Secondary Progressive Multiple Sclerosis - A Case Study

Introduction

Ms. X is a 40 year old female with Secondary Progressive Multiple Sclerosis (SPMS). She came into the Multiple Sclerosis (MS) Clinic at Kingston General Hospital (KGH) as an outpatient to seek progression management and manage her current diagnosis of MS. Ms. X lives with her husband and two adolescent children in a bungalow. Currently, she is equipped with home assisted devices provided by the Occupational Therapist (i.e., raised toilet seat, shower chair, grab bars). Since her diagnosis of MS 10 years ago, Ms. X has complained of episodes of dizziness and fatigue for years and has noticed some changes in her balance and coordination, along with muscle weakness and spasticity. Due to this, she has experienced recent falls and has increasing difficulty in her ambulation. She has also noticed increased pain and reduced sensory deficits in her lower extremities due to her falls. She scored 5.5 on the estimated disability disease steps scale (EDDS). Ms. X has also reported a sensitivity to heat and has often complained that she doesn’t enjoy exercising as it makes her tired and is worried it will exacerbate her symptoms.

Many studies have shown to support Ms. X’s symptoms. Approximately, throughout the course of MS, it is estimated that between 52% and 70% of patients will experience some form of sensory disturbance (reference). A study done by S et al. studied sensory disturbance in people with MS and found that...

Client Characteristics

Ms. X is a 40 year old female with Secondary Progressive Multiple Sclerosis (SPMS) and lives in Kingston, Ontario. She doesn’t have any genetic dispositions as MS is not in her family history. Currently, she is working part-time as an accountant due to her limitations in mobility. Ms. X could benefit from physiotherapy services to help with gait, balance, muscle strength, pain, and a home exercise program. In addition, Physiotherapy services would be able to target functional endurance with day-to-day activities, support independent living, and quality of life in order to reduce her fatigue symptoms.

Examination Findings

References

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Negahban H, Rezaie S, Goharpey S. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clinical rehabilitation. 2013 Dec;27(12):1126-36. Retrieved from:https://journals.sagepub.com/doi/full/10.1177/0269215513491586

Karpatkin, HI, Napolione, D and Siminovich-Blok, B. Acupuncture and Multiple Sclerosis: A Review of the Evidence.Evidence-Based Complementary and Alternative Medicine. 2014; 2014: 1-9. Retrieved from: http://dx.doi.org/10.1155/2014/972935.

Kurtzke J.. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology. 1983;33:1444–52. Retrieved from: https://n.neurology.org/content/33/11/1444.short

Potter K, Cohen ET, Allen DD, Bennett SE, Brandfass KG, Widener GL, Yorke AM. Outcome measures for individuals with multiple sclerosis: recommendations from the American Physical Therapy Association Neurology Section Task Force. Physical therapy. 2014 May 1;94(5):593-608. Retrieved form: https://academic.oup.com/ptj/article/94/5/593/2735536

Rose, JW, Houtchens, M,  Lynch, SG. (2000).  Multiple Sclerosis: Lectures. Retrieved from: https://library.med.utah.edu/kw/ms/clinical_present.html

Wolf BA. Effects of temperature reduction on multiple sclerosis. Physical Therapy. 1970 Jun 1;50(6):808-12. Retrieved from: https://www.researchgate.net/publication/18254241_Effects_of_Temperature_Reduction_on_Multiple_Sclerosis