Episode 35 – Multiple Sclerosis

Watch the video version of this Q&A episode on YouTube - https://youtu.be/3HXTAKUz4aI

After approximately 25 minutes of a 30 minute therapy session focusing on mobility and activities of daily living, a patient diagnosed with multiple sclerosis reports feeling extremely fatigued. The therapist promptly takes the patient's vital signs and concludes they are unremarkable. What is the MOST appropriate therapist action?

1. Discontinue the treatment session
2. Modify the intensity of the current therapy session
3. Complete a formal reassessment of the patient
4. Contact the referring physician to discuss the patient's condition

Welcome back to the Scorebuilders’ Q and A Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

After approximately 25 minutes of a 30 minute therapy session focusing on mobility and activities of daily living, a patient diagnosed with multiple sclerosis reports feeling extremely fatigued. The therapist promptly takes the patient's vital signs and concludes they are unremarkable. What is the MOST appropriate therapist action?

1. Discontinue the treatment session
2. Modify the intensity of the current therapy session
3. Complete a formal reassessment of the patient
4. Contact the referring physician to discuss the patient's condition

The ability to answer this question correctly will be primarily influenced by your knowledge related to multiple sclerosis. This is a good example of a high level question that relies on decision making as opposed to academic fact. Students have to weigh the presented information and then carefully apply the information in the presented clinical scenario.

Let’s take a deeper dive into multiple sclerosis.

Multiple Sclerosis
Multiple sclerosis produces patches of demyelination of the myelin sheaths that surround nerves within the brain and spinal cord. This decreases the efficiency of nerve impulse transmission. Symptoms vary based on the location and the extent of demyelination.

Signs and symptoms – Initial symptoms often include visual problems, paresthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue. The clinical course usually consists of periods of exacerbations and remissions.

Treatment – Management of multiple sclerosis includes pharmacological, medical, and therapeutic interventions. The goal is to lessen the length of exacerbations and maximize the health of the patient.

Physical therapy intervention includes regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance and gait training, core stabilization, and adaptive/assistive device training. 

The question indicates that the patient reported feeling extremely fatigued after 25 minutes of a 30 minute therapy session.Most patients with multiple sclerosis report experiencing fatigue, with greater than 50% of individuals reporting it as their worst symptom. Physical therapists should be vigilant to identify signs of fatigue, particularly excessive fatigue, in this population due to the potential debilitating effects.

Let’s explore each of the options:

Option 1 - Discontinue the treatment session 
Patients with multiple sclerosis are extremely susceptible to exercise-related fatigue, heat intolerance, and falling.The patient described their status as “extremely fatigued.” In addition, the patient already engaged in 25 minutes of a scheduled 30 minute physical therapy session. Without additional information related to the patient’s typical exercise tolerance and the type of multiple sclerosis (e.g., relapsing, primary progressive, secondary progressive), it is necessary to be conservative and discontinue the current session.

Option 2 - Modify the intensity of the current therapy session 
While decreasing the intensity of the therapy session would reduce the workload, the patient has already reached a point of extreme fatigue. With only five minutes remaining in the therapy session, it’s more critical that the patient avoid overexertion and subsequent potential exacerbation of symptoms than it is to attempt to utilize the remaining time.

Option 3 - Complete a formal reassessment of the patient 
Fatigue is a common symptom in patients with multiple sclerosis. A formal reassessment is unnecessary based on an isolated report of extreme fatigue. Discontinuing the current session ensures patient safety and leaves open the possibility for a future reassessment if warranted.

Option 4 - Contact the referring physician to discuss the patient's condition 
Again, fatigue is a common symptom in patients with multiple sclerosis. Contacting the patient’s physician is unnecessary at this time based on the presented information although could be warranted if the patient’s subjective reports of fatigue continue or their symptoms intensify.

The correct answer is Option 1

Let’s explore the all student data:
64% of students selected Option 1, Discontinue the treatment session, the correct response
32% of students selected Option 2, Modify the intensity of the current therapy session
2% of students selected Option 3, Complete a formal reassessment of the patient
2% of students selected Option 4, Contact the referring physician to discuss the patient's condition

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items. 

Level Classification
This question is a Level 3 question since the question requires candidates to systematically analyze and often interpret information to determine an appropriate course of action. Level 3 questions tend to have some degree of subjectivity and candidates are required to assign varying degrees of importance to different variables.

Academic Focus Area
Looking to review related academic content? Check out pages 288, 352-353 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!