This document discusses multiple sclerosis (MS), including its epidemiology, etiology, pathophysiology, clinical course, diagnosis, prognosis, and treatment. MS is a chronic inflammatory demyelinating disease of the central nervous system that affects young adults and has a relapsing-remitting course. It has autoimmune origins and causes focal lesions in the brain, spinal cord and optic nerves. Physical therapy for MS aims to manage symptoms like sensory issues, pain, weakness, balance problems and fatigue through exercises, education and addressing psychosocial needs.
2. CONTENTS
• Introduction and Epidemiology
• Etiology
• Pathophysiology
• Clinical course
• Diagnosis
• Prognosis
• Medical management
• Framework for rehabilitation
• CLINICAL DECISION MAKING
• PHYSICAL THERAPY INTERVENTION
3. Introduction
• Chronic inflammatory – Demyelinating disease of the central nervous
system
• Characterized by focal disturbance of function and a relapsing and
remitting course
• Great crippler of young adults
• Islands of sclerosis
• Dr. jean Cruvillier and jean Charcot
• Charcot Triad
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12. Epidemiology
• 15-50 years
• Peak at 30 years
• 2:1 - female and male ratio
• High frequency areas (30 to 80/100000)
• Medium frequency areas (10 to 20/100000)
• Low frequency areas (5/100000)
• Migration before 15 years
21. Exacerbating factors
• Viral or bacterial infections
• Cold, flu, urinary tract infections and sinus infection
• Disease of the major organ system
• Hepatitis, pancreatitis and asthma
• Life style stress
• Major: divorce, death, losing a job, trauma
• Minor: exhaustion, dehydration, malnutrition and sleep
deprivation.
22. Pseudo exacerbation
• Resolve with 24 hours
• Heat -Uthoffs phenomenon
• Sun exposure, hot muggy environment temperature and
hot bath
• Fever or prolonged exercise
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24. Primary Impairments
• Sensory deficits:
• Hypoesthesia, numbness and paresthesias
• Pain:
• Dyesthesias, optic or trigeminal neuritis, Lhermittes sign, chronic pain
• Visual deficits:
• Blurred or double vision
• Diminished acuity and loss of vision, scotoma, nystagmus
25. • Cognitive deficits:
• Memory or recall problem
• Decreased attention and concentration
• Diminished abstract reasoning
• Diminished problem solving and judgment
• Diminished speed of information processing and visual-
spatial abilities
• Emotional impairments:
• Depression, pseudo bulbar affect, anxiety
30. Pattern of symptoms
• Vary greatly from person to person
• Vary over time each individual affected
• First symptoms are usually transient
• Early symptoms are typically sensory and visuals
• Involves more than one functional components of CNS
35. CLINICAL DECISION MAKING
(PHYSICAL THERAPY)
• Examination
• Evaluation
• Diagnosis
• Prognosis and plan of care (POC)
• Implementation of POC
• Re evaluation
36. PHYSICAL THERAPY
EXAMINATION
• Patient/client history:
• Systems review:
• Test and measures:
• Cognition
• Affective and psychosocial function
• Sensation
• Visual acuity
• Cranial nerve integrity
• ROM
37. • Muscle performance
• Fatigue
• Temperature sensitivity
• Motor function
• Posture
• Balance, gait and locomotion
• Aerobic capacity and endurance
• Skin integrity and conditions
• Functional status
• Environment (home, community and work)
• General health
39. Disease specific measures
• Expanded disability status scale
• The minimum record of disability
• MS functional composite
• Multiple sclerosis quality of life
• MS quality of life inventory
• Functional examination of multiple sclerosis
• Multiple sclerosis impact scale
40. PHYSICAL THERAPY INTERVENTION
• Management of sensory deficits and skin care
• Management of pain
• Strength and conditioning
• Cardiovascular conditioning
• Flexibility exercises
• Fatigue management
41. • Management of spasticity
• Management of coordination and balance deficits
• Locomotor training
• Functional training
• Management of speech and swallowing
• Cognitive training
• Patient and care giver education
• Psychosocial issues
