Introduction

Multiple sclerosis is debilitating in many ways. Although you may fail to find a cure for it, leading a better life with it is possible. Occupational therapy, which focuses on any aspect of your life, can help you adapt to your situation and change the environment to better accommodate you. You may find it worth a try when you understand how it works and how you may benefit from it.

Multiple sclerosis (MS)

Multiple sclerosis is a neurological disorder that can lead to disturbing symptoms like mobility issues. To our best knowledge in 2024, it is incurable, yet it can be managed by many approaches to reduce its impact on patients’ everyday lives. A deeper understanding of the disease can help you know the role occupational therapy plays in managing it.

How does the nervous system get damaged?

The nervous system allows us to sense, move, think, etc. Damages in the nervous system can severely compromise many important daily functions. MS is an autoimmune disease, i.e., your white blood cells produce antibodies that attack part of the nervous system. To be specific, the antibodies attack the myelin layer surrounding nerve cells, which allows signals to be communicated very quickly. Without myelin, many nerves would conduct signals very slowly or even would not successfully conduct at all. The nerve cells affected are those within the central nervous system (CNS), i.e., the brain (which actually includes the eyes) and the spinal cord. With the nerve pathways being damaged in these organs, many vital functions are impacted.

Symptoms of MS

Various symptoms can be caused by damage to the central nervous system:

• Vision problems: The nerves that allow the communication of visual signals are also affected, so double vision and partial vision loss are frequently observed in MS patients
• Cognitive challenges: The parts of the brain that regulate memory and concentration can be affected by MS
• Mood changes: With the brain region controlling the mood being damaged and other factors, MS patients may experience mental health problems like depression and anxiety
• Mobility issues: Both the brain and the spinal cord contain pathways guaranteeing voluntary and involuntary movements. With these pathways affected, problems like spasms and loss of balance are common in MS patients
• Fatigue: Inflammation of the CNS and other factors lead to a sense of tiredness¹

How to treat MS?

To our best knowledge in 2024, MS currently remains incurable. However, drugs are present to control the severity of an attack and to make future relapses less severe and frequent by targeting the immune cells that affect the myelin layer. A wide range of options are also available to treat specific symptoms. For example, cognitive behavioural therapies and antidepressants can be used to tackle depression or anxiety; vision therapies and specialised eyeglasses can help with vision problems. Medications are available for fatigue, mobility issues, and cognitive challenges, Occupational therapy can play a huge role in managing these symptoms.

How does occupational therapy (OT) manage MS?

Our everyday activities require the coordination between our body and mind. Problems regarding mobility and cognition can hinder the ability of MS patients to complete tasks necessary for everyday life. This is where OT comes into play.

What is occupational therapy (OT)

Occupational therapy is an intervention that aims to help patients improve their ability to independently perform everyday tasks in their lives, study, and work, such as getting dressed, cooking, and even driving. People who benefit from OT are especially those experiencing physical and mental disabilities, including MS. 

OT is typically customised for each patient due to the unique nature of each disease and each patient. The therapist may assess the environment and situation that the patient lives in. Your occupational therapist would discuss with you, create realistic and meaningful goals, and devise methods to achieve the goals. For example, OT may involve helping patients use wheelchairs in their homes and neighbourhoods safely by installing ramps beside stairs.

Typical OT Interventions for MS

Managing Fatigue

More than half (55%) of patients with MS report fatigue to be among the worst symptoms.² Instead of lacking the ability to perform tasks, patients experiencing fatigue lack the energy to do things. 

In an OT model developed in 1995, there are a dozen principles for managing fatigue, such as energy conservation, balancing rest and exercise, and using labour-saving equipment.³ During the therapy sessions, you may discuss how you can apply the principles to your own life and set goals for the productivity and duration of your common tasks.⁴ One of the principles, energy conservation, was later emphasised, and energy conservation course treatment is now available as a form of fatigue-managing OT.

There is clinical evidence reported regarding the effectiveness of these OT methods in managing fatigue, and patients indicated that they found the fatigue management OT helpful.^5-7 The exact form of the therapy may vary from therapist to therapist. Communicate with your therapist about the available formats and discuss whether they suit you.

Improving Mobility & Physical Function

Mobility impairments are reported to be a serious burden to MS patients.⁸ These include the inability to walk, reduced manual dexterity, muscle weakness, and intention tremor. OT has been devised to limit the impact of these symptoms. 

Take intention tremor as an example.⁹ The occupational therapist may teach various techniques, such as applying a weight to the wrist when writing and wearing a wrist splint to support the forearm. You may choose the techniques or combinations of techniques that work for you and practice them every day for a week. Available evidence now supports that such techniques are helpful.⁹ 

Similarly, to improve manual dexterity, the occupational therapist may teach you various exercises, like turning nuts onto bolts and modelling clay into specific shapes, which you would try to practice to achieve a faster speed and better accuracy.¹⁰

Occupational therapists may also help you choose appropriate assistive tools, such as wheelchairs and walking canes to tackle walking problems.

Cognitive Challenges

Cognitive damages also contribute to the decrease in the quality of life of MS patients.¹¹ For example, long-term memory is more important than you may notice. It is very troublesome when people fail to remember what they need to buy once they arrive at the supermarket. 

Similar to other OT types focusing on fatigue and mobility, many OT approaches can help with cognitive challenges. Both external and internal strategies exist. One study in 2008 proved that digital memory assistants had improved MS patients’ performance in daily activities.¹²

From the perspective of 2024, even those outmoded devices can work, it is hard to imagine how much mobile phones, with their well-designed interface and huge varieties of applications, can offset the impact of cognitive changes MS patients have experienced. 

Another method is known as self-generation. In simple terms, it is the practice of creating one’s own words to describe items that need to be recalled later.¹³ OT can help you learn this strategy and apply it effectively in your everyday activities. It has been shown to help MS patients improve their ability to prepare meals and manage finances.¹⁴

There may also be OT courses that tackle cognitive problems more comprehensively by teaching how your cognition works and can be remediated and discussing how you may adapt to your cognitive changes and potentially rehabilitate them.¹⁵

MS can impact your cognition very differently compared to other patients. Therefore, it is important to obtain individualised advice from your occupational therapist rather than simply duplicating what other patients are doing.

Vocational Rehabilitation

It is hard for MS patients to lead a normal life, and it is harder for them to return to the workplace. Thankfully, many countries now protect the legal rights of disabled individuals to work and provide substantial support. Many organisations adopt strict anti-discriminatory policies that make your workplace more inclusive. OT can also facilitate your return to work.¹⁶

Occupational therapists can help you tackle problems like fatigue and mobility problems while referring to other issues hindering your workability to different departments. They may visit your office and try to identify changes that can be made so that it is more friendly to you, such as making anywhere necessary step-free.

Further, by meeting your employers, your occupational therapists can tell them how you are legally protected and what they should do to cater to your needs. People who had that OT indicated in interviews that they felt more confident, less anxious, and more supportive when returning to their workplaces.¹⁶

OT is not limited to these approaches mentioned above. Every patient leads a unique life, and OT aims to support your life in a unique and holistic manner.

Summary

To sum up, due to the nature of multiple sclerosis, its biological aspects are hard to be fully resolved. Therefore, to improve the quality of life of MS patients, professionals in occupational therapy need to know your everyday life. They advise you about all the strategies available to make every aspect of your life easier It is either mental/physical or life/work. Thus, consulting with an occupational therapist allows you to find one of the best solutions.