6
- 2-5% diagnosed before age 18
- Diagnosis challenging due to other childhood diagnosis that need to be ruled out with similar symptoms and characteristics
Pediatric MS
- Relapsing or progressive
- Stable or worsening (disability progression)
- Active or not-active
- With progression or without progression
- Active = new relapses, new MRI activity
Additional descriptors
What are the (2) initial signs and symptoms of MS?
1. Visual impairment (diplopia is common)
2. Sensory changes
Name stage of MS:
Preventative:
- Maximize upright posture, out of bed time
- Maximize participation in ADLs
- Prevention of contractures, pressure wounds, and so forth
Compensatory
- Family/caregiver education and training: safety for transfers, positioning, turning, skin care
- Pressure relieving devices
- Hospital bed, WC, mechanical lift
- Psychological support for patient and family/caregiver
- Referral to other health care professionals as needed
Late/advanced
Name stage of MS:
Preventative and restorative:
- Regular exercise to maintain/improve motor performance, strength, mobility, flexibility, ROM, balance, locomotion, endurance and perceived QOL
- Community classes to improve/maintain socialization, camaraderie, positive outlook and life purpose
Compensatory:
- AD to maintain function
- Motorized WC or scooter for community mobility
- Environmental modification to home
- Patient/family/caregiver education and training
- Psychological support for patient and family/caregiver
- Referral to other health care professionals as needed
Middle/moderate
Name stage of MS:
- Few/minimal impairments and activity limitations with independence maintained
- Motor symptoms present but do not interfere with daily activities
- Symptoms for RRMS are more variable and do not progress at the same rate as PPMS
- SPMS initially presents with relapsing-remitting course followed by a more progressive course
Early/mild
Damage on scans, do not relate to symptoms
- EX: plaque on occipital love, but no vision issues
Radiologically isolated syndrome
Name stage of MS:
- Progressive course with numerous impairments with increasing severity
- Severe activity limitations with dependence in most activities
- Great difficulty walking; typically in WC or bed most of the day
- Assistance needed with all ADLs
- Severe participation restrictions
- not able to live alone
- typically requires full-time assistance or placement in chronic care facility
- Social interaction restricted
- Cognitive problems may be prominent, including dementia, hallucinations, and delusions
Late/advanced
Name stage of MS:
Preventative and restorative:
- Regular exercise to improve/maintain motor performance, strength, mobility, flexibility, ROM, balance, locomotion, endurance and perceived QOL
- Community classes to improve/maintain socialization, camaraderie, positive outlook, and life purpose
Compensatory
- Patient/family/caregiver education about disease process, rehabilitation, energy conservation
- Determine need for adaptive or assistive devices
- Provide psychological support with early referral to support groups for patient and family/caregiver
- Referral to other health care professionals as needed
Early/mild
Name the type of symptom:
Social isolation, loss of job
Tertiary s/s
- Can present challenges because disability and symptom set are at their highest
- Needs: pressure ulcers, respiratory complications, OT/ST, adaptations to physical and mental limitations
Advanced disease
Name stage of MS:
- Progressive course with increasing number of severity of impairments
- Minimal to moderate activity limitations, participation restrictions
- ADL with modified independence (assistance)
- Difficulty with balance and gait, postural instability
Middle/moderate
- Optic neuritis
- Lhermitte's sign (when they look down, there's a zinger down back and neck)
- Sensory changes, numbness/tingling
- Pyramidal tract signs (weakness, spasticity)
- Neurogenic bladder
Typical features (s/s) of MS
Name the type of symptom:
Heat sensitivity: elevated temperature further impairs the ability of a demyelinated nerve to conduct electrical impulses. Heat generally produces worsening of symptoms temporarily, but does not change disease process known as Uhthoff's sign. An increase in less than one half degree Celsius can cause MAJOR (transient) weakness.
Unique needs
Name the type of symptom:
Fatigue, visual changes (direct result of demyelination)
Primary s/s
Name the type of symptom:
UTI, skin breakdown, falls
Lack of mobility, bladder issues, sensation issues
Secondary s/s
- Initially thought of as a "painless" disease
- MS hug
- Lhermitte's sign
- MSK and referred pain patterns
- From spasticity, from immobility, from overuse, neuropathic pain, trigeminal neuralgia
Management: cannabis, PT/OT, meds
Pain in MS
- Fatigue
- Pain
- Spasticity
- Tremor and incoordination
- Weakness
- Altered mobility and balance problems
- Visual impairment
- Cognitive dysfunction (40-70% affected)
- Elimination dysfunction (urinary 80% and bowel)
- Altered speech and swallowing
- Sexual dysfunction
- Altered sensation
- Emotional problems
- Dizziness/vertigo
Common signs and symptoms
Fatigue specific to MS, unsafe and can cause damage (AND they also have regular fatigue)
Lassitude
Name the type of symptom:
Fatigue, cognitive changes, dysesthesias/paresthesia, bladder/bowel dysfunction, depression or other mood disorders
"Invisible" symptoms
- If due to lack of use of muscle (deconditioning) due to decreased mobility and activity, safe to perform progressive resisted exercises for these muscles
- If caused by damage in nerve fibers due to demyelination that innervates muscle, weight training for this is not effective and may even weaken and feelings of fatigue, reduce muscular endurance to affected areas
- Strategy: maintain tone and activity of muscles affected by nerve demyelination and strengthen surrounding muscles
Muscle weakness (paresis)
- Worsening of other MS symptoms including weakness and spasticity
- Repeated UTI
- Urosepsis (infection in blood) and skin breakdown
- Challenges with work, home and social activities
- Loss of independence, self esteem
- Remember to refer to pelvic health PT if necessary
Untreated bladder issues
Bladder that is overactive and does not allow for complete urine emptying causing
- Frequency, urgency, nocturia, incontinence, inability to empty bladder completely
Spastic bladder
- Depression (50% experience major depressive episode)
- PHQ2
- Beck's Depression Inventory
- Hospital Anxiety and Depression Scale - CMSC Annual Conference
- Transcranial magnetic stimulation (also for depression/anxiety)
Emotional problems with MS
Trigeminal neuralgia and Lhermitte's type pain are treated with anticonvulsants
Dysesthesias which are painful sensations like MS hug, "nerve pain" are treated by anticonvulsants or antidepressants.
Anticonvulsants= gabapentin, Tegretol
Pain from spasticity treated with baclofen, Tizanidine
Narcotics, aspirin, codeine are NOT affected
Pain meds for MS