OT and MS, multiple sclerosis

The evidence for OT and neurodegenerative disorders (part 1): Multiple Sclerosis

This post reviews evidence-based OT interventions with multiple sclerosis. It covers recent systematic reviews and a randomized controlled trial.

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Cover photo credit:  Lew Holzman (Image here)

Occupational therapy:  Multiple Sclerosis

As usual with my evidence blogs, I am just focusing on what I found in the evidence.  Remember that the best tool is always your own judgement and what the client prefers!!!

Forwell, Hugos, Copperman, & Ghahari (2013) discuss common OT treatments that are used with clients who have MS:

Energy conservation (EC) – It is important for OTs to help clients with MS manage the fatigue that is part of the disease process.  The OT should help clients apply EC techniques to each of the client’s necessary and desired occupations.  A good patient handout about EC was written in Advance for OT.   Studies show that individuals who participate in fatigue management programs (which includes ES) improve their ability to perform occupations (Yu and Mathiowetz, 2014a)

A number of fatigue management programs have been developed.  These programs have been studied by clinician-researchers and found to have benefit for clients with MS (improving ability to complete occupations, not necessarily reducing fatigue).

  • Managing Fatigue – a six week course for energy conservation.  Check out the book here.
  • Fatigue:  Take Control – created by the National MS Society.  It is a 90 minute video that is designed to be used in a group format.  OTs can use the video to supplement groups and activities that are performed in groups.  Link to the video is here.
  • SMOoTh group (Kos, et al., 2016) – three sessions (60-90 minutes each) consisting of awareness of fatigue (difference between primary and secondary fatigue; distinction between low, sedentary, light, moderate, and intensive activity levels), providing information about fatigue (including discussion of and demonstration of energy conservation techniques by therapist), goal setting, problem solving (analyzing facilitators and barriers to performance of occupations), and action planning, evaluating performance, transfering learning to new activities, practicing in the context of the group, looking at social support networks,and reflection on progress in the group and developing future plans outside the group context.

Other self-management techniques

  • Relaxation groups (Kos, et al., 2016) – focus primarily on stress management and relaxation techniques.   Click here for ideas on relaxation training from my other blogs on pain and sleep.
  • Physical activity  – Encouragement of physical activity can counteract muscle weakness from limited activity (but physical activity will not reverse the process).   Scheduling physical activity should be a part of behavioral change – since it would be important to schedule exercise when energy levels are at their peak.
  • Focus on self-concept and self-efficacy  – The therapist should employ techniques to assist the client improve feelings of control, self-concept, and self-efficacy by giving them activities at the “just right” challenge, challenge destructive thinking patterns, and discussing how to balance the expectations of others and their own needs.
  • Employment modifications – Provide the client with resources to advocate for their needs on the job.  Propose ways for a client to manage employment within their limits – for example, requesting flexible schedules, limit tasks that require  endurance, and schedule rest breaks throughout the day.

Equipment – OTs will likely be involved in the process of obtaining or adjusting equipment necessary to improve mobility and/or recommending adaptive equipment and environmental controls that improve independence.

  • Wheelchairs – this would include recommending the right type of wheelchair, the right type of adaptations, and training in how to use the mobility device within the client’s current context.
  • Adaptive equipment – this can include anything from adapted utensils to personal digital assistants  to compensate for cognitive loss (Forwell, Hugos, Copperman, & Ghahari, 2013).
  • Environmental controls – higher end items that make life a little easier thanks to the power of technology. Abledata is a great resource for these!

Interventions for spasticity

  • Stretching -make sure that you encourage low repititions with an extended hold pattern
  • Adapted dressing techniques – for example, using a stool to maintain hip flexion
  • Resting splints

Positioning techniques to reduce the impact of tremor and ataxia

Finally, this is a great handout from the MS Society.  It would be a great handout to download, discuss with, and distribute to your clients with MS.

Hope this helps!! Please share and feel free to leave comments!!!  You can follow me @KarenKeptnerOT, too!

 

References

Forwell, S.J., Hugos, L., Copperman, L.F., & Ghahari, S.(2013). Neurodegenerative Diseases. In Mary Vining Radomski and Catherine A. Trombly Latham (Eds.), Occupational Therapy for Physical Dysfunction (7th ed.) (1079-1088).  Baltimore, MD:  Lippincott Williams, and Wilkins.

Kos, D.,  Marijke, D., Meirte, J., Meeus, M., D’hooghe, M.B., Nagels, G., Willekens, B., Meurrens, T., Illsbroukx, S., & Nijs, J. (2016).  The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue:  A randomized-controlled trial.  International Journal of Rehabilitation Research, 39, 255–262.

Yu, C.-H., & Mathiowetz, V. (2014a). Systematic review of occupational therapy–related interventions for people with multiple sclerosis: Part 1. Activity and participation. American Journal of Occupational Therapy, 68, 27–32. http://dx.doi.org/10.5014/ajot.2014.008672

Yu, C.-H., & Mathiowetz, V. (2014b). Systematic review of occupational therapy–related interventions for people with multiple sclerosis: Part 2. Impairment. American Journal of Occupational Therapy, 68, 33–38. http://dx.doi.org/10.5014/ajot.2014.008680

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