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| Division of Occupational Therapy - OT Connect Multiple Sclerosis
Multiple Sclerosis is a “chronic degenerative disease of the nervous system, the cause of which is unknown” (Encyclopedia, 1994). The myelin sheath (the insulating layer around the nerve fibers in the CNS) is gradually destroyed, causing difficulty for the nervous system to send messages to various parts of the body (Neistadt & Crepeau, 1998). Common Symptoms/Course of Disease Primary symptoms (related directly to demyelination):
Secondary Symptoms (complications from the primary symptoms):
Tertiary Symptoms:
There are four patterns in which MS may occur:
Age of Onset: Usually begins in early adulthood (between 20 and 40 years of age). It is rare for an individual to have symptoms before 16 or after 60 years of age (Longe, 2002). Sex Bias: Affects females almost twice as much as males (Trombly, 1997). Current Medical Treatment: Due to the varied course of the disease and symptoms expressed, there is no single test that confirms the diagnosis of multiple sclerosis. Because of this, a detailed medical history, MRI, lumbar puncture or spinal tap, and/or electrical tests of conduction speed in the nerves are the main components of the diagnostic process (Longe, 2002). There are three main drugs, known as the ABC drugs, which aid in slowing the progression of multiple sclerosis in individuals. Administered by injection, these medications “have been shown to reduce the rate of relapses in the relapsing-remitting form of MS” (Gale). These drugs have not been shown, though, to work well with those “who have reached a steadily progressive stage of MS” (Longe, 2002). Spasticity, a common symptom of multiple sclerosis, can result in serious physical and medical complications and is often lessened with medications such as baclofen, valium, and botox. Medications are also available to decrease symptoms such as dizziness, seizures, tremors, and fatigue (Longe, 2002). Aside from occupational therapy, physical therapy is commonly involved with those diagnosed with multiple sclerosis. Physical therapy’s main goals are to strengthen and retrain affected muscles, maintain range of motion in limbs, and teach individuals how to use assistive devices such as canes and walkers (Longe, 2002). Occupational Therapy Involvement The ultimate goal of occupational therapy is to help the individual maintain a productive and independent lifestyle. Common areas of evaluation and assessment include:
Occupational therapy treatment for individuals with multiple sclerosis includes, but is not limited to:
References
How OT Makes a Difference: Evidence-Based Practice Baker, N.A., & Tickle-Degnen, L. (2001). The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: A meta-analysis. American Journal of Occupational Therapy, 55, 324-331. Since evidenced-based practice is becoming extremely important in validating the effectiveness of occupational therapy, a meta-analysis (comparison of research articles on a similar subject) was performed to determine the impact of occupational therapy treatment on individuals with Multiple Sclerosis (MS). Twenty-three published articles that primarily focused on occupational therapy-related interventions for MS were analyzed, with the results offering promising information for occupational therapy practitioners. An overall finding from the studies found that only 24 percent of individuals with MS had improvements without occupational therapy, while 76 percent indicated positive results with therapy. Also, results of several studies suggested the effectiveness of occupational therapy in individuals with MS who had at least moderate levels of impairment, and others suggested that brief intensive therapy in an inpatient setting improved performance. Limiting factors and future implications of this meta-analysis include a need for a control group “that controls for the attention received by participants in a rehabilitation program” and “measurement of outcomes at the life roles level.” (p. 330). D.G. was diagnosed with Multiple Sclerosis in his early to mid twenties. “When I found out from the neurologist, it was as if my life had come to a complete halt” he expressed to me. Now, in his mid-thirties, he looks at life with a completely different perspective, takes every day one day at a time, and says for that he has his occupational therapists to thank. When I met D.G., he was at a local inpatient rehabilitation center due to a recent MS exacerbation. Though he has been at this facility roughly six to eight times since first being diagnosed, he said he goes home physically, mentally, and emotionally stronger every single time. “When I go to physical therapy they strengthen my muscles, but when I go to occupational therapy they strengthen my mind, as well,” he stated. D.G. explained to me that when he is working with his occupational therapist or occupational therapy assistant (varies each time according to caseload), it is as if he is constantly receiving positive feedback that is outweighing all the negative aspects of his disease. He stated, “The first time I came here to receive occupational therapy, I had no idea what I was in for. By the time I went home, though, I looked in the mirror and saw a clean, well-groomed young man, and that made me the happiest I had been in a long time.” D.G. said that he no longer had to worry about how he was going to get through life, how he was going to cook himself a simple meal or even dress himself in the morning. “I had rolled down a mountain, but with the help of my occupational therapist, I’ve climbed back up, and now I’m back on top,” he declared with a smile. I asked D.G. what advise he would give to someone that was about to receive occupational therapy, and he adamantly stated, “If you let yourself get past the stubbornness, learn to accept help, and have faith, occupational therapy will open up doors and opportunities you never thought possible.” He continued, “Occupational therapy planted a small seed in my garden, and now that seed has grown into a beautiful, lively tree that will live for years to come.“ Now that’s what I call making a difference.
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