1. Multiple Sclerosis Ian Haslam 486

2. What is Multiple Sclerosis? An autoimmune disease that attacks the bodies own nerve cells Leads to partial disability but can eventually lead to complete disability depending on severity.

3. Role of Myelin Protects axons Protects neural signal and conducts neural signals using saltatory conduction

4. Normal vs Damaged Neurons

5. How do Plaques form? T-Cells secrete cytokines Helper-T cells come help and further secrete cytokines B-Cells complement by secreting antibodies Cytokines bind to macrophages which attack myelin and oligodendroglia

6. Epidemiology and Genetics Most common in Caucasians. More prevalent in women. Most people are diagnosed between 20 and 50. Average American has.1% chance of developing MS. First degree relatives of someone with MS has 2.5-5% chance of developing MS.

7. Stages of MS There are 4 different stages of MS Relapsing-Remitting- symptoms occur over weeks, months, or days and may resolve. Primary-Progressive MS- symptoms gradually get worse without flare ups. Secondary-Progressive MS-symptoms get steadily worse, may take years or decades. Progressive-Relapsing MS- Symptoms get steadily worse and patients experience flare ups that may or may not have recovery.

8. Symptoms of MS Early symptoms of MS: Blurred/double vision Thinking problems Lack of coordination Loss of balance Numbness, tingling, weakness in arm or leg Common symptoms of MS: Pins and needles sensations Bladder problems Trouble Walking Dizziness Fatigue

9. Diagnosis of MS To be diagnosed with MS a physician must: Find brain damage in two separate locations of the CNS Find evidence that the damage occurred at two different points in time Must rule out all other diagnosis's

10. MS and Exercise MS limits what type of exercise can be done as well as intensity and duration Exercise may lessen symptoms of disease and lower fatigue levels in patients Exercise Goals: balance, proper gait, and muscular/aerobic endurance

11. Management and Meds MS is incurable. Treatment Goal: Slow progression and lessen symptoms Medications: Injections: Copaxone, Rebif, Avonex, Extavia Oral Meds: Aubagio, Gilenya, Tecfidera

12. Case Study Joe Haslam 70 year old male Diagnosed with Multiple Sclerosis Activity Level: Sedentary Has not smoked within 6months Cholesterol levels unknown Medications: Metoprolol, Lovastatin, Baclofen, Copaxone, Ampyra Risk Level:High

13. Exercise Tests Romberg balance test 2min step in place test Timed up and go Astrand-Rhyming Bike ergometer test Unipedal stance test

14. Exercise Prescription F: 2-3 days/week I: 50-60%max Hr (or lower) or 9-12 on Borg(6-20 scale) T: 10-40min duration 1-2sets for resistance exercise T: Endurance training/resistance training/balance training

15. Types of exercises Airex stands Tandem stance/SLS Gait training Stair walks Mini squats/chair get ups General strengthening with bands/ Balance training Posture exercises ROM stretches Standing perturbations

16. Conclusion Focuses for MS patients: -Balance -ADL’s -Gait Training

17. References http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692682/pdf/10603618.pdf http://www.pathophysiologyjournal.com/article/S0928- 4680%2810%2900037-4/pdfhttp://www.pathophysiologyjournal.com/article/S0928- 4680%2810%2900037-4/pdf http://www.nationalmssociety.org/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375103/