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Multiple Sclerosis

Terms in this set (28)

A chronic progressive demyelinating disease of the CNS affecting mostly young adults is:
MS
Relapsing-remitting MS
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
Primary Progressive MS
steady increase in disability without attacks --> from the very beginning of dx patient will start to deteriorate
Secondary Progressive MS
initial relapsing-remitting MS that suddenly begins to have decline without periods of remission (with or without acute attacks)

(so think of secondary progressive as starting like relapsing remitting type then changing to primary progressive thereby the name is secondary progressive)
Progressive-relapsing MS
Characterized by progressive disease from onset but without clear, acute relapses that may or may not have some recovery or remission

--> it starts out just like primary progressive MS except it has occasional acute attacks in which the disease will progress
__________ is known as the first episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs; can progress to relapsing remitting
clinically isolated syndrome
___________ is characterized by slurred or poorly articulated speech with low volume, unnatural emphasis and slow rate. _________ is poor coordination of the tongue and oral muscles which make swallowing difficult.
a. dysarthria; dysphasia
b. dysphasia; dysarthria
c. dyphagia; dysarthria
d. dysarthria; dysphagia
D .... also note: dysphonia is characterized by changes in vocal quality including horesness, breathiness, or hypernasal sounds
Which of the following is a sensory change in MS?
a. parasthesia
b. hyperpathia
c. dysesthesia
d. trigeminal neuralgia
e. all the above
E ... also Lhermittes sign is common (electric like shock sensation throughout the body when flexing neck)
What is Uthoff's symptom?
Anything that raises the body temp (and can lead to a pseudo MS attack) --> sun exposure, hot muggy environment, hot bath, fever, prolonged exercise
T/F Internuclear opthalmoplegia (INO) produces incomplete eye adduction on thr affected side and nystagmus of the opposite abducting eye with gaze to one side. It is caused by demyelination of the pontine medial longitudinal fasciculus
True
Patients with corticospinal lesions demonstrate signs and symptoms of ________ syndrome
a. UMN
b. LMN
c. palsy
d. paresis
A --> paresis, spasticity, brisk tendon reflexes, involuntary flexor/extensor spasms, clonus, Babinski, cutaneous reflexes, loss of precise autonomic control are all UMN involvement
T/F In some cases spasticity can be beneficial with MS
True --> for some patients, spasticity can be beneficial to sittting and standing
Which of the following can affect spasticity?
a. fatigue
b. stress
c. overheating
d. infection
e. all the above
E --> also a noxious stim
Which of the following is the most likely sign of aspiration pna?
a. cyanosis
b. yelping and crying
c. horseness in the voice quality
d. wet voice with gurgling sounds of congestion
e. chills and shaking
D --> also fever .... this is a serious complication with MS that can develop is foods or liquids are inhaled into trachea
T/F There are no cognitive changes that occurs with MS
False --> about 50% will experience cognitive impairments --> short term memory loss, attention/concentration difficulties, information processing, executive functions, abstract reasoning, problem solving, visuospatial functions, verbal fluency
A small spastic bladder with MS would mean:
a. failure to store
b. failure to empty
c. dyssynergistic
d. all the above
A
A large flaccid bladder with MS would mean:
failure to empty or dyssynergic bladder --> represents a problem with coordination between the bladder contraction and sphincter relaxation ... symptoms include urinary urgency, urinary frequency, hesistancy in starting, nocturia, dribbling and incontinence
Emptying dysfunction with large residual urine volume increases the risk of:
a. pain with urination
b. UTI
c. spasticity
d. all the above
B --> also kidney damage
Sedentary or inactive persons who are dependent on w/c often develop tightness in which of the following muscles?
a. hip flexors
b. adductors
c. hamstrings
d. plantarflexors
e. all the above
E --> note the use of orthosis or dynamic splinting is an appropriate option for prevention
Limited overhead ROM is seen with tightness in which of the following muscles?
a. pec major
b. pec minor
c. lat dorsi
d. all the above
D --> this is associated with a slumped, forward posture
Which of the following symptoms would help you recognize MS fatigue vs. normal response to exercise fatigue?
a. thermal stress
b. heart rate increase
c. sweating
d. muscle pain
e. all the above
A --> MS fatigue is often associated with thermal stress, which can be offset with adequate rest and the use of cooling ad precooling treatments during exercise
What is activity pacing?
Refers to the balancing of activity with rest periods interspersed throughout the day --> for patients with chronic fatigue, rest activity ratios are developed, with periodic rests planning in advance. Time outs with complete rest should be instituted if an activity becomes exhaustive
Although spasticity varies greatly from person to person, muscles that typically demonstrate strong tone include the antigravity muscles. In the LE this might include:
quads, hip adductors, plantarflexors (vs. in the UE its the elbow, wrist and finger flexors with spastic shoulder adductors)
T/F Topical cold or hydrotherapy can temporarily reduce spasticity by decreasing tendon reflex excitability and clonus by slowing conduction of impulses in nerves and muscles
True --> the effects of cryotherapy are relatively short lived, although some patients may experience enhanced ability to move that lasts for minutes to hours

Note: Cold therapy is contraindicated for patients with intact sensation that react to the unplesant sensation of cold with fight or flight (inc. HR, RR, nausea)
Which of the following is not a good technique to be used during the initial stages of MS for improving ROM?
a. stretching with rhythmic rotation
b. hold relax active contraction PNF
c. contract relax active contraction PNF
d. slow reversal PNF
e. maintained stretch for 30 min to 3 hours
D
Maintained stretches can be achieved by all of the following except ?
a. tilt table standing with toe wedges
b. low load weights applied using skin traction
c. serial casts
d. air splints
e. ballistic type stretching
E --> contraindicated to have any fast type stretching .... note: parents and family should be taught stretching exercises as part of HEP
Emphasis on contracting ___________ muscles can assist through mechanisms of reciprocal inhibition
antagonist .... E-stim of muscles antagonist to the spastic muscles can also be used to decrease spasticity
Which of the following exercises would be most likely to reduce proximal extensor tone?
a. weight bearing mini squats against wall
b. quadruped opposite arm/leg reaching
c. lower trunk rotation in hooklying
d. calf raises
e. hamstring stretching
C --> can also position pt. in hook lying with PB under the flexed legs and gently rock the ball back and forth --> moving from quadruped to side sitting can also be effecting in reducing extensor tone in some patients as the activity combines LTR with prolonged inhibitory pressure on quads
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