Today I am reviewing multiple sclerosis (MS)!
What is multiple sclerosis (MS)?
MS is a degenerative disease involving nerves within the central nervous system (CNS). The CNS is composed of the spinal cord and the brain, both of which are essential structures that communicate and facilitate sensory and movement information throughout the body. Myelin sheath within the CNS becomes impaired and lesions (plaques) exist, causing a disruption in messages being sent throughout the body. MS is most commonly diagnosed between the ages of 20-40 years old (Schultz-Krohn, Foti, & Glogoski, 2018). MS involves periods of exacerbations (periods of time in which symptoms are present) and remissions (periods of time in which symptoms are not present).
There are four types of MS which include the following:
- Relapsing-remitting (85% of those diagnosed with MS): This type of MS involves periods of exacerbations and remissions with symptoms disappearing after each exacerbation or the appearance of residual deficits occurring after each exacerbation (Schultz-Krohn, Foti, & Glogoski, 2018).
- Primary progressive (10%): This type of MS involves a steady progression of deficits after each exacerbation resulting in progressive deficits as the course of MS lengthens (Schultz-Krohn, Foti, & Glogoski, 2018).
- Secondary progressive: This type of MS initially begins as relapsing-remitting MS but progresses with fewer remissions, resulting in decreased independence and more deficits (Schultz-Krohn, Foti, & Glogoski, 2018).
- Progressive relapsing (5%): This type of MS involves steady declines from the beginning but deficits do not occur as quickly as with primary progressive (Schultz-Krohn, Foti, & Glogoski, 2018).
Honestly, it has been difficult for me to wrap my brain around each type and their differences; however, I think if you take the time to understand and interpret the name of each type, it will become clearer which is which.
What does MS “look like”?
MS presents itself differently in each individually. The most common symptoms include fatigue, numbness/weakness in 1+ limbs typically on one side of the body, vision problems, bowel/bladder dysfunction, and cognitive deficits (like a “fog”) (Schultz-Krohn, Foti, & Glogoski, 2018). Individuals may also experience motor disturbances including tremors, decreased coordination, unsteady gait (causing balance concerns!), dizziness, slurred speech, and sexual impotence (Schultz-Krohn, Foti, & Glogoski, 2018).
Individuals diagnosed with MS are cautioned to avoid extremely hot temperatures (Schultz-Krohn, Foti, & Glogoski, 2018). During exacerbations, individuals with MS should rest as much as possible. Vision may fluctuate; therefore, it is important one’s meaningful occupations are adapted or flexible when needed. Cognitive changes may also occur, including deficits in short-term memory, attention, and orientation (Schultz-Krohn, Foti, & Glogoski, 2018). In continuation, individuals may experience difficulty with fine motor skills related to sensory loss which could impact one’s ability to complete daily tasks.
How do OTs help individuals with MS?
OTs can work with individuals with MS during periods of exacerbations and remissions. During exacerbations, in which the individual may be on bed rest, OTs can utilize passive range of motion to prevent loss of joint mobility, modify activities to minimize exertion, and provide education to family members to promote optimal care.
During remissions, OTs can help an individual return to their prior level of function through physical conditioning (when appropriate), providing adaptive equipment, and educating an individual on energy conservation and fatigue management. Such recommendations may include establishing a sleep routine, encouraging healthy diet choices, and stress management techniques.
Energy conservation is also important as fatigue is often one of the most influential barriers to independence and quality of life. The checkbook analogy explained in “Chapter 11: Osteoarthritis & Rheumatoid Arthritis” would be applicable for individuals with MS. Likewise, strategies for energy conservation could expand into other occupations such as bathing/dressing, meal preparation, shopping, and leisure activities. These general recommendations may include:
- Prioritizing what needs to be done throughout the day. Can some items on the to-do list wait until tomorrow or later in the week? Balance that checkbook!
- Planning what needs to be done strategically. Plan for periods of activity versus periods of rest throughout the day.
- Sit to work when possible. Sit while cutting veggies for dinner or while doing dishes. Use a riding mower instead of push mower when cutting the grass. Sit to dress or shower (tub bunch required).
- Use appliances. A dishwasher saves you energy from scrubbing dishes. A dryer saves you energy from hanging clothes on the clothes line. An electric can opener saves you energy from using a typical twisty can opener. Use them when possible!
- Plan your shopping trips. Make a list. Try to visualize the store to avoid walking down aisles multiple times. If fatigue is too limiting of a factor, try Instacart in which a personal shopper will do all the shopping for you and deliver to your home!
If vision and cognition are impacted, remedial or rehabilitative strategies would be recommended by an OT. Magnifiers or audiobooks could be recommended to ensure participation in meaningful activities. Phone reminders for important appointments or events could be implemented to compensate for memory deficits. Cognition apps, such as Lumosity, could be recommended for daily cognitive activities.
Fine motor skills and sensory functions are often impacted; therefore, an OT can make recommendations for adaptive equipment or alternate strategies to promote independence. This may include use of built-up handles for kitchen and writing utensils. To promote independent medication management, if an individual has difficulty feeling the small pill within their fingers or knowing if they dropped it or not, the weekly medication box could be positioned on top of a baking sheet. Therefore, if the pill is accidentally dropped, the sound of the pill hitting the baking sheet would alert the individual that it had been dropped. Changing the environment in which medications are taken through this simple change could make a significant difference in prescription compliance.
Referrals to support groups for both the individual and one’s family member(s) may also be beneficial. This is a nice way of connecting individuals to support, educate, and inspire each other!
There are countless other ways that OTs can help individuals with MS improve their quality of life and independence. This is merely a brief overview of the OT-MS relationship. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!
*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.
Schultz-Pendleton, W., Foti, D., & Glogoski, C. (2018). Degenerative diseases of the central nervous system. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 871-903). St. Louis, MO: Elsevier.