People with MS constitute a valuable labour resource for the societies in which they live. They are often well-educated and skilled workers with extensive employment histories, which is not surprising given that MS typically manifests itself in early-to-middle adulthood (after people have begun and, in many cases, established their careers). Too often, however, these highly trained, productive, and experienced workers leave the work force shortly after MS diagnosis, usually of their own choosing and usually before the illness has rendered them unable to work.
Experts do not know exactly why so many people with MS leave the work force prematurely, but some of the most commonly reported barriers to continued employment among people with MS include the unavailability of transportation to and from work, difficulties in obtaining on-the-job accommodations, lack of awareness of assistive technology, limited awareness of employment issues on the part of treating physicians, disincentives to work in government assistance programmes, the unpredictable and sometimes progressive nature of MS, and employer discrimination.
Studies of people with MS show that men, people with higher levels of education, people who do not experience cognitive impairments, workers whose jobs require little physical exertion or exposure to heat, management or professional-level workers, and those whose employers have formal disability related personnel policies are the most likely to retain employment over time.
Vocational rehabilitation provides a mechanism for people with MS to make adjustments in their careers and to continue working as long as they wish to. The purpose of vocational rehabilitation is to provide services, supports, and training that enable people with disabilities to obtain, maintain, and advance in jobs that are compatible with their interests, abilities, and experience. Early intervention is emphasised. For people with MS, that often means job retention services because the majority of people with MS are working at the time of diagnosis. Career re-entry services such as job placement assistance and career counselling are offered to people with MS who have left the work force but wish to return to it. In both job retention and career re-entry services, featured interventions include a comprehensive evaluation of vocational interests and aptitudes, identification and implementation of workplace accommodations, training in the use of assistive technology, selfadvocacy training, and consultation with employers on a wide range of disability-related matters.
Vocational rehabilitation is an interdisciplinary enterprise that blends the expertise of professionals in the fields of medicine, allied health, psychology, counselling, social work, engineering, technology, human resource development, and law.
The person with MS plays a prominent role, as all decisions regarding services are made in deference to the person’s stated goals and preferences. Abiding precepts in vocational rehabilitation are (a) that there is an inherent dignity in working, (b) that people are better off working than not working, and (c) that disability in and of itself should not prevent someone from working if he or she wishes to do so. All available evidence indicates that the onset of MS or any other chronic illness rarely affects vocational interests, that is, the field in which one prefers to work.
MS may affect the person’s abilities in certain areas, in which case a premium is placed on modifying the job that the person is accustomed to or finding another job that is closely related to his or her customary occupation. Often, this modification or transfer is accomplished through the implementation of workplace accommodations, with employer co-operation.
For people with MS, the workplace accommodations that have proven effective in helping them stay in the work force include schedule modifications (the most common form of workplace accommodation implemented on behalf of people with MS), memory aids to combat cognitive impairments, motorised scooters to combat fatigue and mobility problems, climate control in the work station, low vision aids (e.g. magnification machines, voice output software), accessible parking, building renovations to allow for wheelchair access, cooling vests, ergonomic keyboards, voice-activated computer programs, and telecommuting or home-based employment. In some countries, the employer is required to pay for needed employee accommodations. In others, government agencies and sometimes the worker herself or himself assume the costs of accommodations.
Regardless of the country in which one lives, knowing the legal protections available to workers with disabilities, the community services available, and the financial and other resources that can facilitate continued employment is a critical factor in the long-term vocational success of a person with MS. Even more importantly, maintaining an active and effective symptom management regimen, identifying changes in one’s health status and job performance, generating solutions to disabilityrelated problems at work, and advocating for oneself with employers to implement those solutions are the most powerful antidotes to the negative impact that MS can and too often does have on a person’s career.
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