Occupational Therapy in Multiple Sclerosis Rehabilitation
Marcia Finlayson, PhD, OT (C), OTR/L
University of Illinois, Chicago
Focus on Occupational Therapy
Process of Occupational Therapy
Case Studies: Occupational Therapists in MS Care
Multiple sclerosis (MS) is a chronic, frequently progressive disease of the central nervous system that can result in considerable disability. Rehabilitation is an important part of healthcare for people with MS, and occupational therapy is an integral part of that process. Occupational therapists work with people with MS and their families to develop and implement practical solutions to the challenges of everyday living with MS. This document describes occupational therapy, and gives examples of how occupational therapists work with people with MS.
Occupational therapists focus on ‘occupation’, which is defined as all of those tasks and activities that take our time and energy, and provide meaning and focus in our everyday lives. 1 Occupational therapy (OT) focuses on enabling people to participate in those occupations that have value and meaning to them. Occupational therapists recognize, evaluate, and offer intervention to people with MS and their family members to address three broad areas of occupation:
- Self care activities, including functional mobility, dressing, bathing, grooming, and eating,
- Productive activities, including paid work, home management, caregiving, and volunteer activities, and
- Leisure activities, including involvement in social and recreational pursuits.
Evaluation by an occupational therapist identifies the current and anticipated barriers to participation in occupations. Intervention then focuses on removing or reducing those barriers. Intervention can take many forms (e.g., prevention, education, consultation, compensation, and remediation) and involves the therapeutic use of purposeful and meaningful activities to achieve therapy goals. For people with MS, intervention may also focus on maintenance of current functional abilities.
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- Occupational therapists work in a wide variety of community and institutional settings, and their services are covered by most health insurance plans. In most states, occupational therapists require a physician’s referral in order to provide evaluation and treatment. The VA offers a variety of occupational therapy services. It is important to check with your primary care provider about the benefits of an occupational therapy referral.
Once a referral is received, the occupational therapist discusses the specific tasks and activities. The person with MS is:
- Concerned about being able to continue to do,
- Having difficulty doing efficiently or safely, and/or
- Interested in starting to do again or for the first time.
The occupational therapist typically uses a structured interview to gather this information. After learning about the tasks and activities the person with MS wants or needs to perform, the occupational therapist then examines factors that may support or restrict performance of these tasks and activities. These factors may be related to the person with MS (e.g., symptoms of MS, physical and cognitive abilities, emotional issues, specific task skills) or to the environment (e.g., physical accessibility, social supports, and socio-economic issues). The occupational therapist also closely evaluates the physical, cognitive and social demands of the tasks and activities. Together, all of the information gathered through the evaluation process is used by the occupational therapist to set goals for intervention. Occupational therapy interventions may focus on prevention, education for health and disease management, compensation or remediation for lost or restricted abilities, or maintenance of function. 4,5
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The focus of occupational therapy on participation in valued and meaningful everyday activities means that it is relevant throughout the full course of MS from initial diagnosis through to advanced stages of the disease. To illustrate the different ways that occupational therapists may work with people with MS, several case illustrations are provided.
- Case #1: James is a 42-year-old man who has relapsing remitting MS. He lives with his wife and two adolescent children, and is employed in a military supplies warehouse. Although James has very mild physical symptoms, he experiences cognitive difficulties and struggles to keep up with all his responsibilities at work. He forgets tasks that are assigned to him, is easily distracted, and cannot do more than one task at a time. The occupational therapist shows James how to expand the use of the alarm function on his PDA (hand-held electronic device) and use it to remind himself of important tasks, deadlines and appointments. The occupational therapist also suggests environmental changes in James’ office to reduce the number of distractions and help him concentrate.
- Case #2: Mark is a 47-year-old man who has primary progressive MS. He lives alone and uses a power wheelchair full-time. Mark just hired a personal care attendant to help him with daily self-care tasks. The occupational therapist works with Mark to develop strategies for communicating his needs to his personal care attendant, for example, explaining what he needs, giving clear directions about how to help, and providing constructive feedback about the attendant’s actual performance of duties. The occupational therapist also works with Mark and the personal care attendant to practice safe and efficient techniques for dressing, transfers and bathing that maximize and maintain Mark’s current abilities.
Case #3: Georgia is a 67-year-old woman whose MS has recently become progressive. She is experiencing an increased number of falls, and is becoming quite fearful of falling. Her fear has lead to reducing a number of tasks and activities that she felt was important. To enable Georgia to continue to engage in these activities, the occupational therapist shows her ways to safely maintain her balance while she is cooking and cleaning. They work together to complete a home safety checklist to identify fall hazards in Georgia’s home. The occupational therapist suggests several simple changes to reduce Georgia’s risk of falling, and helps her develop a confident approach to handling a fall if one happens.
- Case #4: Amy is a 24-year-old woman who has recently been diagnosed with MS. To date, she has experienced relatively few symptoms but she is anxious about what her future holds and how to manage symptoms when they occur. Amy attends a community based educational program for people with MS that is coordinated by an occupational therapist. Through the program, Amy learns about her MS and a wide range of strategies for managing its many consequences. She also learns about how to find and evaluate community resources, what the different health professionals can offer her, and how to advocate for herself in different situations. Amy leaves with a sense of empowerment, and confidence that she has the necessary resources and support to help her manage her disease.
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These four cases provide only a glimpse into the potential interventions that occupational therapists may offer a person with MS from initial diagnosis through to a more progressive disease course. Many occupational therapists develop special skills in important areas that are relevant to people with MS, for example, home modifications, driver rehabilitation, wheelchair selection and prescription, cognitive rehabilitation, vocational rehabilitation, and assistive technology. In addition, occupational therapists often become involved developing and implementing large scale, community-based programs such as Gateway to Wellness2 and Managing Fatigue3. Ultimately, occupational therapists work together with their clients to find ways to enable people with MS to continue to live active and productive lives despite the personal, environmental and occupational challenges that they face.
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- Canadian Association of Occupational Therapists (1997). Enabling occupation: An occupational therapy perspective. Ottawa, Canada: CAOT Publications ACE.
- Neufeld, P. & Kniepmann, K. (2001). Gateway to Wellness: An Occupational Therapy collaboration with the National Multiple Sclerosis Society. Community Occupational Therapy Education and Practice, 13, 67-84.
- Packer, T. L., Brink, N., & Sauriol, A. (1995). Managing fatigue: A six-week course for energy conservation. Tucson, AZ: Therapy Skill Builders.
- Pedretti, L. W. & Early, M. B. (2001). Occupational therapy: Practice skills for physical dysfunction. (5th ed.) St. Louis, MO: Mosby.
- Trombly, C. A. & Radomski, M. V. (2002). Occupational therapy for physical dysfunction. (5th ed.) Philadelphia, PA: Lippincott Williams & Wilkins.
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Last Updated: October 2009