A compensatory rehabilitative approach can appropriately complement treatment with symptomatic and disease-modifying therapies for people with MS. This process involves the modification of techniques and the development of new strategies to compensate for functional limitations. Occupational therapy is an important part of this approach, and focuses on skills that are important for the “occupations” of daily life and on reducing participation restrictions and activity limitations.
Evidence from the literature
The role of occupational therapy in multi-disciplinary rehabilitation is well acknowledged. However, the multi-disciplinary character of MS treatment means it is difficult to demonstrate the net effect of occupational therapy, as people receiving multidisciplinary rehabilitation will be seen to benefit from interventions from a variety of fields. While currently there is no reliable scientific evidence available that occupational therapy helps people with MS in managing their disease, it is likely that most professionals and individuals with MS, based on experience, do see benefit from occupational therapy interventions. Small studies have found that fatigue can be relieved using energy conservation techniques.
Primary objectives and aims
The primary objective of occupational therapy is to enable individuals to participate in self-care, work and leisure activities that they want or need to perform, thereby optimising personal fulfilment, well-being and quality of life. The occupational therapist evaluates whether people with MS are limited in the life domains that are important to them (Figure 1) and determines strategies for overcoming these difficulties. Possible strategies include restoration, compensation, adaptation and prevention (Table 1).
Interventions
Evaluation is the first step in the occupational therapy programme. The therapist assesses the performance skills in daily life activities, assesses general physical and cognitive abilities, discusses personal goals and may assess the home and work environments to evaluate the potential need for modifications. A customised occupational therapy rehabilitation programme improves the individual’s ability to perform daily activities within his or her own unique situation, thus, often requiring a combination of different techniques.
Applicability at different stages of the disease
For people in the early stage of MS who experience changes in their ability to function effectively at some tasks, the occupational therapist focuses on teaching new strategies for dealing with fatigue, information about home environment adjustments, modifications to the car or workplace as well as job performance. Energy management courses may also be most appropriate at an early stage of the disease.
If functional loss increases, the occupational therapist assists theperson with MS in maintaining and improving skills in different areas of the life
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domains. Depending on the functional abilities and needs of the individual, more attention may be focused on compensation techniques in combination with advice on obtaining an assistive device, as well as the opportunity to try out different devices and other options to meet short and long-term needs.
Occupational therapy in the home
Meeting the individual and the family in their environment can provide the occupational therapist with valuable information that may not be readily available when assessing the person within a healthcare setting. The assessment includes an evaluation of the individual’s current functional status in relation to the performance of activities of daily living.
An assessment of the home situation includes the evaluation of the need for assistive equipment and training. Finally, the occupational therapist’s visit to the home can serve to determine whether additional paid assistance may be useful.
Working with other disciplines
Collaboration with professionals promotes independence in all life domains. Occupational therapists work with social services for organising home visits, with physiotherapists regarding functional exercises, with speech and swallowing therapists on issues related to communication, with nurses in performing evaluations and improving performance in activities of daily living and with neuropsychologists and speech therapists on cognitive training.
Conclusion
Occupational therapy focuses on learning strategies for managing daily life, based on the person’s physical, social and psychological needs.
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