Multiple Sclerosis - A Practical Guide to Rehabilitation - 18

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

The patient is asked if his or her vision is
blurred or doubled, and the examiner is
watching for the ability of the eyes to adduct
Vestibulo-ocular assessments include the
following:
* VOR: The patient is asked to focus on the
examiner's finger, while moving his or her
head side to side in a "no" movement, then up
and down in a "yes" movement. The examiner
is looking for the patient's ability to maintain
gaze and asking about blurred vision, double
vision, or dizziness
* VOR cancellation: The patient is asked to
focus on the examiner's nose, while the
examiner moves the patient's head. The
examiner is testing the ability of the patient to
move the eyes together with the head,
cancelling the VOR.
* Dynamic visual acuity: Keeping his or her
head still, the patient is asked to read the
lowest line he or she can clearly and accurately
see on a Snellen chart. The examiner then
passively shakes the patient's head at
approximately 2 Hz and again asks the patient
to read the lowest line possible on the Snellen
chart. A difference of 3 lines or greater between
these 2 tasks is indicative of a VOR deficit.
Vestibular examinations include the Dix Hallpike
and head thrust tests. For the Dix Hallpike test,
the patient is on a plinth table in a long sitting
position. The head is turned 45 degrees, and the
patient is rapidly brought into supine position
with the head extended off the table. The most
common type of nystagmus in this position is
torsional and vertical, usually of short duration,
and indicative of BPPV (which is not associated
with MS, but if present would alter the patient's
balance). For the head thrust test, the patient
(while seated) is asked to focus on the examiner's
nose. The examiner moves the patient's head from
side to side in a "no" motion, then quickly
"thrusts" the patient's head 30 degrees from
midline. The patient's inability to maintain

18

fixation on the examiner's nose indicates a
defective VOR. The head thrust may also be used
to determine the presence of vestibular neuritis,
an inflammation or infection of cranial nerve VIII
(vestibulocochlear).
The Berg Balance Scale is useful for providing a
more general assessment of balance with
relevance to need for ambulatory assistive
devices.50 It includes 14 predetermined tasks,
listed below, that together require about 20
minutes to complete.
1. Sitting to standing
2. Standing unsupported
3. Sitting with back unsupported but feet
supported on floor or on a stool
4. Standing to sitting
5. Transfers
6. Standing unsupported with eyes closed
7. Standing unsupported with feet together
8. Reaching forward with outstretched arm
while standing
9. Pick up object from the floor from a standing
position
10. Turning to look behind over left and right
shoulders while standing
11. Turn 360 degrees
12. Place alternate foot on step or stool while
standing unsupported
13. Standing unsupported one front in front
14. Standing on 1 leg
Each task is scored from 0 to 4, with 0 being the
lowest level of functioning and 4 the highest. A
score of 56 indicates functional balance. Scores
below 45 indicate a greater risk of falling. Scores
can also be broken out to inform the need for an
assistive device. Scores of 0-20 indicate a high fall
risk with ambulatory assistive device required.
Scores of 21-40 indicate a moderate fall risk,
warranting consideration of an ambulatory assist
device. Scores of 41 and higher indicate a low fall
risk, supporting safe independent ambulation.50

Mobility



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
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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