Marcia Finlayson, PhD, OT (C), OTR/L
University of Illinois, Chicago
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:
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.
Return to Top
Once a referral is received, the occupational therapist discusses the specific tasks and activities. The person with MS is:
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
Return to Top
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 #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.
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.
Return to Top
Last Updated: October 2009