Secondary Progressive Multiple Sclerosis (MS)
by Diamond Collins
1. Vital Signs
2. Cranial nerves
3. Balance
4. BP: 124/76
5. Pulse: 64 bpm
6. Respiratory rate: 18 breaths/min
7. progressive weakness, balance problems, spasticity, sensory disturbances, cognitive impairments
8. affects sensory, motor, and autonomic pathways
9. Pathophysiology
10. Cognition
11. Sensation
12. Perception
13. chronic, inflammatory demyelinating disease of the CNS
14. mild impairments with processing speed. memory. cognitive challenges
15. Motor
15.1. Tone
15.2. Control
15.3. Strength
16. spasticity; lower extermities
17. impaired coordination: dysdiadochokinesia
18. Weakness; both UEs and LEs
19. compensation weakness; decreased hip/knee flexion during swing, decreased dorsiflexion
20. Gait: ataxia, scissoring
21. normal sitting
22. loss of balance
23. Sensory loss
24. impaired light touch and proprioception in L lower extermity; balance/coordination difficulties
25. cognitive challenges: affect functional performance
26. Cardiovascular/endurance
27. Functional Skills
27.1. Functional transfer
27.2. Ambulation
28. Vestibular Examination
29. VOR cancellation: normal
30. 6 Minute walk test: 1,111 ft with B walking poles; reduced cv endurance/possible fatigue
31. TUG: 19s; functional mobility limitations
32. floor to stand - independent w/ support when fatigued
33. sit to stand - independent but with decreased stability, wgt shift to R LE, bilateral knee valgus collapse.
34. MSIS-29: 55% physical, 37.8% psychological; significant impact on both physical and emotional health
35. Outcome measures
36. Modified fatigue impact scale: 51/84; mod fatigue
37. Stairs: difficult ascending stairs when fatigues --> weakness and coordination impairments
38. FGA: 11/30; high risk for falls
39. unsteady surfaces: need contact guard assist w/ B walking poles, min assist w/o AD
40. 5X sit to stand test: 27.04s; severed difficulty w/ postural transitions, support motor control/strength deficits
41. Community distance: mod independent with B walking poles
42. secondary progressive MS: worsening w/o acute pathways
43. 10-meter walk test: 1.03 m/s (self-selected), 1.26 m/s (fast); slow walking speeds, weakness, possible fatigue
44. Short distance: independent
45. Gaze stability: negative
46. mCTSIB: 2s; instability with eyes closed/foam surface.
47. examination: normal
48. Berg balance: 41/56; moderate balance impairment
49. sinlge limb stance: 3s L, 6s R; imbalance/weakness L LE
50. standing: tandem stance 5.9s L, 11.3s R; significant asymmetry
51. Cardiovascular: no abnormalities