multiple sclerosis (MS)
an inflammatory disease of the central nervous system; myelin sheaths in multiple areas of the brain and spinal cord are damaged (demyelination); scar tissue is formed (sclerosis)
4 causes of MS
1. immunologic
2. genetic
3. environmental
4. infections
CNS includes ___
brain, spinal cord, and optic nerves
where is MS more common and why
more common in areas farther away from the equator because less vitamin D
more exposure to viruses near the equator, so those people usually have better immunity
how many people have MS worldwide
>2.3 million
how many people have MS in US
400,000
how many diagnosed cases of MS are women
60%
MS is more common in __ and __
Northern US and Canada
who is more likely to have MS
whites of northern European decent
__% of MS patients are disabled within 10 years of diagnosis
>50%
lifetime cost of MS
>$1 million per person (meds are major cost)
etiology of MS
not known
explain the pathophysiology of MS
auto reactive T-cells enter the CNS and secrete lymphokines or cytokines (these are the cells that cause demyelination)
oliogodendrites and myelin sheath are destroyed
plaque forms on the axons causing disruption of nerve impulses leading to disability
MS is a __ disease
autoimmune
symptoms of MS
fatigue, numbness, walking, balance, and coordination problems, bladder dysfunction, bowel dysfunction, vision problems, dizziness and vertigo, sexual dysfunction, spasticity, pain, cognitive impairment, emotional changes, depression
less common symptoms:
4 common signs of MS
1. optic neuritis
2. nystagmus (abnormal eye movement)
3. paresthesia (hallucinations)
4. spasticity
fatigue
overwhelming tiredness
primary fatigue
fatigue from lesions/demyelination in the brain; medication can help
secondary fatigue
deconditioning, medications (beta interference), sleep patterns affected due to spasticity, diet, depression
disease exacerbation aka __
relapse, attack, or flare up
disease exacerbation is caused by __
acute inflammation damaging myelin
disease exacerbation causes __
new symptoms or the worsening of old symptoms
(some people may not feel symptoms after remission)
can vary in intensity
may affect motility
most common form of MS
relapsing-remitting MS
__% of cases are relapsing-remitting
85%
relapsing-remitting MS
relapses followed by remissions as the inflammatory process gradually comes to an end
__ is used to manage symptoms, treat exacerbations, and slow disease progression for MS
medication
__ is done to improve function of MS patients
rehab
MS patients' thermoregulation is altered so they need__ bc they get hotter
assistive devices (fans, fluid replacement, temp changes, etc)
diagnostic testing for MS patients
CAD, autonomic dysfunction
functional testing for MS patients
safety and effectiveness of exercise testing; exercise prescription
best form of exercise for MS patients
leg cycling
GXT recommendations for MS patients
10-25 Watts increase/ stage for leg cycling
8-12 Watts increase/ stage for arm cycling
2 min stages
ramping protocols
4 types of MS
1. clinically isolated syndrome (CIS)
2. relapsing-remitting MS (RRMS)
3. primary progressive MS (PPMS)
4. secondary progressive MS (SPMS)
clinically isolated syndrome (CIS)
first episode of neurologic symptoms caused by inflammation and demyelination
CIS must last for at lease __
24 hours
(T/F) CIS meets the diagnostic criteria for MS
false
(T/F) some people with CIS may not develop MS
true
when lesions can be seen on the brain MRI, there is a high likelihood for __
another episode (relapsing-remitting)
RRMS has __ followed by __
clearly defined attacks of worsening function followed by a partial of complete recovery periods (remission)
can have periods with or without progression
primary progressive (PPMS) make up __% of persons with MS
15%
PPMS
worsening neurologic function from onset
no early relapses or remissions
occasional relapses later
can have periods with or without progression
secondary progressive MS (SPMS) follows after __
RRMS (most people with RRMS transition to this course)
occasional relapses possible
can have periods with or without progression
people with MS have lower ....
muscular strength and muscular endurance, motor unit firing rates, muscle activation, cardiorespiratory fitness, respiratory muscle function, muscle oxidative capacity, walking speed, habitual physical activity
exercise can lower __ for MS patients
fatigue
types of cardiovascular training for MS patients
cycling, walking, swimming, other
intensity of cardiovascular training for MS patients
40-70% VO2 reserve (lower initially for those with more symptoms)
monitor RPE
(T/F) published formulas for VO2 estimation work for MS patients
false
best time to take a nap
noon
average O2 uptake when walking 1 meter
0.1
when should MS patients do strength training
on days when there is no other training or fatigue
intensity for strength training for MS
60-80% 1 RM (8-15 RM)
patients with balance problems should avoid __
free weights
MS patients should consider the need for __
unilateral training and aquatic exercise
how often should MS patients do flexibility training
daily (static stretching more common)