1. Multiple Sclerosis

2. Multiple sclerosis (MS) is a disease that affects central nervous system (brain and spinal cord). It damages the myelin sheath.  Females are more affected than males

3. Signs and Symptoms Spasticity Weakness Fatigue Sensory disturbances – Numbness and Tingling sensations Balance problems Gait disturbances Visual problems

4. The most common type of multiple sclerosis is relapsing – remitting type.

5. Diagnosis At least two separate areas of damage in Central Nervous System The damage occurred at least one month apart Rule out all other possible diagnoses

6. Management of Multiple Sclerosis Drug therapy – Treat new attacks (exacerbations) – Prevent the occurrence of future attacks – Slow or prevent disease progression – Treat the chronic symptoms of the disease Physical Therapy Psychosocial support

7. Physiotherapy assessment Range of motion Strength Tone Sensory impairment Balance Coordination Cardiovascular and respiratory status Bed mobility and transfer Bowel and bladder impairment Activities of daily living Outcome measure -Kurtzke scale

8. Physical Therapy Intervention Range of motion exercises Strengthening exercises Coordination exercises Balance training Gait rehabilitation – Light weight Walking aid, Ankle foot orthosis (AFO) and Functional electrical stimulation Safe Transfers techniques Energy conservation techniques – For management of fatigue.

9. Guillain Barre Syndrome

10. Acute Post-infectious ascending demyelinating polyneuropathic paralysis Affects the peripheral nervous system Commonest cause of rapid-onset flaccid paralysis

11. Clinical Manifestations Usually develop 1 to 3 weeks after Upper Respiratory tract infection (URTI) or Digestive infections Weakness of lower extremities (symmetrically) Parathesia (numbness and tingling), followed by paralysis Hypotonia and areflexia (absence of reflexes) Pain in the form of muscles cramps Involvement of lower brainstem leads to facial and eye weakness Complication  The most serious complication is respiratory failure

12. Tests EMG and nerve conduction studies will be abnormal Cerebro spinal fluid (CSF)- elevated protein

13. Criteria for Diagnosis Symmetric weakness of two or more limbs Decreased reflexes Short course (less than 4 weeks of weakness) No fever Cranial nerves Involvement - (eye movements, double vision, swallowing; respiratory involvement)

14. Outcome Measures Hughes scale 0 – Healthy, no signs of GBS 1 – Minor symptoms or signs; able to run 2 – Able to walk > 5 meters without assistance but unable to run 3 – Able to walk > 5 meters with assistance (human or crutch) 4 – Bed or chair bound; unable to walk 5 – Requiring assist with ventilation for at least part of the day or night

15. Physical Therapy Intervention in acute stage ROM exercises Positioning. Respiratory management - In severe cases, ventilator support is needed. In other cases – Breathing exercises and airway clearance techniques. To prevent deep vein thrombosis – compressive stockings. Pain control – TENS can be used.

16. Post – acute Physical Therapy Intervention ROM exercises Strengthening exercises. Balance training Gait rehabilitation - Ankle foot orthosis (AFO) may be used. Functional training