Multiple Sclerosis
Although there is no cure for multiple sclerosis (MS), occupational and physical therapy can help a person manage the symptoms, perform daily activities, and retain as much of their independence as possible.
WHAT IS MULTIPLE SCLEROSIS?
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective coating on nerve fibers (myelin sheath) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves. Depending on where the nerve damage occurs, MS can affect vision, sensation, coordination, movement, bladder and bowel control.
SYMPTOMS
Symptoms may differ from person to person and over the course of the disease depending on the location of affected nerve fibers. They can include:
- Slurred speech
- Fatigue
- Numbness/weakness in one or more limbs that typically occurs on one side of your body at a time.
- Blurry vision and or prolonged double vision
- Electric shock-like sensations that occur on flexion of the neck, especially bending the neck forward called “Lhermitte’s sign”.
- Tremor, lack of coordination or unsteady gait
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Dizziness
- Tingling or pain in parts of your body
- Problems with sexual, bowel and bladder function
OCCUPATIONAL THERAPY AND MS
Below are some of the functions and benefits of occupational therapy in relation to MS.
- Help with day-to-day activities
One of the main goals of occupational therapy is to help you lead a more independent life. When you have MS, even routine activities can be challenging. An occupational therapist helps you to learn how to perform day-to-day tasks more efficiently. They include bathing, using the bathroom, grooming, working, taking medications, driving, cleaning, dressing up, cooking/meal prep, cleaning, laundry etc. This is especially important when the symptoms of MS make you constantly fatigued or affect your memory, concentration, coordination and organization.
- Energy conservation teaching
Energy conservation is one of the biggest challenges when you are living with MS. Exerting yourself or becoming physically exhausted can be disabling. It could cause your MS to flare, or could make a flare worse. And this is an issue because it is not always possible to recover from the damage caused by a flare. OTs can help people with MS learn to use their energy in ways that are beneficial, not harmful. They can also help you identify tools and techniques that will help to simplify tasks and reduce the burden on your body.
- Setting up adaptive devices at work, school and home
One of the most important tasks of an occupational therapist is to evaluate how you interact with your various environments. The therapist can then identify ways to improve these interactions based on your personalized needs. There are different types of adaptive or assistive technologies and gadgets available to promote independence. Your OT can recommend which ones will help you the most. Examples include:
- Wheelchairs, canes and walkers
- Bathroom equipment to prevent falls e.g. grab bars, shower chairs, etc.
- Devices that improve driving safety and comfort
- Weighted utensils to counteract tremors
- A tool for picking up items off the floor e.g. reacher/grabber
- Reading and writing aids e.g. pencil grips
- Jar openers
- Visual aids e.g. magnifying glasses/readers, etc.
- Coordination and strength improvement
Many people with MS lose strength or coordination in the hands. This can make even the simplest of tasks, like buttoning a shirt, very difficult. An OT can teach you exercises for improving the strength and range of motion of your hands.
- Cognitive rehabilitation
An OT can evaluate you for issues with memory, concentration, or problem-solving. They can then find ways to compensate for these issues. Your OT may recommend computerized cognitive training. They can also teach you to use smartphone apps to help you remember important events or manage your finances.
PHYSIOTHERAPY AND MS
Below are some of the functions and benefits of physiotherapy in relation to MS.
- Exercising
Exercise is essential. It is safe and effective in symptom management and disease modification. It helps in delaying the negative symptoms of the disease. Exercises are chosen based on what is appropriate to each clients’ strengths and weaknesses. As much as it is considered a safe and effective means of rehabilitation, it is also beneficial on mood and quality of life. Some of these exercises are as follows:
- Strength and aerobic training: The resistance training program is recommended for maintaining bone and muscle mass. This type of training improves impairments of aerobic capacity, lower extremity muscle strength and mobility; reduces fatigue, depression and enhances health-related quality of life; reduced activity limitations such as walking performance and balance.
- Aquatic exercise programs: This type of exercise has a positive effect on persons with progressive multiple sclerosis. It promotes general health, improves energy levels and mental health, and aids social interaction in the presence of physical disability. Because of the reduced impact of gravity, aquatic training allows patients with even severe paresis of the lower extremities to perform standing and moving exercises.
- Specific balance exercisescan improve balance. Poor postural control increases the risk of falls. MS patients have increased sway in quiet stance, delayed postural perturbations and reduced ability to move towards limits of stability. These impairments are likely to cause falls.
- Gait rehabilitation
This forms a large part of neuro-rehabilitation for people living with MS as they tend to show a decrease in gait speed and stride and step length, increase in step width, decrease in hip extension during the stance period, a reduction in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantarflexion during the pre-swing phase.
- Hippotherapy
This has a positive effect on the balance of persons with multiple sclerosis and improves the quality of life. Horseback riding can have positive physical and emotional effects in individuals with neuro-motor development and physical disabilities. Horseback riding improved balance and gait of ambulatory patients with MS and helps the rider by providing effective sensory stimulation and rhythmic anterior and posterior swinging motion. It also improves posture and balance.
In summary, working with therapists will help establish techniques and strategies that will ensure greater independence for as long as possible.