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    Multiple Sclerosis: Saadia Perwaiz, PT BSPT, M. Phil-Msk

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    Arslan Aslam
    This document provides information about Multiple Sclerosis (MS), including its etiology, pathophysiology, clinical subtypes, common symptoms, diagnosis, and physical therapy management. MS is an autoimmune disease characterized by inflammation and demyelination in the central nervous system. It has four major clinical subtypes defined by patterns of relapse and progression. Physical therapy aims to manage symptoms like pain, fatigue, spasticity, and functional impairment through interventions like exercise, sensory retraining, pain relief techniques, and energy conservation strategies.

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    Multiple Sclerosis: Saadia Perwaiz, PT BSPT, M. Phil-Msk

    Uploaded by

    Arslan Aslam
    98 views39 pages
    This document provides information about Multiple Sclerosis (MS), including its etiology, pathophysiology, clinical subtypes, common symptoms, diagnosis, and physical therapy management. MS is an autoimmune disease characterized by inflammation and demyelination in the central nervous system. It has four major clinical subtypes defined by patterns of relapse and progression. Physical therapy aims to manage symptoms like pain, fatigue, spasticity, and functional impairment through interventions like exercise, sensory retraining, pain relief techniques, and energy conservation strategies.

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    A highly knowledge concept basis of Multiple Sclerosis

    Original Title

    Multiple Sclerosis

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    This document provides information about Multiple Sclerosis (MS), including its etiology, pathophysiology, clinical subtypes, common symptoms, diagnosis, and physical therapy management. MS is an autoimmune disease characterized by inflammation and demyelination in the central nervous system. It has four major clinical subtypes defined by patterns of relapse and progression. Physical therapy aims to manage symptoms like pain, fatigue, spasticity, and functional impairment through interventions like exercise, sensory retraining, pain relief techniques, and energy conservation strategies.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    98 views39 pages

    Multiple Sclerosis: Saadia Perwaiz, PT BSPT, M. Phil-Msk

    Uploaded by

    Arslan Aslam
    This document provides information about Multiple Sclerosis (MS), including its etiology, pathophysiology, clinical subtypes, common symptoms, diagnosis, and physical therapy management. MS is an autoimmune disease characterized by inflammation and demyelination in the central nervous system. It has four major clinical subtypes defined by patterns of relapse and progression. Physical therapy aims to manage symptoms like pain, fatigue, spasticity, and functional impairment through interventions like exercise, sensory retraining, pain relief techniques, and energy conservation strategies.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 39

    Multiple

    Sclerosis
    SAADIA PERWAIZ, PT
    BSPT, M. PHIL-MSK
    AKHTAR SAEED MEDICAL AND DENTAL COLLEGE
    Multiple Sclerosis

     An auto Immune Disease characterized by inflammation,


    selective demyelination, and gliosis.

     It causes both acute and chronic symptoms and can result in


    significant disability and impaired quality of life.
    Etiology

     Genetic
     Genetic susceptibility, an exposure to viral agent can induce
    an immune reaction causing myelin reactive lymphocytes to
    attack myelin sheath.

    Vitamin-d deficiency and smoking are


    considered as risk factors
    Pathophysiology:

    Slow neural Oligodendrocytes


    CD4, T-cells, B- Acute
    Demyelination transmission, survive in early
    cells, cross inflammation, phase , but with
    blood brain autoantigens and disruption of nerve fatigue,
    edema, progression anti-
    myelin sheath conduction inflammatory
    barriers infiltrates response weakens
    block

    GLIOSIS, BRAIN ATROPHY, LOSS OF AXONS AND MYELIN


    THROUGHOUT THE BRAIN.
    Four Major Clinical Subtypes
    of MS
    1. Relapsing-Remitting MS (RRMS)
     Characterized by discrete attacks of neurological deficits
    (relapse) with either full or partial recovery (remission) in
    subsequent weeks to months.
     The periods between relapses are characterized by lack of
    disease progression.
     85% of patients
    2. Secondary-Progressive MS
    (SPMS)
     Characterized by an initial relapsing-remitting course,
    followed by a change in clinical course with progression to
    steady and irreversible decline with or without continued
    acute attacks.
    3. Primary-Progressive MS
    (PPMS)
     Characterized by disease progression and steady functional
    decline from onset; patients may experience modest
    fluctuations in neurological disability but discrete attacks do
    not occur.
    4. Progressive-Relapsing MS
    (PRMS)
     Characterized by a steady deterioration in disease from
    onset (similar to PPMS) but with occasional acute attacks.
     Intervals between attacks are characterized by continuing
    disease progression.
    Common Symptoms in
    Multiple Sclerosis
     Sensory Symptoms
    • Hypoesthesia, numbness
    • Paresthesias
     Pain
    • Paroxysmal limb pain,
    • Headache
    • Optic or trigeminal neuritis
    • Lhermitte’s sign
    • Hyperpathia
    • Chronic neuropathic pain
     Visual Symptoms
    • Blurred or double vision (diplopia)
    • Diminished acuity/loss of vision
    • Scotoma
    • Nystagmus

     Cognitive Symptoms
    • Short-term memory deficit
     Bladder and Bowel Dysfunction
     Motor Symptoms
    • Paresis or paralysis
    • Fatigue
    • Spasticity, spasms
    • Ataxia: Inco-ordination, intention tremor
    • Postural tremor
    • Impaired balance and gait
     Depression and Anxiety
     Sexual dysfunction
     Speech and Swallowing
    • Dysarthria
    • Diminished verbal fluency
    • Dysphonia
    • Dysphagia
    Patterns of symptoms

     Varies greatly from person to person


     Varies over time in each individual affected
     First symptoms usually transient; typically sensory and
    visual
     Diagnosis involves evidence of damage occurring in at least
    two separate areas of CNS and at two separate points in
    time at least one month apart (dissemination of lesions in
    space and time)
    Stages

    3 stages

    Mild Moderate Severe


    Diagnosis

     MRI, demyelinating areas


     Lesions on MRI do not always correlate with clinical
    symptoms
     Evoked potential, visual, auditory, somatosensory areas
    showed evoked potentials
     Lumbar puncture CSF fluid raised IgG antibodies
    Management

    Management

    Medical Symptomatic
    Corticosteroids, Physiotherapy, Speech And Language
    DMARDS(Interferons) Therapists, Psychiatrist
    Physical therapy Examination

    Examination

    Systems and Tests and


    History
    reviews measures
    Physical therapy examination

    • Mini mental status examination


    Cognition • Minimum examination of cognitive function in MS

    • Superficial and deep sensations


    Sensation • Effects in relation with Quality of life scales

    • Anxiety, stress, depression


    Psychosocial function • Beck depression inventory

    Pain • VAS, Mc-Gill pain questionnaire, neuropathic pain scale

    •Gag reflex, dysphagia

    Cranial Nerve Integrity


    •Trigeminal neuritis
    •Occulo-motor Dyscontrol, optic nerve, nerve 3, 4 and 6 examination
    Musculoskeletal

    Neural Control
    Flexibility Motor function, Dexterity, Muscle performance, Strength,
    coordination, gross and fine power, endurance, performance Tone and reflexes, Modified
    Joint integrity, range of motion,
    motor movements during functional activity Ashworth scale, Deep tendon
    muscle strength
    reflexes
    Gait
    Postural alignment,
    6 Minute walk test, Respiratory function Integument
    Control and balance
    10- Meter walk tests

    Functional status
    Fatigue
    Functional Environmental
    factors Fatigue severity
    independence
    scale
    measures
    PHYSICAL THERAPY
    INTERVENTIONS
    1. Sensory and integumentary
    deficit management:
     Increase awareness of sensory deficits, compensate for
    sensory loss, and promote safety
     Visual compensation techniques
     Tapping, verbal cueing, and/or biofeedback
     Proprio-ceptive loading through exercise, light tracking
    resistance, resistance bands or weights, and the use of a pool
     Safety = adequate lighting, no obstacles, color contrast
     Double vision = placing a patch over one eye
     Pressure ulcers = Awareness, protection, and care of
    desensitized parts
     Regular pressure relief is essential… every 2 hours in bed
    and every 15 to 30 minutes when sitting in a wheelchair.
     Pressure-relieving devices (PRDs)
     Prevention = good nutrition and drinking plenty of fluids
     If nonblanchable skin redness develops (lasting longer than
    30 minutes), patients should be instructed to stay off the
    area until the redness disappears.
     If the redness does not disappear within 24 hours, the
    individual should seek medical attention.
    2. Management of Pain
     Relief of pain with regular stretching or exercise, massage, and ultrasound
     Stabbing pain from Lhermitte’s sign may be
    relieved with a soft cervical collar to limit neck flexion.
     Hydrotherapy or pool therapy using lukewarm water
     Pressure stockings or gloves can also be used to relieve pain, converting
    the sensation of pain to one of pressure.
     Neutral warmth
     Multidisciplinary pain clinic
    3. Exercise Training

     Meaningful physiological and psychological changes,


    improving function while lessening disability, and
    enhancing quality of life.
     Patients with RRMS who are experiencing an exacerbation
    should not exercise until remission is evident.
    3.1: Strength and
    Conditioning
     Exercise sessions should be scheduled on alternate days
     Carefully balancing exercise with adequate rest periods.
     Progression is generally slower than with healthy
    individuals.
     Exercising to the point of fatigue is contraindicated
    3.2. Aerobic Conditioning

     Sub-maximal aerobic exercise


     3 to 5 days/week, on alternate days
     Training intensity should be limited to 60% to
    85% HR peak or 50% to 70% peak VO2.
     Duration = 30 minutes per session or, for more involved
    individuals, three 10-minute sessions per day.
    3.3. Flexibility Exercises

     Stretching and ROM exercises are necessary to ensure


    adequate joint motion and to counteract the effects of
    spasticity
     Stretching and ROM exercises should be performed daily.
     For adequate stretching, holding at end range should be a
    minimum of 30 to 60 seconds repeated for a minimum of 2
    repetitions.
     Orthoses or dynamic splinting
    4. Management of Fatigue

     Energy Effectiveness Strategies (EES)


     Adequate rest and the use of cooling and pre-cooling
    treatments during exercise
     Energy conservation = modifying the
    task or modifying the environment
     Activity pacing refers to the balancing of activity with rest
    periods interspersed throughout the day.
    5. Management of Spasticity

     Mostly antigravity muscles


     Including cryotherapy, hydrotherapy, therapeutic exercise,
    stretching, positioning, or any combination thereof.
     Fast, ballistic stretching movements are contraindicated,
    because spasticity is velocity sensitive.
    6. Cerebellar deficits (ataxia,
    postural instability)
     Postural control should first focus on static control (holding)
    in weight-bearing, antigravity postures.
     Progression through a series of postures to gradually
    increase postural demands by varying the base of support
    (BOS), raising the center of mass (COM), and increasing
    the number of body segments moving.
     Progress to dynamic postural control
     The pool is an important therapeutic medium to practice static and
    dynamic postural
     Biofeedback training
     Involve functional activities
     Control of ataxic limb movements (tremor and dysmetria) can be achieved
    through proprioceptive loading and light resistance.
     PNF with light tracking resistance
     Resistance bands or light weights to stabilize movements.
     weight cuffs (wrist or ankle), weighted boots, or a weighted jacket or belt
    can reduce tremors of the limbs or trunk.
     Stress management techniques
    7. Locomotion
    8. Supportive role:

     Orthosis and assistive devices


     Functional training
     Speech
     Psychological issues
     Education

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