Types of MS
What is it called when a person with MS has exacerbations of symptoms and then remissions?
RRMS- relapse remitting
What does pharmacologic treatment help with in MS?
For relapsing forms of MS: slows disease progression, limits new MS activity on MRI, reduces # of relapses
For PPMS: Ocrevus--> immunosuppressant
What is the first SC level that will has the chance to ambulate functionally after an injury?
T10 and higher --> will need some assistance with AFOs and crutches/walker
When level SCI can we expect independent transfers, bed skills and WC skills?
T1 and higher
What are the impairments we would see with someone who has a central cord injury?
More severe involvement of the UE vs LE
Motor > Sensory deficits
Typically can recover walking ability
What is it called when a person has some MS symptoms but has not been diagnosed with MS yet?
Clinically isolated syndrome
What is the recommended dosage for aerobic training for patients with MS?
3-5 days/week on alternate days, 60-85% peak HR, 30 mins sessions (or 3, 10 min sessions)
For a SCI to be considered an ASI A what would the motor and sensory findings be?
NO MOTOR OR SENSORY function below the lesion
NO sacral sparing
For a C6 SCI how much assistance will they need for bed mobility, transfers and WC skills?
Bed skills: some assist
Transfers:
-EVEN: some-independent
-UNEVEN: some-total assist
WC skills: Power- independent, Manual- independent indoors, some-total assist outdoors
What can cause a posterior cord injury? What are the deficits that would be common with this injury?
Loss of deep touch, proprioception, vibration below the level of the lesion (DCML tracts)
Which type of MS is usually diagnosed about 10 years after their diagnosis of RRMS?
SPMS: secondary progressive MS
How often should patients with MS perform stretching exercises?
DAILY with 30-60 second hold, repeat minimum 2 reps
This is necessary to counteract effects of spasticity
What is the main difference between an ASI C and ASI D?
ASI C: Incomplete, there is motor below the neurological level, BUT less than half of the myotomes below the neurological level have a score >3
ASI D: Incomplete, there is motor below the neurological level AND more than half of the myotomes below the neurological level have a score >3
If a patient had Brown Sequard Syndrome, what deficits can we expect to see?
IPSILATERAL: motor: spasticity, abnormal reflexes, paralysis, sensory loss: proprioception, light touch, vibration
CONTRALATERAL: sensory loss: pain and temperature (spinothalamic)
What are cauda equina injuries considered? What are some common impairments?
They are considered LMN injuries
Impairments: areflexic bowel and bladder, saddle anesthesia, LE paralysis/paresis
Who is more likely to be diagnosed with PPMS? When is it usually diagnosed? What are the characteristics of PPMS?
More equal gender distribution male=female
Usually diagnosed 10 years later compared to RRMS
Gradual progression with NO relapses/remissions
What functions would a person still have if they had an C7 ASI B?
Motor: everything C7 and above
Sensory: some sensory below the lesion, including sacral segments (S4-5)
Usually from a flexion injury
Loss of bilateral motor function (corticospinal) and bilateral pain and temperature (spinothalamic)
SCI T6 and above
BP will rise 20-30 mmHg
Sit them upright-->loosen tight clothing --> check catheter--> check for bowel impaction
What is the difference between relapses and pseudo exacerbations?
Pseudo exacerbations: remporary appearance of SxS of a flare, transient-usually resolves in 24 hours
What is considered no disability, minimal disability, moderate and more severe disability on EDSS scale for MS? When would a person be confined to their WC?
0: normal
1-1.5: no disability, but some abnormal neuro signs
2-2.5: minimal disability
3-4.5: moderate disability
5-8: more severe
- 5-5.5: increasing limitation to walk
- 6-6.5: walking assistance NEEDED
- 7-7.5: CONFINED TO WC
8.5-9.5: very severe disability
10: death
For a C7-8 SCI patient what do we expect for their bed mobility, transfers and WC skills?
Bed mobility: independent- some assist
Transfers:
- EVEN: independent
-UNEVEN: some-total assist
WC skills: Manual-independent indoor and outdoors on level/unlevel surfaces
Central Cord Syndrome
Happens due to hyperextension injuries or congenital narrowing of spinal canal
Which SCI's are more susceptible to impaired temperature control?
Cervical or complete injuries