STUDY: WHERE DOES MARY FIT IN? ICF MODEL OVERVIEW Multiple Sclerosis Blurry Vision, Numbness, Tingling, Balance, Gait (walking & stair), Taking Transit Difficulty walking, Low strength Muscular Strength Weather Flare-ups: low vision & low Accessibility of Transit balance Temperature Overheating Side Effects from Medication MARY’S SYMPTOMS:  OTHER CHARACTERISTICS: (PHYSICAL, MENTAL, EMOTIONAL, SOCIAL) GENERAL CONDITION MANAGEMENT EFFECTS OF MS ON EXERCISE RESPONSE: EFFECTS OF MS ON EXERCISE RESPONSE: Multiple Sclerosis Physical Activity Limited mobility Relapses Temperature Overheating Accessibility Fatigue EFFECTS OF MS ON EXERCISE RESPONSE:  EXERCISE GOALS FOR MANAGEMENT OF MS PHYSIOLOGICAL/NEUROMECHANICAL BENEFITS MARY’S EXERCISE GOALS 1. 2. 3. 4. ICF MODEL OVERVIEW Multiple Sclerosis Blurry Vision, Numbness, Tingling, Balance, Gait (walking & stair), Taking Transit Difficulty walking. Muscular Strength Weather Flare-ups: low vision & low Accessibility of Transit balance Temperature Overheating Side effects from medication  COMMON MEDICATIONS AND SIDE EFFECTS: Medication Use Potential Side Effect(s) Slows progression of disability Flu-like symptoms: muscle aches, fever, chills Interferon Beta-1a Decreases frequency of attacks and weakness (Avonex, Rebif, Plegridy) Reduce amount of brain lesions seen Pain/ reactions from injection Self- Injection on MRIs for relapsing forms of MS. Delays onset of CDMS for at risk. Reduce frequency of attacks for RRMS Redness, pain and swelling and Slow progression of disability and discolouration at injection site, Interferon Beta-1b reduce frequency of attacks for Flu-like symptoms, (Betaseron) secondary-progressive MS Depression, anxiety, depersonalization, To delay progression of CDMS for suicide attempts. those at risk Injection site reaction Decrease frequency of MS attacks and/or depression under skin. Glatiramer Acetate Reduce number of active brain lesions Immediate postinjection reaction (Copaxone, Glatect) seen on MRI scans Rash, hives, headache, anxiety, Chest pain, muscle stiffness  COMMON MEDICATIONS AND SIDE EFFECTS: Medication Use Potential Side Effect(s) Flu, headache, diarrhea, back pain, cough. Reduces frequency of attacks Sinusitis, fungal infections, dizziness, migraine, Gilenya (Fingolimod) Delay progression of physical disability. weakness, skin rash, hair loss, itchy skin, weight For patients 10-18. loss, blurred vision, breathlessness, tingling or numbness, depression, eye pain. Tecfidera (dimethyl Reduce frequency of attacks and delay Flushing, stomach upset at initial use fumarate) progression of disability Diarrhea, nausea, flu or sinus infection, upset Decrease number of relapses and stomach, abdominal pain, rash, abnormal Aubagio (Teriflunomide) slows accumulation of disability liver tests, hair thinning/loss, abnormal blood tests Nausea, headache, cold sores, rash, hair loss, Immunoseppressant for RRMS to abdominal pain, toothache, flu/ cold Mavenclad (Cladribine) reduce frequency of attacks and delay symptoms, bronchitis/ chest infections, progression of disability gastroenteritis symptoms, back pain, anxiety.  MARY’S MEDICATIONS Medication Justification Use Long history of safe use First line of medication as she is Every other day, 250 mcg in diluting solution via Glatiramer Acetate recently diagnosed pre-filled self-injection Less extreme mental health side effects  EFFECTS OF EXERCISE TRAINING ON CONDITION: PHYSIOLOGICAL BENEFITS OF EXERCISE  EFFECTS OF EXERCISE TRAINING ON CONDITION: PHYSIOLOGICAL BENEFITS OF EXERCISE  EFFECTS OF EXERCISE TRAINING ON CONDITION: NEUROMECHANICAL BENEFITS OF EXERCISE  EFFECTS OF EXERCISE TRAINING ON CONDITION: PRIMARY RESEARCH ARTICLES THAT SUPPORT THIS:  EFFECTS OF EXERCISE TRAINING ON CONDITION: PRIMARY RESEARCH ARTICLES THAT SUPPORT THIS: RECOMMENDATIONS FOR EXERCISE PROGRAMMING BENEFICIAL & CONTRAINDICATED EXERCISES RECOMMENDATIONS FOR EXERCISE PROGRAMMING FUNCTIONAL EXERCISES RECOMMENDATIONS FOR EXERCISE PROGRAMMING 5 IN 5 RECOMMENDATIONS FOR EXERCISE PROGRAMMING SAFETY CONSIDERATIONS RECOMMENDATIONS FOR EXERCISE PROGRAMMING OTHER CONSIDERATIONS RECOMMENDATIONS FOR EXERCISE PROGRAMMING OTHER CONSIDERATIONS  MARY’S HYPOTHETICAL EXERCISE PLAN: Sun Mon Tues Wed Thurs Fri Sat 5 in 5 5 in 5 5 in 5 5 in 5 5 in 5 5 in 5 5 in 5 Lower-body Aquatic Lower-body resistance Yoga Fitness resistance Yoga (1 Rest Day Rest Day training (1 (optional) class (1 training (1 hour) hour) hour) hour)  CASE STUDY OVERVIEW: Mary’s MS will progress and she will become more disabled. Her goals are practical and functional, and serve to slow progression and increase her comfort and abilities. Mary will exercise as she is able, and she will take transit whenever she can. She will also be taking medication to slow the progression of her MS as much as possible. Thank You! REFERENCES:  REFERENCES: Andreasen, A., Stenager, E., & Dalgas, U. (2011). The effect of exercise therapy on fatigue in multiple sclerosis. Multiple Sclerosis Journal, 17(9), 1041–1054. https://doi.org/10.1177/1352458511401120 Boumlah, S., Duieb, O., Touil, T., Elhessni, A., & Mesfioui, A. (2024). Biological mechanisms and benefits of physical exercise in multiple sclerosis: A Review. Neuroscience and Behavioral Physiology. https://doi.org/10.1007/s11055-024-01708-5 Dalgas, U., Stenager, E., Jakobsen, J., Petersen, T., Hansen, H., Knudsen, C., Overgaard, K., & Ingemann-Hansen, T. (2010). Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Multiple Sclerosis Journal, 16(4), 480–490. https://doi.org/10.1177/1352458509360040 Halabchi, F., Alizadeh, Z., Sahraian, M. A., & Abolhasani, M. (2017). Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology, 17(1). https://doi.org/10.1186/s12883-017-0960-9 Hao, Z., Zhang, X., & Chen, P. (2022). Effects of different exercise therapies on balance function and functional walking ability in multiple sclerosis disease patients—a network meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health, 19(12), 7175. https://doi.org/10.3390/ijerph19127175 Latimer-Cheung, A. E., Pilutti, L. A., Hicks, A. L., Martin Ginis, K. A., Fenuta, A. M., MacKibbon, K. A., & Motl, R. W. (2013). Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: A systematic review to inform guideline development. Archives of Physical Medicine and Rehabilitation, 94(9). https://doi.org/10.1016/j.apmr.2013.04.020  REFERENCES: Máté, S., Soutter, M., Hackett, D., Barnett, M., Singh, M. F., & Fornusek, C. (2021). Pilot study of enhancing cardiorespiratory exercise response in people with advanced multiple sclerosis with hybrid functional electrical stimulation. Archives of Physical Medicine and Rehabilitation, 102(12), 2385–2392. https://doi.org/10.1016/j.apmr.2021.07.001 Mostert, S., & Kesselring, J. (2002). Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Multiple Sclerosis Journal, 8(2), 161–168. https://doi.org/10.1191/1352458502ms779oa MS Society. (n.d.). https://www.mssociety.org.uk/living-with-ms/physical-and-mental-health/staying-active/yoga-for-ms Treatments for multiple sclerosis. MS Canada. (n.d.). https://mscanada.ca/managing-ms/treatments-for-multiple-sclerosis WebMD. (n.d.). Exercise & multiple sclerosis: Workout ideas and safety tips. WebMD. https://www.webmd.com/multiple- sclerosis/multiple-sclerosis-exercise YogaJournal Editors. (2022, April 25). 5 yoga poses for people with multiple sclerosis (+ easy-to-hard variations). Yoga Journal. https://www.yogajournal.com/practice/yoga-sequences-level/beginners-sequences/5-yoga-poses-for-people-with-multiple- sclerosis/