Lorin G., OT

I work now with JTP in a Skilled Nursing Facility, which is centered on senior care.  One of our patients is a 57 year old lady, we’ll call her “Mari”, who used to be a special education teacher and who has had her life radically altered by a diagnosis of multiple sclerosis about 5 years ago.   It was a difficult diagnosis for her doctors to make; first it was called Parkinson’s disease and only later was it understood as MS.  So, what can we, as therapists, do for an individual with the diagnosis of multiple sclerosis?  As there is no hard and fast cure for the condition, there is nothing we can ultimately do to completely alter an individual’s life that has been diagnosed with this condition.  As therapists, we can help an individual take better control of the MS through ADL training, relaxation techniques, functional transfer training, therapeutic exercise energy conservation and psychosocial remediation.

As for a quick review of the condition: the presentation of multiple sclerosis is a real-mixed bag of signs, symptoms and history.  The cause of MS is not entirely understood (1).  Its cause is understood to be part genetic and part environmental.  People generally start to experience multiple sclerosis between the ages of 20 and 40 and there are several different presentations, including primary progressive, relapsing-remitting, relapsing-progressive, and secondary progressive.  Generally, multiple sclerosis is a process of demyelination of the axons of neurons in the central nervous system, the brain and/ or spinal cord.  The demyelination of axons causes nerve signals to slow down or stop. The symptoms of multiple sclerosis can include: tremors of the hands or head and other areas of the body, muscle weakness, ataxia, spasticity, pain or impairment of pain, touch and other senses, speech and vision disturbances, vertigo, bowel and bladder dysfunction, sexual disorders, abnormal fatigue, and psychosocial abnormalities like depression, euphoria and cognitive deficits.

Mari uses a wheelchair for her functional mobility, and is able to do limited functional ambulation with a walker to get from her bed to the bathroom, or around the therapy gym when she so chooses.  One of our key roles as therapists helping a person with an MS diagnosis is to make sure that proper pacing and relaxation is followed (2).  Frequent rest breaks during therapeutic exercise, the teaching of energy conservation and relaxation techniques during ADLs are essential approaches to help with MS.   Our training in psychosocial rehabilitation is important for men and women with the diagnosis of multiple sclerosis.  Mari has been offered adaptive devices like a reacher to help her with dressing.  She was feeling sick the other day and said that she “aches all over”, more so than when she was sick before being diagnosed with multiple sclerosis.

Multiple sclerosis, like diabetes, is one of those conditions that an individual just has to learn to live with.  As I had to learn to inject insulin and test my blood sugar, a person with MS has to learn to adapt their life to the fatigue and other symptoms that are so common with MS.  Living with MS, may be easier than living with diabetes?  Who’s to know?  The mortality with MS is probably lower than that of diabetes, but individual cases certainly var.  The key with both is control; with diabetes this involves control of blood sugar through exercise insulin and diet, while with multiple sclerosis, a satisfying life involves monitoring fatigue, muscle tremors and other symptoms.

References:

1.  Alison Baker, “Multiple Sclerosis”, accessed at:  http://occupational-therapy.advanceweb.com/Article/Multiple-Sclerosis-1.aspx on September, 4, 2011.

2.  Tom Kerr, “Living with MS, “accessed at:  http://occupational-therapy.advanceweb.com/Article/Living-with-MS.aspx, on September 8, 2011.

1. Salvatore      Napoli, “Searching for Answers”,      accessed at:  http://occupational-therapy.advanceweb.com/Article/Searching-for-Answers-5.aspx on      September 9, 2011.