Role of Occupational Therapy in Multiple Sclerosis PDF

Role of Occupational Therapy in Multiple sclerosis Multiple sclerosis (MS) is a progressive, inflammatory, demyelinating disease of the brain and spinal cord. It is the most common neurological condition that has a disabling effect on young and middle‐aged adults. - In 2020, the estimated number...

Role of Occupational Therapy in Multiple sclerosis Multiple sclerosis (MS) is a progressive, inflammatory, demyelinating disease of the brain and spinal cord. It is the most common neurological condition that has a disabling effect on young and middle‐aged adults. - In 2020, the estimated number of people living with MS worldwide was 2.8 million (36 per 100,000 people). - The average age of MS diagnosis globally is [32 years], an age at which many people are planning families and building careers. Based on the disease course, the main phenotypes of MS are described: relapsing‐remitting MS (RRMS), primary‐progressive MS (PPMS), secondary‐progressive MS (SPMS), and progressive‐relapsing MS (PRMS) Globally, [12% are initially diagnosed with progressive MS] [and 85% with the relapsing‐remitting type] (3% is unknown). Impairments and Functional Limitations: - ADL, IADL, work and leisure impairment - Functional mobility impairment - Impaired strength - Contractures - Unusual fatigue - Impaired balance and/or dizziness - Sensory deficit (dysesthesias, numbness, paresthesia) - Pain -- acute (trigeminal neuralgia, Lhermitte's Sign, optic neuritis) - Pain -- chronic (spasticity, spasms) - Impaired coordination - Intention tremor - Cognitive impairment (attention, memory, planning, problem solving, reasoning) - Depression - Fear of falling - Fall risk - Bowel and bladder dysfunction - Impaired vision due to optic neuritis (diplopia, nystagmus, optic neuritis) - Dysarthria - Other symptoms and conditions -- heat intolerance, dysphagia Assessment: **1-Expanded Disability Status Scale** **2-Modified Fatigue Impact Scale:** Items on the MFIS can be aggregated into three subscales (physical, cognitive, and psychosocial), as well as into a total MFIS score. All items are scaled so that higher scores indicate a greater impact of fatigue on a person's activities. Please read each statement carefully, the circle the one number that best indicates how often fatigue has affected you in this way during [the past 4 weeks.] Occupational therapy role in M.S: **[1-Energy conservation techniques (or ECTs):]** are also referred to as work simplification techniques, ***is the way activities are done to minimize muscle fatigue, joint stress, and pain. By using the body efficiently and doing things in a sequential way, you can save your energy, remain independent, and be less frustrated by your illness when the energy you have lasts throughout the day*** - Educate your patient on **pacing** during the task and taking rest breaks throughout the day when they feel fatigued. - Discuss **planning and prioritizing** the day around completing the most important tasks first, as well as the importance of not over-planning the day. - Work with your patient to **modify or simplify** difficult tasks. - Discuss **delegating tasks** as needed to family members, friends, or hired caregivers. - Educate patients on the use of [**adaptive equipment**](https://www.myotspot.com/adaptive-equipment/) during ADLs. - Discuss completing ADLs and IADLs in the seated position. (It is useful to have chairs in every living area to take breaks.) - Provide education and visual handouts on [**pursed lip breathing**](http://www.med.umich.edu/1libr/InternalMedicine/PursedLipBreathing.pdf) to complete as needed. **[2- compensatory approach ]** Definition: The **compensatory** approach involves compensation for the lost function. It involves learning adaptive, compensatory methods to perform a task.  - Example: the affected upper extremity is flaccid and has not regained any strength, so a one-handed adapted dressing technique is taught to the patient to compensate for their upper limb that has no strength.  - It is used in conditions with irreversible impairments or degenerative conditions. **[3- Splint/Orthosis:]** - Ulnar deviation splint - prevents ulnar drift and encourages normal alignment of the MCP joints during pinch and grasp activities.  - Wrist cock-up splint - provides support to weakened or painful wrist during ADLs. - Thumb spica splint - provides support to weakened or inflamed thumb CMC and MCP joints. [Stop wearing your splint/orthosis and contact the therapist if you experience: ] - Increased pain or discomfort - Numbness - Swelling - Skin irritation - Pressure area such as sores or red marks that do not go away within one hour - after removing the splint/orthosis **[4- Resistance Band Arm Exercises:]** Exercise Guidelines: - Do not overstretch the resistance band by more than 3 times its resting length - Don\'t hold your breath during any of the exercises. - If you experience chest pain, unusual shortness of breath, dizziness, nausea, blurred vision, or other unusual symptoms while exercising, stop immediately - Strengthening exercises, progress slowly using sub-maximal resistance and frequent repetitions. - Avoid fatigue and avoid increasing core body temperature. - Instruct in home program with verbal and written instructions Elbow Flexion Secure the resistance band under one foot. Grasp the band. Start with your hand at your knee. Bend your arm and pull the band up towards your shoulder. Elbow Extension Secure the resistance band under one foot. Grasp the band with your hand. Start with your elbow bent. Straighten your arm, pulling the band back. Shoulder Flexion Secure the resistance band under both feet. Grasp the band with both hands. Keep your elbows straight. Lift your arms pulling the band up in front. Shoulder Extension Secure the resistance band under one foot. Grasp the band with your hand. Start with your hand down at your side. Keeping the elbow straight. Lift the arm back, pulling the band behind you.  Horizontal Abduction Hold the resistance band between your hands at shoulder height. Pull the band out to the sides. **[5- Provide functional balance activities to increase balance]** confidence with ADL tasks. Graded activities in sitting and standing, supported and unsupported. - Dynamic Balance Exercises: Perform the following exercises while holding.... (circle one) A person with his arms out to sides Description automatically generated  **Half Turns** Turn one half-circle (180 degrees) to the right. Then turn one half-circle to the left. **Heel-to-Toe** Walk forward heel to toe, then walk backwards heel to toe.  **Cross Over Walking** Stand with your feet apart. Cross the right foot in front of the left leg. Step out with the left foot. Cross the right foot in back of the left leg. Using an aerobic step or similar. Step up onto the step and then down the off the step on the other side. Without turning around, step backwards up the step and then off backwards down the other side. Place six paper cups or similar object on the floor. Space them about 16 inches (40 cm) apart and 16 inches (40 cm) from a wall or kitchen counter. - Step forward over each object. - Step sideways over each object.