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Definition
Chronic, progressive, demyelinating disease of CNS
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Etiology
- Unknown
- Most likely viral, autoimmune
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Characteristics
- Affects mostly young adults
- Demyelinating lesions (plaques) impair neural transmission, cause nerves to fatigue rapidly
- Variable symptoms
- Variable course with fluctuating periods -- exacerbations and remission progressing to permanent dysfunction
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Precipitating/Exacerbating Factors
- Infections
- Trauma
- Pregnancy
- Stress
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Transient Worsening of Symptoms
- Adverse reactions to heat
- Hyperventilation
- Dehydration
- Fatigue
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Categories
- Relapsing-remitting
- Primary-progressive
- Secondary-progressive
- Progressive-relapsing
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Relapsing-Remitting MS
- Characterized by relapses with either full recovery or some remaining neurological signs/symptoms and residual deficit on recovery
- Periods between relapses characterized by lack of disease progression
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Primary-Progressive MS
- Characterized by disease progression from onset
- Without plateaus or remissions or with occasional plateaus and temporary minor improvements
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Secondary-Progressive MS
- Initial relapsing-remitting course
- Followed by progressing at variable rate
- May also include occasional relapses and minor remissions
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Progressive-Relapsing MS
- Progressive disease from onset
- Without clear, acute relapses that may or may not have some recovery or remission
- Commonly seen in those who develop disease after 40 years of age
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Diagnostic Tests
- LP/CSF
- Elevated gamma globulin
- CT/MRI
- Myelogram
- EEG
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Examination
- History: symptoms, disease progression, functional deficits
- Cognitive/behavioral status: mild-mod cognitive impairment common, also euphoria, emotional dysregulation
- Communicaiton: dysarthria and scanning speech, dysphagia
- ROM, deformity: associated with disuse/inactivity
- Sensation: paresthesias, hyperpathia (hypersensitivity to sensory stimuli), dysthesias, trigeminal neuralgia, Lhermitte's sign
- Vision: diplopia or blurred vision, optic neuritis, scotoma (blind spot), nystagmus
- Skin integrity
- Muscle tone, DTRs: spasticity and hyeprreflexia (pyramidal tract lesions)
- Muscle strength and control: paresis common, spasticity
- Coordination: ataxia, intention tremors, dysmetria, dysdiadochokinesia
- Balance: vestibular involvement, vertigo, dizziness, unsteadiness, paroxysmal or sudden onset of symptoms
- Gait: ataxic
- Fatigue: number 1 complaint, common with high levels of activity or as day progresses
- Respiratory status
- Functional status: FMS, ADLs
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Lhermitte's Sign
- Electric shock-like sensation through the body
- Produced by flexing neck
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Standardized Tests and Measures
- Expanded Disability Status Scale (EDSS)
- Minimum Record of Disability (MRD)
- Modified Fatigue Impact Scale
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Medical Management
- Immunosuppressant drugs: treat acute flare-ups and shorten duration of episode
- Interferon drugs: slow progression of disease, decrease symptoms
- Symptomatic management of spasticity: baclofen, diazepam, baclofen pump, phenol block surgery
- Symptomatic management of urinary problems: anticholinergic drugs
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PT Goals, Outcomes, and Interventions
- Monitor changes associated with disease progression: signs of UTI, respiratory infection (common causes of death)
- Restorative goals: intensive, time-limited rehab designed to improve/stabilize pt status after relapse
- Functional maintenance goals: manage effects of progressive disease and prevent/minimize indirect impairments associated with disuse and inactivity
- Maintain ROM, prevent contractureMaintain skin integrityImprove respiratory functionImprove sensory awareness
- Improve strength/motor control/coordination
- Improve postural control and balance
- Locomotor training
- Independence in functional mobility skills and ADLs
- Promote max mobility in home and community
- Energy conservation techniques
- Avoid precipitating exacerbations
: schedule therapy sessions during optimal times for function, minimize fatigue, schedule rest and moderate exercise, avoid stress/overheating
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