Multiple Sclerosis - A Practical Guide to Rehabilitation - 17

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

2 More marked increase in muscle tone through
most of the ROM, increased resistance with
quick stretch
3 Considerable increase in muscle tone, passive
movement difficult
4 Affected part(s) rigid in flexion or extension

BALANCE
Balance dysfunction in MS directly impacts
mobility and performance of activities of daily
living. Common gait deviations observed in
individuals with balance and coordination
difficulties include hesitation to move, slow
deliberate movement, small range of motion in
movements, stiff movements, sliding or shuffling
feet forward, increased stance time bilaterally,
wide base of support, and ataxia of foot
placement.
Physiological components necessary for balance
are adequate strength and postural control; visual,
vestibular, and somatosensory processing; and
integration and processing of this information for
appropriate equilibrium reactions, righting
reactions, and upright postural control to support
functional sitting, standing, and ambulation. In
people with MS, weakness or spasticity in lower
extremities, ataxia, weak trunk control, sensory
deficits, internuclear opthalmoplegia (INO), and
vestibular disorders may all contribute to balance
dysfunction.
The following elements are part of a
comprehensive examination to assess balance in
persons with MS:
* Musculoskeletal (adequate strength and active
range of motion for minimal to no spasticity)
* Somatosensory (proprioception, kinesthesia,
and localization)
* Visual (smooth pursuits, saccades,
convergence)
* Vestibulo-ocular reflex (VOR) and
cancellation
* Vestibular (benign paroxysmal positional
vertigo [BPPV])

Assessment of posture and trunk strength involves
examining the patient's static and dynamic
posture while sitting and standing. Righting
reactions should be evaluated when the postural
alignment is challenged. Extremity strength can be
tested with manual muscle testing. Somatosensory
assessments include proprioception, kinesthesia,
and localization. Proprioception can be assessed as
follows: with the patient in a supine position and
eyes closed, the rehabilitation professional moves
a joint to a stationary position, then asks the
patient to match that position with the opposite
extremity. Similarly, kinesthesia can be evaluated
by asking the patient to mimic the opposite
extremity while movement is taking place. For
localization, the patient, with eyes closed, is asked
to give (verbally or by pointing) the location of
the examiner's touch.
Ocular motor deficits in MS include INO and
nystagmus and may cause diplopia, oscillopsia,
blurred vision, and reading fatigue.48 These
abnormalities are often attributed to brainstem or
cerebellar lesions.49 Visual testing can be
conducted with the patient in a seated position,
with the examiner moving a finger or other object
in front of the patient's face.
Visual assessments include:
* Spontaneous and gaze-holding nystagmus:
The patient is asked to focus on the examiner's
finger in midline, and at 30 degrees
horizontally to both sides and vertically up and
down (the examiner is looking for the presence
of nystagmus in each position)
* Smooth pursuits: The patient follows the
examiner's finger, typically in an "H" pattern,
while the examiner is watching for smoothness
of eye movements
* Saccades: The patient moves his or her eyes
between 2 points, while the examiner is
assessing velocity, accuracy of movement, and
ability of the eyes to move together
* Convergence: The patient follows the
examiner's finger as it moves in toward the
patient's nose (no closer than 6-8 cm away).

Mobility

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Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
Multiple Sclerosis - A Practical Guide to Rehabilitation - 6
Multiple Sclerosis - A Practical Guide to Rehabilitation - 7
Multiple Sclerosis - A Practical Guide to Rehabilitation - 8
Multiple Sclerosis - A Practical Guide to Rehabilitation - 9
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 13
Multiple Sclerosis - A Practical Guide to Rehabilitation - 14
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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