occupational therapy in multiple sclerosis

Multiple sclerosis

04/11/2023Mohsen Eslampanah OT18

2Outline

• Incidence • Etiology• Clinical picture• Medical management• Role of Occupational Therapist• Goal setting


3incidence

• MS is a progressive, inflammatory neurologic disease that damages the myelin sheath in the CNS.

• Ages 20 and 45 years• More prevalent in women


4incidence

• Damaged in discrete region of the with matter, with axon remaining preserved => effect on axonal conduction => slower manner => intermittent symptoms of sensory distortion, incoordination, visual loss or weakness


5incidence

Advanced case of MS:

Acute and chronic plaques developed throughout the with matter especially: spinal cord, optic nerve, and periventricular with matter including corpus callosum.

Axons may be damaged


6Etiology

• The Specific cause of MS is unknown• Combination of environmental and genetic factors• Immune system acts on the nervous system,• 30% to 60% of new clinical attacks occur after a cold,

flu, or common viral infection


7Clinical picture

Symptoms are related to the area of CNS affected.

Early symptoms may consist of:

1. Paresthesias2. Diplopia3. Visual loss in one eye4. Fatigability5. Emotional lability6. Sensory loss in the extremities


8

Other initial symptoms:

1. Trigeminal neuralgia2. Worsening of symptoms when body

temperature is elevated3. Cognitive deficits in 30% to 70%

Clinical picture


9Clinical picture

in advanced stages of disease process:1. Varying degrees of paralysis2. Dysarthria3. Dysphagia4. Severe visual impairment5. Ataxia6. Spasticity7. Nystagmus8. Neurogenic bladder9. Impaired cognition


10Courses of MS


11

Pre

dict

ors

of a

fa

vora

ble

pro

gnos

is • Minimal disability 5 years after onset of the disease

• Complete, rapid remission of the initial symptoms

• Age at onset <40 years• Only 1 symptom during the

first year• Onset with sensory

symptom or mild optic neuritis P

redi

ctor

s of

a p

oor

prog

nosi

s • Progressive course• Age at onset >40 years• Cerebellar involvement• Polysymptomatic onset• Male sex

Courses of MS


12

MEDICAL MANAGEMENT

• Disease-modifying drugs => RR• Anti-inflammatories => all forms of MS

Treating the symptom of disease:• Spasticity• Bladder management• Prevention of bladder infection• Management of pain and fatigue


13

• Change in cognition• Depression• Dementia

MEDICAL MANAGEMENT

Decline in:complex attention, processing speed, and verbal memory.

Size of 3rd ventricleCognition


14

Medical management

Expanded Disability Status Scale Assessment neurological function, measure a client’s ambulatory and functional mobility status.

The MS functional compositeMeasure leg function and ambulation, arm and hand function, and cognition.


15

Role of occupational therapist

Evaluation:• Occupational profile• Analysis of occupational performance


16

Analysis of occupational performance

Instrument to assess occupational performance of :• ADL• IADL• Education• Work• Play• Leisure• Social participation


17

During the performance of various occupations, the following skills should be evaluated:• Motor and praxis• Sensory perceptual• Emotional regulation• Cognitive• Communication skills

Analysis of occupational performance


18

• Home evaluation• Sensorimotor skills• Sleep patterns• Visual abilities• Perceptual processing and cognitive status => Basso• Cultural, social, and physical environment• Emotional and behavioral issue

Role of occupational therapist


19Goal setting

Occupational therapy intervention:

1. Problem-solving compensatory strategies

2. Time and energy management

3. Role delegation

4. The use of adaptive equipment to compensate for motor, sensory, endurance, cognitive, and visual deficits.


20

Pedretti’s , Occupational Therapy: practice skills for physical dysfunction,

7th edition, chapter 35

Reference

occupational therapy in multiple sclerosis

Health & Medicine