View source for Primary-Progressive Multiple Sclerosis (PPMS) - A Case Study

== Introduction ==
[[File:Types all.gif|thumb|Types of Multiple Sclerosis<ref>Types of Multiple Sclerosis. [https://mymsaa.org/ms-information/overview/types/ Multiple Sclerosis Association of America]. Available from: <nowiki>https://mymsaa.org/ms-information/overview/types/</nowiki> (accessed May10 2022)</ref>]]
[[Multiple Sclerosis (MS)|Multiple sclerosis (MS)]] is a neurological, autoimmune disease that affects the central nervous system.<ref>What is multiple sclerosis (MS)?: The Johns Hopkins Multiple Sclerosis Center. 2015. Available from: <nowiki>https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/multiple_sclerosis/conditions/</nowiki> (accessed May10 2022)</ref> Though the exact aetiology of MS is unknown, it occurs when the immune system attacks nerve fibers and the myelin sheath of neuronal axons, leading to inflammation and demyelination of the central nervous system.<ref name=":6">Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. Treasure Island (FL): StatPearls Publishing; 2022  Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK499849/</nowiki> ([accessed May10 2022)</ref> As a result, it alters electrical signaling in the brain and leads to a variety of symptoms, such as difficulty with walking, blindness, paralysis, etc.<ref>What is MS? National Multiple Sclerosis Society. Available from: <nowiki>https://www.nationalmssociety.org/What-is-MS</nowiki> (accessed May10 2022)</ref> In Canada, over 90,000 people are living with MS, which equates to 1 in every 400 people.<ref name=":7">Latest MS Research News: Prevalence and incidence of MS in Canada and around the world - MS Society of Canada. MS Society. 2020. Available from: <nowiki>https://mssociety.ca/research-news/article/prevalence-and-incidence-of-ms-in-canada-and-around-the-world</nowiki> (accessed May10 2022).</ref> Annually, 4,377 Canadians are diagnosed with MS, which equates to almost 12 people per day.<ref name=":7" /> 

A thorough medical history in conjunction with a neurological examination and imaging are used to diagnose MS, and it is diagnosed once other potential reasons for symptoms are ruled out.<ref>Diagnosis - MS Society of Canada. MS Society.  Available from: <nowiki>https://mssociety.ca/about-ms/diagnosing-ms</nowiki> (accessed May10 2022).</ref> MS can be classified into four types of diagnoses: clinically isolated syndrome, relapsing remitting, secondary progressive and primary progressive.<ref>Types of MS. National Multiple Sclerosis Society. Available from: <nowiki>https://www.nationalmssociety.org/What-is-MS/Types-of-MS</nowiki> (accessed May10 2022).</ref> 

Primary progressive multiple sclerosis (PPMS) is characterised by a gradual deterioration in functional capacity due to neurological deficits, without the occurrence of early relapses (exacerbation or flare-ups). Furthermore, this type of MS can be categorized as active (confirmed via an occasional relapse and/or imaging) or inactive, as well as progressive (evident decrease in functional capacity) or non-progressive.<ref>Primary progressive MS (PPMS). National Multiple Sclerosis Society. Available from: <nowiki>https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS</nowiki> (accessed May10 2022).</ref> Globally, 10-15% of individuals diagnosed with MS present with PPMS<ref name=":6" />. 

This fictional case study will highlight the experience of Michelle White, a 47-year-old female who was diagnosed with PPMS. Michelle was referred to physiotherapy due to an acute exacerbation of PPMS, and her primary goals with rehabilitation are to improve her walking capacity and ability to perform ADLs. The purpose of this case study is to provide evidence-based information from the literature regarding symptoms, objective findings, and interventions for PPMS.