1 / 24

Fatigue, weakness and spasticity in MS… a self-management challenge! Thomas R. Holtackers, PT

Fatigue, weakness and spasticity in MS… a self-management challenge! Thomas R. Holtackers, PT. Self-Management Challenges. Progression of the disease Overlapping grieving processes Cognitive issues Depression and apathy Lack of health literacy Life’s stresses Lack of support/follow-up.

imala
Download Presentation

Fatigue, weakness and spasticity in MS… a self-management challenge! Thomas R. Holtackers, PT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Fatigue, weakness and spasticity in MS… a self-management challenge!Thomas R. Holtackers, PT

  2. Self-Management Challenges • Progression of the disease • Overlapping grieving processes • Cognitive issues • Depression and apathy • Lack of health literacy • Life’s stresses • Lack of support/follow-up

  3. Self-Management Concepts “The most consistent aspect of MS, is its inconsistency!” “Rely on delayed-gratification more than instant-gratification” “Stretch the stiffness; Strengthen the weakness; Endure the fatigue.” “Activity rest; activity rest; activity rest…”

  4. Fatigue • Not a single entity - many components • 1 ˚ nerve fatigue (demyelination, sclerosing process & axonal damage) • muscle, emotional, cognitive • “MS” fatigue • Interaction of other symptoms • spasticity/tone • weakness/muscle imbalance • Other possible contributors • poor balance/ataxia/tremor • cognitive dysfunction • bladder dysfunction

  5. Other Factors • Autonomic Nervous System dysfunction • diminished sweat response • heart rate/blood pressure change not concomitant with increases in activity • Sleep deprivation • Bladder dysfunction • Restless legs • Dehydration • Diminished activity • Heat sensitivity!

  6. Variables of Increased Core Body Temperature • Activity/exercise • Ambient temperature/humidity • Poor sweat response • “Diurnal” temperature change • Temperature of food/drink • Radiant energy/direct sunlight • Heavy/warm clothing • Thermogenesis of digestion

  7. Fatigue Management • Managing other symptoms • Practice heat sensitivity management skills • Sleep management • Practicing good nutritional habits • Use of adaptive equipment • Prioritizing energy expenditure • Pacing activities • Finding a balance between exercise, activity and inactivity • Adopting the concept of… activity, rest; activity, rest; etc

  8. Spasticity/Tone Spasticity is velocity related Postural tone Mild to severe Often co-exists with weakness More apparent in the lower extremities

  9. Pain/discomfort Contractures  energy-cost  sheer forces  skin breakdown  safety  work for caregiver May interfere with: - ADL’s - hygiene -bowel/bladder - sexual activity - gait/transfers - general mobility - posture - sleep - breathing Spasticity/ToneNegative Consequences

  10. Spasticity/TonePositive Consequences • Possible advantages of spasticity • Good vs. bad spasticity • Maintains muscle tone/bulk • Helps support circulatory function • May prevent formation of deep vein thrombosis • May assist with postural control • May assist in activities of daily living, i.e. transfers, dressing, gait

  11. Spasticity/ToneManagement • Stretching (primary) - intensity} moderate - duration} short - repetition} many - frequency} often

  12. Positioning/change in position • Activity (“motion is lotion”) • Strengthen antagonist muscle groups • Other considerations: • rotatory trunk movements • reciprocal movements • vibration • topical heat vs cold • reciprocating electrical stimulation

  13. Spasticity/ToneMedical Management • Medical intervention • Baclofen • Zanaflex/valium/catapres • Baclofen pump • Botox injections • Nerve blocks • Surgical intervention • Neurotomy • Tendinotomy

  14. Weakness • Primary (organic) • Due to MS plaques in the CNS • results in physiological muscle fatigue, paresis, or paralysis • Secondary • 2º disuse, deconditioning, compensatory movements, pain, contractures, proprioceptive loss, tendonitis, etc. • 2º spasticity & fatigue

  15. Weakness Management • Primary weakness - Strengthening exercise to maintain - Be aware of overuse - May require compensatory intervention (mobility aids, electrical stimulation, bracing, etc.)

  16. Secondary weakness - Often overlooked - May be minimized with early intervention - emphasize posture/stability - correct compensatory gait - reduce lifestyle risk factors - incorporate energy management strategies

  17. Weakness Management • Strengthening exercises - Positioning to reduce effects of tone & spasticity - Isometric vs Isotonic - Functional antigravity muscle groups - “Core” groups - Quality of repetitions - Relaxation between reps - Number of repetitions - Speed of contractions

  18. Treatment Considerations Lower Extremity FWS Functional considerations • Gait/standing/transfers • Wheelchair/sitting posture to help reduce extensor/flexor/adductor tone • Bed positioning to help reduce same • Driving: gassing/braking

  19. Ankle/Foot • Weak dorsiflexion vs. strong, spastic plantar flexion vs. extensor tone • Stretch ankle into dorsiflexion • Strengthen anterior tib with knee flexed • Strengthen anterior tib with knee in extension • If a walker, consider rocker bottom shoe; use the toe test • Consider extensor tone during gait on ankle/knee/hip synergy • AFO to help prevent foot drop; consider weight increase/influence on hip flexion; disuse atrophy • FES of anterior tib; consider over stimulation/fatigue/spasticity; disuse atrophy

  20. Knee • Quadriceps/hamstring strength/spasticity inequities vs. extensor/flexor tone • Stretch and strengthen both • Consider stretch of antagonist prior to strengthening agonist • Position to reduce tone • When strengthening use a circuit of alternating between knee extension and knee flexion

  21. Hip • Hip flexor/extensor imbalance • Stretch and strengthen • Positioning/posture considerations • Hip abductor/adductor imbalance • Stretch and strengthen • Positioning/posture considerations • Trunk instability/“core” weakness • Get “on the ball” • Pilates concepts

  22. Other Considerations • Asymmetry of weakness/spasticity • Increased work of mobility with gait aids; cane, crutches, walkers • Wheelchair use • Other MS symptoms - pain, tremor, sensory dysfunction, central ataxia, cognitive dysfunction, emotional dysfunction • Other diseases: Cardiopulmonary/vascular, arthritis, etc

  23. Conclusions • Fatigue, weakness and spasticity (FWS) are common symptoms of MS • FWS are manageable through physical and medical interventions • Self-management of FWS is challenging and requires effort, consistency and support

  24. For professionals 1-866-MS-TREAT www.nationalmssociety.org/PRC.asp Healthprof_info@nmss.org (bulletin) For clients 1-800 FIGHTMS MS Society Resources

More Related