Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that results in inflammation and damage to myelin. It affects more than 2 million people worldwide. Common symptoms include visual impairment, sensory issues, motor difficulties, and fatigue. While the exact cause is unknown, genetic and environmental factors are believed to play a role. There is no cure for MS, but treatments can help reduce relapses and manage symptoms. Exercise and rehabilitation are also important for improving physical function and quality of life for those living with MS.
Pediatric multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that can affect children and adolescents under 18 years of age. While symptoms are similar to adult MS and include sensory deficits, optic neuritis, motor deficits and fatigue, diagnosis can be more challenging in children due to atypical presentations. The incidence is highest between 13-16 years of age and females are more commonly affected than males. Diagnosis involves evaluating clinical symptoms, MRI images showing lesions, and CSF analysis. Treatment involves disease-modifying drugs like interferons or corticosteroids for relapses.
This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system where the body's immune system attacks the protective myelin sheath surrounding the nerves. It most commonly affects people between 20-40 years of age. While the exact cause is unknown, genetic and environmental factors are thought to play a role. The four main types are relapsing-remitting MS, primary-progressive MS, progressive-relapsing MS, and secondary-progressive MS. Symptoms vary depending on the affected areas of the brain and spinal cord but may include vision issues, weakness, numbness, and problems with coordination and balance. Diagnosis involves neurological exams, MRI scans and analysis of cerebrospinal fluid
Multiple sclerosis is a disease where the immune system attacks the myelin sheath surrounding nerves. This damages communication between the brain and body and can eventually damage nerves themselves. Symptoms vary depending on location of damage and affected nerves, and include numbness, vision problems, tingling, fatigue, and more. Most people experience relapses followed by remissions. Eventually, about 60-70% develop steady progression of symptoms. The cause is unknown but is believed to be autoimmune, and risk factors include age, sex, family history, and certain infections. Diagnosis involves ruling out other conditions and may include MRI, spinal tap, and blood tests showing abnormalities associated with MS. Treatment focuses on reducing inflammation with steroids or plasma
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
This project was developed for a competitive intelligence company by mining data from the various information sources e.g. Company (News, Investor Section, SEC filings, Annual Reports, Presentations etc), Universities/Medical Schools/Organizations, Medical Affairs Companies, Non- Profit Medical Agency, Government Agencies, Drug Delivery Companies, Contract Manufacturing Organizations, Contract Research Organizations, Consultancies and Financial Institutions. The complete information available there complied into a single MS word document, listed in MS Excel and then by using MS publisher it was converted into the report which finally converted into PDF.
This document provides information on Multiple Sclerosis (MS), including its epidemiology, etiology, clinical presentation, diagnostic tests, disease course, and treatment options. MS is an immune-mediated disease that attacks the central nervous system, destroying myelin and axons. Common symptoms include visual changes, numbness, weakness, and balance issues. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and evoked potentials testing. The disease course varies between relapsing-remitting, primary progressive, and secondary progressive forms. Treatment focuses on reducing inflammation and disability through medications like interferon beta, glatiramer acetate, and natalizumab, as well as managing symptoms with drugs for pain,
Pediatric multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that can affect children and adolescents under 18 years of age. While symptoms are similar to adult MS and include sensory deficits, optic neuritis, motor deficits and fatigue, diagnosis can be more challenging in children due to atypical presentations. The incidence is highest between 13-16 years of age and females are more commonly affected than males. Diagnosis involves evaluating clinical symptoms, MRI images showing lesions, and CSF analysis. Treatment involves disease-modifying drugs like interferons or corticosteroids for relapses.
This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system where the body's immune system attacks the protective myelin sheath surrounding the nerves. It most commonly affects people between 20-40 years of age. While the exact cause is unknown, genetic and environmental factors are thought to play a role. The four main types are relapsing-remitting MS, primary-progressive MS, progressive-relapsing MS, and secondary-progressive MS. Symptoms vary depending on the affected areas of the brain and spinal cord but may include vision issues, weakness, numbness, and problems with coordination and balance. Diagnosis involves neurological exams, MRI scans and analysis of cerebrospinal fluid
Multiple sclerosis is a disease where the immune system attacks the myelin sheath surrounding nerves. This damages communication between the brain and body and can eventually damage nerves themselves. Symptoms vary depending on location of damage and affected nerves, and include numbness, vision problems, tingling, fatigue, and more. Most people experience relapses followed by remissions. Eventually, about 60-70% develop steady progression of symptoms. The cause is unknown but is believed to be autoimmune, and risk factors include age, sex, family history, and certain infections. Diagnosis involves ruling out other conditions and may include MRI, spinal tap, and blood tests showing abnormalities associated with MS. Treatment focuses on reducing inflammation with steroids or plasma
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
This project was developed for a competitive intelligence company by mining data from the various information sources e.g. Company (News, Investor Section, SEC filings, Annual Reports, Presentations etc), Universities/Medical Schools/Organizations, Medical Affairs Companies, Non- Profit Medical Agency, Government Agencies, Drug Delivery Companies, Contract Manufacturing Organizations, Contract Research Organizations, Consultancies and Financial Institutions. The complete information available there complied into a single MS word document, listed in MS Excel and then by using MS publisher it was converted into the report which finally converted into PDF.
This document provides information on Multiple Sclerosis (MS), including its epidemiology, etiology, clinical presentation, diagnostic tests, disease course, and treatment options. MS is an immune-mediated disease that attacks the central nervous system, destroying myelin and axons. Common symptoms include visual changes, numbness, weakness, and balance issues. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and evoked potentials testing. The disease course varies between relapsing-remitting, primary progressive, and secondary progressive forms. Treatment focuses on reducing inflammation and disability through medications like interferon beta, glatiramer acetate, and natalizumab, as well as managing symptoms with drugs for pain,
1) Multiple sclerosis is an immune-mediated disease that causes inflammation and damage to the central nervous system, often resulting in disability. It primarily affects young and middle-aged adults.
2) Recent advances include more effective monoclonal antibody treatments like natalizumab that greatly reduce relapse rates, but also carry risks like progressive multifocal leukoencephalopathy.
3) New diagnostic criteria allow use of cortical lesions on MRI and certain biomarkers like neurofilament light chain levels provide additional insight into disease activity and progression.
This document provides an overview of demyelinating diseases of the central nervous system, with a focus on multiple sclerosis. It discusses the etiology, pathogenesis, clinical features, diagnosis, treatment and management of multiple sclerosis. Key points include: MS results from an autoimmune attack on the myelin sheath surrounding nerves in the brain and spinal cord; diagnosis involves evidence of lesions disseminated in space and time via MRI or other tests; and treatments include steroids for acute attacks and disease-modifying drugs such as interferons to reduce relapse rates long-term.
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document provides an overview of multiple sclerosis (MS) and other demyelinating diseases of the central nervous system. It describes common symptoms in patients with MS including fatigue, vision problems, numbness, bladder issues, and more. The causes of MS are thought to involve genetic predisposition and an autoimmune response targeting myelin. Diagnosis involves MRI, lumbar puncture, and ruling out other potential causes. Available treatments target reducing relapses and slowing disease progression. Prognosis varies between individuals but many experience a mild to moderate long-term course. Other demyelinating conditions like ADEM and NMO are also summarized.
This document provides guidelines for the diagnosis and treatment of multiple sclerosis (MS). It discusses the different subtypes of MS, diagnostic criteria, disease mechanisms, epidemiology in India, clinical features of relapses, and guidelines for using disease-modifying therapies. Key recommendations include using McDonald criteria for diagnosis, treating relapsing forms of MS with approved disease-modifying drugs, monitoring patients on treatment, and considering ocrelizumab for primary progressive MS.
Multiple sclerosis is a progressive disease of the central nervous system where communication between the brain and body is disrupted. It is caused by damage to the protective myelin sheath covering the nerves, which can affect functions throughout the body. While MS was first diagnosed in the 19th century, there is no definitive test and diagnosis involves evaluating symptoms, medical history, and use of tests like MRI and evoked potentials to detect lesions in the brain and spinal cord. The disease typically appears between ages 20-40 and can range from mild to severe. There are several types but most common is relapsing-remitting MS where symptoms flare up and then decrease. Currently there is no cure but treatments can help manage symptoms and slow progression.
This document provides information about multiple sclerosis (MS), including:
- MS is an immune-mediated disease that attacks the myelin sheath surrounding nerves in the central nervous system.
- Symptoms vary between individuals but can include fatigue, mobility issues, sensory changes, and cognitive difficulties. Diagnosis involves ruling out other conditions and detecting lesions in the brain and spinal cord.
- Treatment involves managing relapses, symptoms, and slowing disease progression using disease-modifying therapies like interferons that aim to reduce inflammation. Prognosis depends on individual characteristics but the disease course is generally unpredictable.
The document provides an overview of multiple sclerosis (MS), including its history, types, signs and symptoms, diagnosis, and treatments. MS is an inflammatory disease that damages myelin in the central nervous system. It most commonly affects people aged 20-40 and is more prevalent in women. There are four main types of MS based on symptoms and progression. Diagnosis involves neurological exams, MRI scans, and spinal fluid tests. While there is no cure, current treatments aim to reduce relapses and slow progression by managing symptoms and suppressing the immune system.
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
Multiple Sclerosis And The Central Nervous SystemAmanda Brady
Multiple sclerosis is an autoimmune disease that affects the central nervous system, including the brain and spinal cord. It causes damage to the myelin sheath that surrounds nerve fibers, which can impair nerve signals. There is currently no cure for MS, but treatments can help suppress symptoms and slow progression. The disease is characterized by different types defined by periods of relapse and remission. Neurons transmit signals throughout the body, and damage from MS can disrupt these signals and cause issues like fatigue, vision problems, and mobility issues.
Multiple Sclerosis (MS) and Myasthenia Gravis (MG) are autoimmune disorders where the immune system attacks the body's own healthy cells. MS affects the central nervous system by damaging the protective myelin sheath surrounding nerve fibers, while MG affects the neuromuscular junction by blocking or destroying acetylcholine receptors. Common symptoms of MS include sensory issues, muscle weakness, fatigue and vision problems. MG symptoms often begin with eye weakness and drooping eyelids and may progress to generalized weakness. While there is no cure for either condition, treatments can help manage symptoms and delay disease progression.
In his Master of Science in Osteopathy (M.Sc.O) thesis for London College of Osteopathy and Health Sciences (LCO), Dr. Arun Vijayan explores the potential benefits of osteopathic treatment techniques on symptoms related to Multiple Sclerosis.
What is Multiple Sclerosis (MS)? Causes, Prognosis, and Management | The Life...The Lifesciences Magazine
Multiple sclerosis (MS) is a chronic and often disabling neurological disorder that affects the central nervous system (CNS), including the brain and spinal cord.
1) Dr Sandhya Manorenj presented information on multiple sclerosis (MS) including its epidemiology, clinical patterns, diagnosis, management, and monitoring of treatment response.
2) MS is a chronic inflammatory disease that affects the central nervous system. It is most common in young adults aged 20-40 years and affects more women than men.
3) There are four main clinical patterns of MS including relapsing-remitting MS, primary progressive MS, secondary progressive MS, and progressive-relapsing MS. Diagnosis involves evaluating clinical symptoms and MRI findings based on McDonald criteria.
4) Management of MS includes treating acute relapses, disease-modifying therapies, and symptomatic treatments. Disease-
1) Dr Sandhya Manorenj presented information on multiple sclerosis (MS) including its epidemiology, clinical patterns, diagnosis, management, and monitoring of treatment response.
2) MS is a chronic inflammatory disease that affects the central nervous system. It is most common in young adults aged 20-40 years and affects more women than men.
3) There are four main clinical patterns of MS including relapsing-remitting MS, primary progressive MS, secondary progressive MS, and progressive-relapsing MS. Diagnosis involves evaluating clinical symptoms and MRI findings based on McDonald criteria.
4) Management of MS includes treatment of acute relapses with corticosteroids, disease-modifying therapies,
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1) Multiple sclerosis is an immune-mediated disease that causes inflammation and damage to the central nervous system, often resulting in disability. It primarily affects young and middle-aged adults.
2) Recent advances include more effective monoclonal antibody treatments like natalizumab that greatly reduce relapse rates, but also carry risks like progressive multifocal leukoencephalopathy.
3) New diagnostic criteria allow use of cortical lesions on MRI and certain biomarkers like neurofilament light chain levels provide additional insight into disease activity and progression.
This document provides an overview of demyelinating diseases of the central nervous system, with a focus on multiple sclerosis. It discusses the etiology, pathogenesis, clinical features, diagnosis, treatment and management of multiple sclerosis. Key points include: MS results from an autoimmune attack on the myelin sheath surrounding nerves in the brain and spinal cord; diagnosis involves evidence of lesions disseminated in space and time via MRI or other tests; and treatments include steroids for acute attacks and disease-modifying drugs such as interferons to reduce relapse rates long-term.
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document provides an overview of multiple sclerosis (MS) and other demyelinating diseases of the central nervous system. It describes common symptoms in patients with MS including fatigue, vision problems, numbness, bladder issues, and more. The causes of MS are thought to involve genetic predisposition and an autoimmune response targeting myelin. Diagnosis involves MRI, lumbar puncture, and ruling out other potential causes. Available treatments target reducing relapses and slowing disease progression. Prognosis varies between individuals but many experience a mild to moderate long-term course. Other demyelinating conditions like ADEM and NMO are also summarized.
This document provides guidelines for the diagnosis and treatment of multiple sclerosis (MS). It discusses the different subtypes of MS, diagnostic criteria, disease mechanisms, epidemiology in India, clinical features of relapses, and guidelines for using disease-modifying therapies. Key recommendations include using McDonald criteria for diagnosis, treating relapsing forms of MS with approved disease-modifying drugs, monitoring patients on treatment, and considering ocrelizumab for primary progressive MS.
Multiple sclerosis is a progressive disease of the central nervous system where communication between the brain and body is disrupted. It is caused by damage to the protective myelin sheath covering the nerves, which can affect functions throughout the body. While MS was first diagnosed in the 19th century, there is no definitive test and diagnosis involves evaluating symptoms, medical history, and use of tests like MRI and evoked potentials to detect lesions in the brain and spinal cord. The disease typically appears between ages 20-40 and can range from mild to severe. There are several types but most common is relapsing-remitting MS where symptoms flare up and then decrease. Currently there is no cure but treatments can help manage symptoms and slow progression.
This document provides information about multiple sclerosis (MS), including:
- MS is an immune-mediated disease that attacks the myelin sheath surrounding nerves in the central nervous system.
- Symptoms vary between individuals but can include fatigue, mobility issues, sensory changes, and cognitive difficulties. Diagnosis involves ruling out other conditions and detecting lesions in the brain and spinal cord.
- Treatment involves managing relapses, symptoms, and slowing disease progression using disease-modifying therapies like interferons that aim to reduce inflammation. Prognosis depends on individual characteristics but the disease course is generally unpredictable.
The document provides an overview of multiple sclerosis (MS), including its history, types, signs and symptoms, diagnosis, and treatments. MS is an inflammatory disease that damages myelin in the central nervous system. It most commonly affects people aged 20-40 and is more prevalent in women. There are four main types of MS based on symptoms and progression. Diagnosis involves neurological exams, MRI scans, and spinal fluid tests. While there is no cure, current treatments aim to reduce relapses and slow progression by managing symptoms and suppressing the immune system.
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
Multiple Sclerosis And The Central Nervous SystemAmanda Brady
Multiple sclerosis is an autoimmune disease that affects the central nervous system, including the brain and spinal cord. It causes damage to the myelin sheath that surrounds nerve fibers, which can impair nerve signals. There is currently no cure for MS, but treatments can help suppress symptoms and slow progression. The disease is characterized by different types defined by periods of relapse and remission. Neurons transmit signals throughout the body, and damage from MS can disrupt these signals and cause issues like fatigue, vision problems, and mobility issues.
Multiple Sclerosis (MS) and Myasthenia Gravis (MG) are autoimmune disorders where the immune system attacks the body's own healthy cells. MS affects the central nervous system by damaging the protective myelin sheath surrounding nerve fibers, while MG affects the neuromuscular junction by blocking or destroying acetylcholine receptors. Common symptoms of MS include sensory issues, muscle weakness, fatigue and vision problems. MG symptoms often begin with eye weakness and drooping eyelids and may progress to generalized weakness. While there is no cure for either condition, treatments can help manage symptoms and delay disease progression.
In his Master of Science in Osteopathy (M.Sc.O) thesis for London College of Osteopathy and Health Sciences (LCO), Dr. Arun Vijayan explores the potential benefits of osteopathic treatment techniques on symptoms related to Multiple Sclerosis.
What is Multiple Sclerosis (MS)? Causes, Prognosis, and Management | The Life...The Lifesciences Magazine
Multiple sclerosis (MS) is a chronic and often disabling neurological disorder that affects the central nervous system (CNS), including the brain and spinal cord.
1) Dr Sandhya Manorenj presented information on multiple sclerosis (MS) including its epidemiology, clinical patterns, diagnosis, management, and monitoring of treatment response.
2) MS is a chronic inflammatory disease that affects the central nervous system. It is most common in young adults aged 20-40 years and affects more women than men.
3) There are four main clinical patterns of MS including relapsing-remitting MS, primary progressive MS, secondary progressive MS, and progressive-relapsing MS. Diagnosis involves evaluating clinical symptoms and MRI findings based on McDonald criteria.
4) Management of MS includes treating acute relapses, disease-modifying therapies, and symptomatic treatments. Disease-
1) Dr Sandhya Manorenj presented information on multiple sclerosis (MS) including its epidemiology, clinical patterns, diagnosis, management, and monitoring of treatment response.
2) MS is a chronic inflammatory disease that affects the central nervous system. It is most common in young adults aged 20-40 years and affects more women than men.
3) There are four main clinical patterns of MS including relapsing-remitting MS, primary progressive MS, secondary progressive MS, and progressive-relapsing MS. Diagnosis involves evaluating clinical symptoms and MRI findings based on McDonald criteria.
4) Management of MS includes treatment of acute relapses with corticosteroids, disease-modifying therapies,
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
MULTIPLE SCLEROSIS slide.pptx
1. MULTIPLE
SCLEROSIS (MS)
GROUP 5
Azman Bin Kasim - 2021836888
Mohd Sharizal Bin Che Jamel - 2021656678
Nurul Najwa Ab Rahman - 2021638124
Jass Nuur Farah Farzanah - 2021425446
2. Introduction Of Multiple Sclerosis (MS)
Idiopathic Inflammatory demyelinating disease of the central nervous system
involve white matter mainly
● Hall mark : characterized typical lesions disseminated in time and space
● Multiple – different areas of the Central nervous system
● Sclerosis – greek word ‘scleros” –Scarring due to plaque formation
3. Causes of MS
Why the immune system attacks the myelin sheath is unknown.
It appears likely that a combination of external triggers and genes passed down from
your parents contribute to the condition.
As potential causes of MS, the following are some factors that have been put forth:
● Genetics - MS is not inherited, but people who are related to someone who has it
are more likely to develop it; the chance of a sibling or child of someone with MS
developing it is estimated to be 2 to 3 in 100.
● Environmental - lack of vitamin D, Infectious agents, Smoking
4. Pathophysiology
● MS causes inflammation and demyelination of nerves in the central nervous
system (CNS):
the brain and spinal cord → Loss of insulation (myelin) → poor electrical
conduction, poor coordination of signals → impaired nerve functions,
depending on affected locations
● Continued inflammation results in axonal damage and loss.
5. ● Figure 2.1 Multiple sclerosis
pathophysiology.
Lymphocytes, microglia, and
macrophages destroy myelin
by an as-yet-unknown
mechanism. Antibodies
against myelin also play a
role in the pathogenesis of
this disease.
6. EPIDEMIOLOGY
● MS affects more than 2 million people worldwide, including about 1 million
individuals in the United States.
● The incidence of MS varies greatly. It is highest among young adults (ages 20–
40),12 but the disease can occur in persons of any age.
● Females are affected more commonly than males, with an approximate female-
to-male ratio of 3:1.
● Genetic risk:
- General population: 0.1%
- People with an affected first-degree relative: 2–4%.
- Monozygotic twins: 30–50%.
7. Sign & Symptoms
No single symptom or constellation of symptoms is pathognomonic of MS (Thompson
AJ et.al, 2018). However, clinical symptoms stem from neuronal demyelination and loss
of saltatory conduction, resulting in slowing of action potential propagation.
Visual Loss
● Optic neuritis is due to demyelination of the optic nerve, which typically presents
as rapidly progressive visual acuity loss, pain on eye movement, and color
(especially red) desaturation.
Sensory Symptoms
● Impaired vibratory sensation , Loss of proprioception, Pain and temperature loss,
Paresthesias, Numbness
8. Motor Symptoms
● Weakness affects most patients with MS. Focal weakness is usually due to involvement of
the corticospinal tracts.
● Spasticity is defined as a velocity-dependent increase in resistance to passive muscle
stretch associated with stiffness, pain, spasms, cramping, and gait impairment. Spasticity
typically improves with stretching, exercise, or ambulation.
Gait Abnormalities
● Multiple factors can cause gait abnormalities, including cerebellar or vestibular
dysfunction, weakness, spasticity, and sensory loss.
Pain
● The different types of pain associated with MS can be neurogenic or non- neurogenic, as
well as intermittent or persistent.
Fatigue
● Fatigue is a characteristic finding in patients with MS.It is typically described as physical
exhaustion that is out of proportion to the amount of physical activity performed.
9.
10. Types Of MS
1. Clinically isolated syndrome (CIS)
● The first clinical presentation of neurological symptoms attributed to inflammation and loss of
myelin in the central nervous system, or CNS, which includes the brain, spinal cord, and optic
nerves.
● This episode must last 24 hours or more, and not be accompanied by fever or infection, to be
considered a first presentation of the disease.
1. Relapsing-remitting MS - The most common form of MS is relapsing-remitting MS (RRMS).
● This form of the disease is characterized by relapses (also called exacerbations), which are
defined by the appearance of new symptoms or the worsening of old symptoms for 24 hours or
more, without a change in body temperature or an infection.
● These relapses are followed by remissions, which are periods of partial or complete recovery
from symptoms. During remissions, all symptoms may disappear or some may continue and
become permanent. However, no apparent progression of the disease occurs during this time.
11. 3. Secondary progressive MS
● Secondary progressive MS (SPMS) is a disease stage that follows RRMS. With this type of MS, a
person’s symptoms steadily worsen, even if the individual experiences no relapses.
● Notably, disease exacerbations still may occur in SPMS. But symptom changes generally are
much less drastic than in the RRMS stage. Also, symptoms do not completely disappear in the
remission phases.
4. Primary progressive MS
● Primary progressive MS (PPMS) is a progressive form of the disease that is diagnosed in about
15% of MS patients.
● Similar to SPMS, it also is characterized by symptoms that become worse over time, without
periods of relapse and remission. However, disease progression starts right from disease
onset — hence the term “primary” progressive.
12. MS prevalence in Malaysia
● MS is an important neurological disease in Asian neurological practice because of the
high morbidity and mortality although it is not frequently encountered in Asia as
compared to the West.
● Malaysia is an equatorial country located at the latitudes 3°8′N and 101°41′E, with an
estimated 2017 population of 32,179,572, of which 28.7 million are citizens. (Malaysian
Department of Statistics: The 2010 Population and Housing Census of Malaysia,
Malaysian Department of Statistics, 2010)
● Observed MS crude prevalence was defined as the ratio of persons with a confirmed
diagnosis of MS residing nationwide on the prevalence day 29 December 2017, to the
total distribution of the Malaysian population nationwide on the same day, expressed
per 100,000 population, and revalidated using the capture–recapture method on 1
March 2018.
13. ● Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA) looking at the descriptive
data, means, medians, percentages, standard deviations, variances, and confidence intervals (CIs)
● Survey has identified 767 cases with validated MS.
● The national crude prevalence rate for MS was 2.73 per 100,000 (95% CI: 2.53; 2.92 per 100,000
population).
● The observed crude annual incidence was 0.55 per 100,000 (95% CI: 0.43; 0.58) for MS.
● These results were comparable to those of the 2013 prevalence study from MOH hospitals, where
MS was 3.23 per 100,000 population, respectively. (S Viswanathan, 2019)
14. Prevalence of MS by capture–recapture method
● The capture–recapture method revealed the estimated MS population of 913
(95% CI: 910.0; 915.9).
● The estimated MS prevalence values were 3.26 per 100,000 (95% CI: 3.05,
3.47 per 100,000) population.
Prevalence for MS in most urbanized states in Malaysia
● The crude prevalence rates for the most urbanized states with the highest
number of MS patients, is the Federal Territories (FT) and Selangor, were 6.0
per 100,000 (95% CI: 5.28; 6.53 per 100,000 population).
15. ● MS and NMOSD in Malaysia appear to have an urban bias. This may be due to hospital
referral bias and the improved availability/accessibility to neurological/ radiological
services in highly urbanized Selangor and FT. Future studies incorporating the rural
community may reconfirm this and explore the causes. Epidemiologically, the urban-to-
rural mismatch in South East Asia needs more research and attention.
● On a global scale, the prevalence of MS in Malaysia is reflective of the estimated
prevalence in the 2013 revised MSIF Atlas of MS which is applicable to date6. However,
compared to Caucasian-predominant regions and the Middle East, the prevalence of MS
in our study remains low although increasing modestly compared to the past Malaysian
studies from the 1980s suggesting a combination of environmental rather than pure
latitudinal/genetic effects. (Cheong et al., 2018)
16. Management for MS
Oral Management
● Fingolimod (Gilenya), Dimethyl fumarate (Tecfidera) to
reduce relapse rate.
● Siponimod (Mayzent) to reduce relapse rate and slowing MS
progression.
● Cladribine (Mavenclad) as a second line treatment for relapsing-
remitting MS.
17. Infusion Management
● Ocrelizumab (Ocrevus). Humanized monoclonal antibody medication is the
only DMT approved by the FDA to treat both the relapse-remitting and
primary-progressive forms of MS.
● Natalizumab (Tysabri). To block the movement of potentially damaging
immune cells from bloodstream to the brain and spinal cord.
● Alemtuzumab (Campath, Lemtrada). Helps to reduce relapses of MS by
targeting a protein on the surface of immune cells and depleting white blood
cells. This effect can limit potential nerve damage caused by the white blood
cells.
18. Physical Management
Impairment of MS patients like limited mobility, spasticity or paresis is primarily a consequence
of the disease itself, but it can be aggravated by reduced physical activity. (Dalgas et al., 2008).
Exercise has been shown to improve various clinical symptoms in MS patients, particularly
inactivity-related impairment.
Flexibility exercises such as stretching the muscles may diminish spasticity and prevent
future painful contractions.
Cardiorespiratory exercises a review of studies has shown that cardiorespiratory exercise at
low- or moderate-intensity have positive effects on both physiological and psychological factors
among people with MS
Resistance and endurance training enhances muscle strength, and showed beneficial
effects on walking-speed, stepping endurance, stair climbing, timed up and go test, self-
reported disability, and self-reported fatigue have been described in MS patients (Cakit et al.,
2010).
19. ● General therapeutic recommendations can be defined. Since exercise programs have not sufficiently
been investigated in more severely disabled patients, these recommendations are restricted to MS
patients with a maximum EDSS score of 7.0. (Asano et al., 2009)
● Patients should be supervised until they can perform the program adequately and independently.
● Exercise programs should specifically target weaker muscles and encompass preferably multi-
segmental complex movements.
● The intensity should be increased only slowly and should not reach the point of pain. Special care
should be paid to peripheral nerves, particularly overstretching should be avoided.
● Training sessions are recommended to start at a low level, include a light warm up, progress
according to the patients’ clinical state and specific problems, and finally reach light to moderate
intensity
20. Flexibility Exercises
● Child’s Pose Yoga Stretch - Flexibility for back muscles and glutes
● Arm Circles - Flexibility for upper body
● Seated Hamstring Stretch - Flexibility for hamstring muscles
Cardiorespiratory Exercises
● Walking - A low impact activity that can improve cardiorespiratory
fitness and functional fitness
● Stairmaster - Improving cardiorespiratory fitness
● Seated Cycle - A low impact stationary activity that can improve
cardiorespiratory fitness and increase lower body strength
21.
22. Resistance and Endurance Training
● Squatting - Strengthen leg muscles. Muscle groups are activated
to simulate functional movements of daily tasks
● Shoulder Press - Strengthen deltoids and triceps and provide
functional movement
● Plank - Strengthen core muscles and incorporates balance
23. Treatment goals for MS population
● Modify the course of the disease.
● Treat flare-ups.
● Control symptoms.
● Improve physical function.
24. 1. Modify the course disease
Disease-modifying agents are medications that reduce disease activity and slow the progression of MS.
They’re most often used for relapsing forms of MS, which are characterized by a flare-up of symptoms
followed by periods of remission. These medications reduce the frequency and severity of those flare-ups.
Each drug works a little differently, so together with the doctor can decide which is best for the
patient, based on the disease characteristics and health history. There are currently 14 FDA-
approved disease-modifying medications for MS.
25. Type oF FDA-approved disease-modifying medications for MS
● Aubagio (teriflunomide), a daily pill
● Avonex (interferon beta-1a), a weekly injection
● Betaseron (interferon), an injection taken every other day
● Copaxone (glatiramer), a daily injection
● Extavia (interferon beta-1b), an injection taken every other day
● Glatopa (glatiramer), a subcutaneous injection taken every other day
● Gilenya (fingolimod), a daily pill
● Lemtrada (alemtuzumab), a five-day daily infusion
● Novantrone (mitoxantrone), an IV infusion taken four times a year
● Ocrevus (ocrelizumab), an IV infusion taken once every six months following a pair of initial
infusions taken two weeks apart
● Plegridy (interferon beta-1a), a biweekly injection
● Rebif (interferon beta-1a), an injection taken three times per week
● Tecfidera (dimethyl fumarate), a twice-daily pill
● Tysabri (natalizumab), an IV infusion taken every four weeks
26. 2. Treat Flare-Ups
Because of the anti-inflammatory qualities, corticosteroids are the most commonly
used as medication when MS symptoms flare up. Not all flare-ups require
treatment. However, if the symptoms significantly impair the capacity to function in
daily life, the doctor may recommend a course of corticosteroids.
A flare-up is often treated with a 3 to 5-day course of high-dose corticosteroids
delivered intravenously. Patient may be able to get the IV medication as an
outpatient, either at home or any place Some patients may require hospitalisation
for this treatment.
27. 3. Control Symptoms
Overview of some of the types of medications used to treat different symptoms.
● Ampyra (dalfampridine)—helps walking speed and leg strength
● Antivert (meclizine)—helps control nausea, vomiting, and dizziness
● Cymbalta (duloxetine)—for depression and pain
● Detrol (tolterodine), Minipress (prazosin), and Oxytrol (oxybutynin)—for
bladder dysfunction
● Nydrazid (ixoniazid)—controls tremors
● Levitra (vardenafil)—for erectile dysfunction
28. 4. Improve Physical Function
As part of the treatment, MS patient may be participate in several forms of rehabilitation to help improve how they might be
function in different aspects of their life.
Physical and Occupational Therapy
- Improve in ADL activities
- Improve in balance and coordination
- Improve in cognitive function
- Physical fitness
- Walking mobility
- Improve Balance
- Reduce Fatigue and Depressive symptoms
- Quality of life
- Cognition: Ongoing Study: Study of Exercise on Impact of Cognitive Functioning in Multiple Sclerosis
Patients
29. Exercises and Multiple Sclerosis
● Impairments related to the disease process itself are irreversible by exercise, but
impairments resulting from deconditioning are often reversible with exercise
(Sandoval, 2013).
● Furthermore, inactivity places MS patients in raised possibility of comorbid health
dependent conditions. (functioning & sclerosis, 2021)
● regular exercise and training is a possible solution during disease period by
limiting the deconditioning process and achieving an optimal level of patient
activity, functions and many physical and mental health benefits without any
concern about a triggering onset or exacerbation of disease symptoms or relapse
(Hvid et al., 2022).
● Appropriate exercise can lead to significant and important improvements in
different areas of cardiorespiratory fitness (Aerobic fitness), muscle strength,
flexibility, stability, tiredness, cognition, quality of life and respiratory
function.(Motl & Sandroff, 2015)
30. Exercise Screening and Testing for MS
● The 6-min walk test (endurance), timed 5-repetition sit to- stand (strength), timed 25-ft
walk (gait speed), Berg Balance Scale (balance) (Berg, 1989), and Dynamic Gait Index
(dynamic balance) (Herman et al., 2009) are commonly used functional tests for special
population such as stroke, geriatrics, Multiple Sclerosis and etc.
● aerobic training of low to moderate intensity is effective on cardiovascular fitness, mood
and QOL(quality of life) in multiple sclerosis patients with EDSS < 7. (Heine et al., 2015)
(Mostert & Kesselring, 2002)
● resistance training with moderate intensity can induce improvements in muscle strength
and function among moderately impaired persons with MS. (Sandoval, 2013)
31. patients (Halabchi et al., 2017)
Types Fitness Parameter Measures Comments
Aerobic fitness 6-min walk test
It is used to measure
improvements and
differences in Pre and
Post program
performances but not
to compare them
to “healthy
individuals.”
Total distance walked,
heart rate, RPEa, BP.
The HR response to
exercise may be
decreased
due to autonomic
dysfunction.
Therefore, the
use of the RPE scale
is preferred in these
patients.
Using air conditioner
for all aerobic testing.
Spasticity, lower limb
weakness, and
paralysis
will preclude walking
tests in some patients.
(Halabchi et al., 2017)
32. Types Fitness Parameter Measures Comments
Aerobic fitness Submaximal, upright,
or recumbent leg cycle
ergometry. Intermittent
instead of continuous
protocol may be
indicated. Increase
work rate
by 12–25 W per stage.
Workload and steady-
state heart rate to
predict VO2peak;
RPE.
Toe clips and foot
straps may be
necessary in
persons with tremors,
spasticity, or
weakness in
the lower extremities.
Begin with a warm-up
of
unloaded pedaling or
cranking.
(Halabchi et al., 2017)
33. Types Fitness Parameter Measures Comments
Aerobic fitness Combination arm/leg
cycle ergometry.
Workload and steady-
state heart rate to
predict VO2peak;
RPE.
May reduce difficulty in
individuals with
lower extremity
uncoordination
Experience.
Arm ergometry—
increase work rate 8–
12
W per stage.
Workload and steady-
state heart rate to
predict VO2peak;RPE.
Alternative for persons
with lower extremity
weakness or paralysis.
(Halabchi et al., 2017)
34. Types Fitness Parameter Measures Comments
Muscular
Strength/Endurance
30-s sit-to-stand test
These tests are used
to measure
improvements
and differences in pre-
and postprogram
performance but not to
compare them to
“healthy individuals.”
Number of times
patient comes to a full
stand with arms
crossing a standard
size chair.
A functional measure
of lower extremity
strength, power, and
muscle endurance.
10RM Testing. Maximal weight lifted
for 10 repetitions
(reps).
Machines provide test
reliability, support, and
joint stability. Remind
patients to exhale on
concentric action and
avoid breath holding.
(Halabchi et al., 2017)
35. Types Fitness Parameter Measures Comments
Flexibility Modified bench sit and
reach test
(1 ft on floor and other
straight).
Distance reached in
hip/trunk flexion.
Administer test with
client seated on a
table.
Goniometry. Range of motion. Focus on flexibility of
hamstrings, hip
flexors,
ankle plantar flexors,
shoulder adductors,
and
internal rotators.
(Halabchi et al., 2017)
36. Types Fitness Parameter Measures Comments
Power/functional Timed up and go test. Time to stand from a
chair, walk a 3-m
round
trip, and sit back down
on the same chair.
Results correlate with
gait speed, balance,
functional level, the
ability to go out.
Five-times sit-to-stand
test.
Time to stand and sit 5
consecutive times on
a standard size chair.
Most useful in patients
≤60 y.
(Halabchi et al., 2017)
37. General Exercise Guidelines
● Guidelines from the AHA and the ACSM :
○ A minimum of 30 minutes of moderate-intensity aerobic activity on five
days each week, or a minimum of 20 minutes of vigorous-intensity
activity on three days each week, or some combination of the two.
Exceeding the recommended minimum amount of physical activity will
lead to greater health benefits.
● Muscle strengthening
○ A minimum of two non-consecutive days of the week and should
target 8 to 10 major muscle groups (abdomen, bilateral arms, legs,
shoulders, and hips).
○ Individuals should strive to perform 10 to 15 repetitions of each
exercise at a moderate to high level of intensity and gradually
increase resistance over time.
❖ Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart
Association.AUNelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C, American College of Sports Medicine,
American Heart Association SOCirculation. 2007;116(9):1094. Epub 2007 Aug 1.
38. Guidelines Cont.
● Flexibility Training
● Flexibility exercises should be performed twice a week
for at least 10 minutes
● Balance Training
○ Balance training may involve activities that challenge gait patterns, such as heel-to-toe walking;
increase awareness of use of the center of gravity for basic movements; and augment different
sensorial systems involved in balance maintenance
39. Measurement of Intensity
● MET:
○ A metabolic equivalent (MET) is an estimate of oxygen consumed at rest. A
three-MET activity would be an activity that utilizes roughly three times the
amount of resting energy expenditure. Activities between three to six METs are
considered moderate, and activities greater than six METs are considered
vigorous
○ MET are a highly effective way for therapists to measure their patients
progress. Treadmills and other gym equipment will often display METS and
they are a useful method of working out how many calories are burned during
exercise.
○ 1MET = 3.5 mL O2 uptake x body weight in KG x 1minutes.
● Borg Rating of Perceived Exertion
● OMNI-Resistance Exercise Scale
40.
41. Max and Target HR
● For moderate-intensity physical activity, a person's target heart rate should be 50 to 70% of his or her
maximum heart rate. This maximum rate is based on the person's age. An estimate of a person's maximum
age-related heart rate can be obtained by subtracting the person's age from 220.
● For example, for a 50-year-old person, the estimated maximum age-related heart rate would be
calculated as 220 - 50 years = 170 beats per minute (bpm). The 50% and 70% levels would be:
○ 50% level: 170 x 0.50 = 85 bpm, and
○ 70% level: 170 x 0.70 = 119 bpm
● For vigorous-intensity physical activity, a person's target heart rate should be 70 to 85% of his or her
maximum heart rate
● For example, for a 35-year-old person, the estimated maximum age-related heart rate would be
calculated as 220 - 35 years = 185 beats per minute (bpm). The 70% and 85% levels would be:
○ 70% level: 185 x 0.70 = 130 bpm, and
○ 85% level: 185 x 0.85 = 157 bpm
42.
43. Guidelines for Exercise in MS
⚫ American Academy of Neurology (AAN) systematic review on rehabilitation in multiple sclerosis (MS) 2015:
● Comprehensive multidisciplinary outpatient rehabilitation (six weeks) is possibly effective for improving
disability/function as measured by functional independence measure (1 Class II study).
● Weekly home PT or outpatient PT (eight weeks) is probably effective for improving balance,
disability, and gait. (1 Class I study)
● Motor and sensory balance training or motor balance training (three weeks) is possibly effective for
improving static and dynamic balance.
● Motor balance training (three weeks) is possibly effective for improving static balance (1 Class II study).
44. Exercises in MS
● Passive Exercise: Stretching
● Strengthening specific muscle groups: Bands or active
repetitions or weights
● Aerobic Exercise
● Balance Exercise
● Core exercise
45. MS Benefits of Exercise
● MS specific in the literature:
○ Physical fitness
○ Walking mobility
○ Balance
○ Fatigue
○ Depressive symptoms
○ Quality of life
○ Brain Derived Neurotrophic Factor
■ Brain derived neurotrophic factor (BDNF) is suggested to play a
neuroprotective role in multiple sclerosis (MS)
“Brain derived neurotrophic factor in multiple sclerosis: effect of 24 weeks endurance and resistance training”
Wens I1, Keytsman C1, Deckx N2, Cools N2, Dalgas U3, Eijnde BO1. Eur J Neurol. 2016 Jun;23(6):1028-35
46. Exercise Training Considerations
● Whenever possible, incorporate functional activities (e.g., stairs, sit-to-stand)
into the exercise program.
● With individuals who have significant paresis, consider assessing RPE of the
extremities separately using the 0–10 OMNI scale to evaluate effects of local
muscle fatigue on exercise tolerance.
● When strengthening weaker muscle groups or working with easily fatigued
individuals, increase rest time (e.g., 2–5 min) between sets and exercises as
needed to allow for full muscle recovery. Focus on large postural muscle
groups and minimize total number of exercises performed.
47. Exercise Training Considerations
Cont.
● Stretching is most effective when muscles are “warmed up” via exercise.
Caution should be used if moist heat packs are used to warm a muscle due to
the possibility of a reduced ability to thermoregulate body temperature due
to MS.
● Slow and gentle passive ROM exercise should be performed while seated or
lying down to eliminate balance concerns.
● In spastic muscles, increase the frequency and time of flexibility exercises.
Muscles and joints with significant tightness or contracture may require
longer duration (several minutes to several hours) and lower load positional
stretching to achieve lasting improvements. Very low-intensity, low-speed, or
no-load cycling may be beneficial in those with frequent spasticity.
● Watch for signs and symptoms of the Uhthoff phenomenon which typically
involves a transient (<24 h) worsening of neurological symptoms, most
commonly, visual impairment associated with exercise and elevation of body
temperature. Symptoms can be minimized by using cooling strategies and
adjusting exercise time and intensity.
48. References
Berg, K. (1989). Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada, 41(6), 304–311. https://doi.org/10.3138/ptc.41.6.304
functioning, T. role of aerobic exercise in improving, & sclerosis. (2021). The role of aerobic exercise in improving functioning and treating the symptoms of individuals with multiple
sclerosis. International Journal of Advanced Research in Medicine, 3(2), 91–94. https://doi.org/10.22271/27069567.2021.v3.i2b.222
Heine, M., van de Port, I., Rietberg, M. B., van Wegen, E. E., & Kwakkel, G. (2015). Exercise therapy for fatigue in multiple sclerosis. Cochrane Database of Systematic Reviews.
https://doi.org/10.1002/14651858.cd009956.pub2
Herman, T., Inbar-Borovsky, N., Brozgol, M., Giladi, N., & Hausdorff, J. M. (2009). The Dynamic Gait Index in Healthy Older Adults: The Role of Stair Climbing, Fear of Falling and Gender. Gait
& Posture, 29(2), 237–241. https://doi.org/10.1016/j.gaitpost.2008.08.013
Hvid, L. G., Langeskov-Christensen, M., Stenager, E., & Dalgas, U. (2022). Exercise training and neuroprotection in multiple sclerosis. The Lancet Neurology, 21(8), 681–682.
https://doi.org/10.1016/s1474-4422(22)00219-8
Latimer-Cheung, A. E., Martin Ginis, K. A., Hicks, A. L., Motl, R. W., Pilutti, L. A., Duggan, M., Wheeler, G., Persad, R., & Smith, K. M. (2013). Development of Evidence-Informed Physical
Activity Guidelines for Adults With Multiple Sclerosis. Archives of Physical Medicine and Rehabilitation, 94(9), 1829-1836.e7. https://doi.org/10.1016/j.apmr.2013.05.015
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
Motl, R. W., & Sandroff, B. M. (2015). Benefits of Exercise Training in Multiple Sclerosis. Current Neurology and Neuroscience Reports, 15(9). https://doi.org/10.1007/s11910-015-0585-6
Sandoval, A. E. G. (2013). Exercise in Multiple Sclerosis. Physical Medicine and Rehabilitation Clinics of North America, 24(4), 605–618. https://doi.org/10.1016/j.pmr.2013.06.010