MS AND NEUROPSYCH
Bryanna Bruger, MS, PsyD
Clinical Neuropsychologist
Advocate Aurora St. Luke’s
WELCOME & INTRODUCTION
Workout of the Day
WHAT IS MS?
Definition of MS
MS is a chronic neurological disorder affecting the brain and/or spinal cord due to immune system attacks on myelin.
Types of MS
MS has multiple types including Relapsing-Remitting, Secondary Progressive, and Primary Progressive, each with unique progression patterns.
Common Symptoms
Symptoms of MS include fatigue, mobility challenges, muscle spasticity, and cognitive changes, varying widely between individuals.
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Types
DEMOGRAPHICS
MS & THE NERVOUS SYSTEM
Demyelination Impact
MS causes loss or damage of the myelin sheath that surrounds nerve fibers, disrupting signal transmission.
Symptoms of MS
Disrupted electrical signals lead to symptoms like poor coordination, balance issues, and muscle control problems.
Visual Analogies
Comparing damaged nerves to frayed electrical wires helps explain MS’s interference with nervous function.
Therapeutic Exercise Role
Understanding MS mechanisms supports targeted exercise to maintain or improve neurological function.
COGNITION AND MENTAL HEALTH IN MS
COGNITIVE CHANGES IN MS
Prevalence rates of cognitive impairment in MS have remained consistently in the range of 40-65% across almost 50 years of studies
10% will experience severely disabling changes
It is probable that cognitive function is more vulnerable in chronic progressive or secondary progressive disease than in the relapsing-remitting form although this has not been a constant finding.
Cognitive impairment can have a significant impact on a patient’s quality of life and impedes participation in life roles including employment
Most are mild to moderate and manageable with compensatory strategies
AFFECTED COGNITIVE ABILITIES
Cognitive Challenges in MS
MS often causes difficulties with learning new information, memory retrieval, attention/concentration, processing speed, and executive functions like planning or solving new problems.
Symptom Variability
Cognitive symptoms in MS are highly variable, vary in severity, and may fluctuate between individuals and over time. Changes can occur early or late or not at all; course is variable. Not related to age, disability status, course or duration of illness. Sometimes confused with depression
What is the Cause?
New and old lesions, immune system response (causing fatigue and pain), and/or stress and emotional difficulties
Management Strategies
Cognitive rehabilitation, mental exercises, and lifestyle changes help maintain cognitive health in MS.
MENTAL HEALTH IN MS
50% to 55% will have some problems with mood dysfunction
Depression is not uncommon in people with MS
Following onset of MS, lifetime prevalence of major depression increases from 15% to approx. 50%
Mindfulness and relaxation techniques reduce anxiety and improve focus for better cognitive wellness.
EXERCISE AND BRAIN HEALTH
BENEFITS OF EXERCISE IN MS
Improved Mobility and Strength
Regular exercise enhances muscle strength and mobility, helping manage MS-related fatigue effectively.
Cardiovascular and Mental Health
Physical activity supports heart health and positively influences mood and mental well-being in MS patients.
Brain Health and Neuroplasticity
Exercise increases blood flow and promotes neuroplasticity, supporting brain health for individuals with MS.
Personalized Exercise Routine
Finding a suitable exercise routine and consulting healthcare providers ensures safety and effectiveness for MS patients.
ADAPTIVE STRATEGIES & SAFETY
Managing Heat Sensitivity
Exercising during cooler times/temperatures and using cooling garments reduces heat-related fatigue and enhances comfort.
Supporting Balance
Using assistive devices or stable surfaces helps maintain balance and prevents falls during exercise.
Pacing and Rest
Listening to the body, pacing activity, and taking rest breaks ensure sustainable exercise progress without overexertion.
Hydration and Nutrition
Proper hydration and nutrition support energy levels and overall exercise safety for individuals with MS.
COGNITVE WELLNESS
COGNITIVE REHAB
Intervention for cognitive/behavioral deficits resulting from neurological illness or injury
Two fundamental principles:
Plasticity: the brain can recover from damage that causes cognitive impairment (restorative)
Behavioral Adjustment: Individuals can change behavior or environment to adapt to circumstances as a result of illness or injury (compensatory)
HOW IS INTERVENTION PROVIDED?
Education regarding and Awareness of deficits, as well as strengths
Training to recover skills in areas that are impaired; “practicing” cognitive skills to develop them
Strategies to compensate for weaknesses and capitalize of strengths
Integration and Application of skills in daily life
EXAMPLES OF COMPENSATORY STRATEGIES
Tape recording
Note taking and obtaining hand outs
(memory notebook)
Tape recording
Calendars/dry erase boards/to do list
Signs/labels/other recognition prompts
Repetition and multiple modes
Time: Clocks, written dates (including the day, date, month, and year), calendar within view
Timers for turning lights/appliances on and off
Watch or cell phone alarms and reminders
Voice-messages or recordings
Q&A & DISCUSSION
Interactive Q&A Segment
Ask questions and share personal experiences!
RESOURCES
CLOSING & RESOURCES
Practical Wellness Resources
This Gym!
Support Networks
Milwaukee County MS Friends Support Group
https://msfocus.org/Get-Help/Support-Groups/Search?State=WI
Education
Multiple Sclerosis Foundation
CLOSING & RESOURCES
Symptom and condition tracking
My MS Manager: Tracks symptoms, moods, and pain levels, and can generate reports to share with your healthcare team. It is HIPAA-compliant and developed by the Multiple Sclerosis Association of America (MSAA).
SymTrac: Tracks symptoms, their severity, and the affected body part to create a comprehensive view of your condition over time. It can generate charts for medical consultations.
Floodlight MS: Features simple tasks to test hand function, walking ability, and mental processing, and shares this information with your doctor.
Icompanion MS: Allows users to monitor symptoms, record treatments and visits, and upload MRI scans.
Misha: Aims to help identify subtle changes or patterns over time, with insights informed by MS specialists.
Medication management
MyTherapy: Provides medication reminders, tracks doses, and sends refill alerts for both disease-modifying and symptom-relief medications.
RxmindMe: Helps with tracking pharmacy refills and pills.
Multiple Sclerosis Journal: Specifically helps track injections.
Support and community
Bezzy MS: Connects you with other people who have MS, virtually or in person, in a support group-like environment.
MyMSTeam: A social networking app to build a team of providers and connect with other MS patients.
Lifestyle and data management
Overcoming Multiple Sclerosis (OMS) app: Helps track lifestyle factors such as diet, exercise, meditation, and vitamin D levels.
CareZone: While not MS-specific, it is useful for managing chronic conditions, especially for coordinating with family and caregivers.
CLOSING & RESOURCES
Mental Health Resources