Multiple Sclerosis (MS) Case Study

Case Study Assignment

  * In progress, please do not edit prior to May 22, 2020*

The purpose of the present fictional case study is to demonstrate major multiple sclerosis (MS) clinical findings and propose appropriate, evidence-based management interventions that effectively address an active patient’s participation restriction.

Patient Profile

Gender: Female Occupation: Graphic Designer Subtype: MS (relapsing-remitting) Dx currently?

Referral: Recent Dx from family physician, referred to PT to aid in functional goals related to hiking/something else?

Problem List:

- Fatigue (mental & physical)

- Deteriorating dexterity (typing, things falling out of hand)

- Psychosocial aspects of life affected (inability to participate in bike rides with husband, fatigue affecting ability to work full days? And some job tasks affected)

Introduction

MS Sub- Types

RRMS	...	85% of individuals	Test Table
SPMS
PPMS
PRMS

Table 1

Multiple sclerosis (MS) is a neurological condition characterized by inflammatory demyelination over multiple episodes and locations in the central nervous system (Kalb, 2010). MS’ complex nature - its variance among patients, unpredictability, potential to create a heavy social and emotional burden on patients - can make appropriate, effective management challenging for community physiotherapists (Kalb, 2010). The debilitating symptoms (fatigue, arm movement and/or vision problems, ambulatory impairment, etc.; Kalb, 2010) can considerably impact patients’ ability to fulfill their occupational, familial, and community roles. The purpose of the present fictional case is to illustrate the clinical presentation of MS and propose appropriate, evidence-based management interventions that effectively address an active patient’s participation restriction.

Case:

29 year-old graphic designer Betty Jackson first noticed her symptoms in the summer of 2019 when she was biking along the lake with her husband and noticed she was experiencing difficulty reading signage and using her arms to keep her bike steady. As she finished her route she felt excessively fatigued. These symptoms persisted for a few days, eventually affecting her productivity at work, prompting a visit to her family physician. Upon assessment of MRI findings which showed demyelination plaques in the corpus callosum, the physician classified her event as a “clinically isolated syndrome” (Kalb, 2010) of MS. A year later, Betty’s symptoms: she experienced the same fatigue, vision and arm issues as before, but at a greater degree of intensity. Furthermore she noticed she was tripping frequently. After seeing her physician again, a secondary MRI revealed more distal demyelination plaques. She was diagnosed with primary progressive MS (PPMS), characterized by increasing disability over time with or without plateaus (Kalb, 2010). The physician referred her to a private physiotherapy clinic in the community for gait and motor control training. Betty is under considerable stress as a result of her recent diagnosis. She is fearful she will lose her job or will not be able to support her children considering her gait impairment and considerable fatigue.

Gait impairment will be central in Betty’s rehabilitation to address her safety (fall prevention) and her ability to continue (commuting to) work. The National Multiple Sclerosis Society recommends addressing multiple aspects of gait including vision, fatigue, foot wear, and balance impairments, and using mobility aids to “normalize” the gait (Kalb, 2010). Interestingly, in a case study conducted on a woman with similar concerns and clinical presentation, a 3 month locomotor training program involving a combination of virtual-reality based and overground balance interventions, and body-weight-supported/treadmill training twice a week, improvements were observed both at post-intervention and 2-month follow-up in gait speed, endurance and balance (Fulk, 2005). Fatigue is also of great importance to Betty’s participation as a worker and a parent. Regular exercise has been cited widely in the literature as beneficial for promoting restful sleep and reducing fatigue in multiple sclerosis (see the giant blob of sources (5-ish) in our notes for physiotherapy management). Therefore education on, and implementation of regular safe exercise should play an important role in Betty’s treatment plan.

A challenging aspect of this case is the significant occupational modification that will likely be necessary for the patient. Graphic design requires a high level of upper extremity motor function, and without considerable workplace modification, ergonomic intervention, or additional support from the employer, continuing to pursue this line of work may prove unrealistic. For this reason the involvement of an occupational therapist and/or social worker may be warranted.

Client Characteristics

Betty Jackson is a 29 years old woman living alone in a Sudbury, Ontario apartment. Her primary condition is MS, which presents with ataxic gait, bilateral arm control impairment, blurred vision, and decreased activity tolerance (rapidly fatigues). She was referred to the clinic by her general physician for gait and motor control training as a fall prevention measure. Additionally, Betty hopes to mitigate her fatigue so she can get more done at work.

Abstract

Complete Last

Intervention

Fatigue: Naps, moderate aerobic exercises, cooling Dexterity: Psychosocial:

Self study questions

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References [1]

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