The primary goal of physical and occupational therapy in MS is to minimize the impact of existing impairments on a person’s ability to carry out daily activities and participate comfortably and effectively in his or her world. To accomplish this goal, PTs and OTs must have an in-depth, working knowledge of multiple sclerosis and the symptoms it can cause, and be able to translate the multiple, often interactive, presenting complaints into their underlying impairments.  Regardless of the specific impairment(s) being addressed, however, the strategies utilized by these specialists emphasize a thorough assessment.

Evaluation

A thorough neuromusculoskeletal evaluation provides baseline information about the person’s physical status and present level of function.  The initial evaluation should include assessment of all symptoms currently affecting the individual’s performance.  The evaluation focuses on the following areas:

-Early Intervention: Early intervention, particularly in relapsing-remitting MS, can help people continue to function effectively in their life roles and prevent premature retirement from the workforce.  The increased stability provided by the new disease-modifying drugs allows more opportunities for therapists to intervene to preserve a person’s individual activities and overall participation.

-Modification and compensation more than restoration:  While some restoration of function may occur following an acute exacerbation, the primary emphasis in OT and PT is on teaching the person effective ways to compensate for existing impairments and make the necessary adaptation to behavioral and environmental modifications.  It is these adaptations that will allow the person to remain functionally independent and productive, regardless of the extent of impairment.

-Education, support, and motivation:  A major focus of the interaction between the therapist and the person with MS is motivational.  The therapist helps the person to understand the connection between the intervention being prescribed and the person’s own goals.  It is only with this understanding that the person will develop the motivation and commitment necessary to follow through on a lifetime of adaptation and change.

-Self-management via skills training and the use of adaptive equipment:  A primary objective of PT/OT intervention is to help people with MS learn to manage their own disease as comfortably and effectively as possible.  Skills training and the proper use of adaptive equipment will make it possible for people to keep their lives as full, active, and satisfying as they want them to be.  PT and OT are discussed together because there is considerable overlap in the evaluation and treatment strategies used by these two specialty area.  The same problem that is treated with PT in one setting may well be treated by OT in another setting.  The following factors are likely to determine which of these specialists evaluates/treats a particular person with MS:

-The person’s insurance plan, which may cover one specialty but not the other

-The particular background and training of the OT and PT at a given facility

-The availability of only one of these specialists in a given facility or geographic area

-Institutional variation

Taking these factors into account, Table 3 presents the assessments and interventions used by PT and/or OT to address specific impairments, and points out specific areas in which one or the other specialty is most likely to be involved.

(Source: "Rehabilitation." Multiple Sclerosis: A Focus on Rehabilitation. Ed. Rosalind Kalb. 3rd ed. 49-52.)

Sara Henrichsmeyer PTA