MS/SCI

Types of MS

100

What is it called when a person with MS has exacerbations of symptoms and then remissions?

RRMS- relapse remitting

200

What is it called when a person has some MS symptoms but has not been diagnosed with MS yet?

Clinically isolated syndrome

300

Which type of MS is usually diagnosed about 10 years after their diagnosis of RRMS?

SPMS: secondary progressive MS

400

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 

500

What is the difference between relapses and pseudo exacerbations?

Relapses: NEW signs/symptoms, last longer than 24 hours, unrelated to another etiology 

Pseudo exacerbations: remporary appearance of SxS of a flare, transient-usually resolves in 24 hours 

MS treatment

100

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 

200

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)

300

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 

400

What would make a more favorable prognosis for a patient with MS?

Female, younger age at diagnosis, full recovery between exacerbations (RRMS), onset of 1 symptom during first flare, longer times between exacerbations, absence/late onset of pyramidal/cerebellar signs, minimal MRI findings 

500

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 

SCI

100

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 

200

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 

300

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 

400

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)

500

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 

more SCI

100

When level SCI can we expect independent transfers, bed skills and WC skills?

T1 and higher 

200

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 

300

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)

400

What deficits are we likely to see with a patient who has anterior cord syndrome?

Usually from a flexion injury

Loss of bilateral motor function (corticospinal) and bilateral pain and temperature (spinothalamic)

500

What is the most common SCI and how does it happen?

Central Cord Syndrome

Happens due to hyperextension injuries or congenital narrowing of spinal canal 

types of SCI

100

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 

200

What can cause a posterior cord injury? What are the deficits that would be common with this injury?

Infarct or trauma to the posterior spinal artery, edema, disc compression, MS, syphilis, B12 insufficiency 

Loss of deep touch, proprioception, vibration below the level of the lesion (DCML tracts)

300

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 

400

When do you need to worry about autonomic dysreflexia? What would the BP show if a patient was experiencing this? What do you do first?

SCI T6 and above

BP will rise 20-30 mmHg

Sit them upright-->loosen tight clothing --> check catheter--> check for bowel impaction

500

Which SCI's are more susceptible to impaired temperature control?

Cervical or complete injuries