Multiple Sclerosis/Occupational Therapy

Multiple sclerosis: Evidence-Based Practice
Institution
Date
Multiple Sclerosis is a disorder where the body has an abnormal response in the body’s immune system that is directed against the central nervous system (CNS) as shown in (Loma & Heyman, 2011). The myelin sheath covers the nerve fibers, is attacked by the immune system. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name as indicated by Loma & Heyman (2011). The destruction of the myelin sheath and the nerves disrupts the transmission of messages between the brain and spinal cord. The outcome is a variety of symptoms which include; fatigue, weakness, gait problems, spasticity, vision problems, numbness, and dizziness. Different people present different symptoms, which may begin between the ages of 20-40 years old. The disease is progressive, and in some cases renders a person unable to attend to most of their ADL’s such as walking, bathing and eating.
The PICO Question
In patients with physical impairment as a result of MS, can the OT intervention help them preserve their jobs, as compared to not seeking OT intervention, by teaching the patients’ self-care skills?
Summary of the articles
Patients presenting with isolated syndromes that are suggestively clinical to be multiple-sclerosis(MS) for instance symptoms of the spinal cord and optic nephritis are likely to develop MS in later years (Brex, Ciccarelli, O’Riordan, Sailer, Thompson, & Miller, 2002)). Longitudinal case study findings confirmed that patient with multiple sclerosis first present with these syndromes before MS condition developed (Brex, 2002).

Over 70 percent of patients in the study who presented with lesions on the white matter (isolated syndrome) through magnetic resonance tests were at a risk of developing MS as shown in (Brex, 2002). A different study on various chronic illnesses indicated that people with MS exhibited the highest levels of unemployment (Shahrbanian, Auais, Duquette, Anderson, & Mayo, 2013). This study suggested that pain was the main reason for their unemployment or early retirement for those at risk to slow the progression (Shahrbanian, 2013). Another study revealed that clinical assessment of the MS outcome is complicated since the condition attacks various aspects of the CNS and its progression follows the various course (Hohol, Orav, & Weiner, 1999). The study compared the outcome of clinical MS by the use of disease steps method and a different scale called Expanded Disability Status Scale, whose results had high correlation (Hohol, et al., 1999). They were used to study the progression of MS to help establish treatment for the disease.
The use of the information by Occupational Therapist
Occupational therapist attends to MS patients presenting with loss of sensation, weakness in the limbs, fatigue among other MS symptoms (Steultjens, Dekker, Bouter, Cardol, Van den Ende, & van de Nes, 2003. These presentations hinder their ability to perform physical tasks including social activities. An occupational therapist can use such information to help MS patients learn self-care strategies and enable them to work, for instance, the people who leave employment or early retirement because of pain related to MS. The occupational therapist can use the information above to understand the course MS takes in progression to devise a reliable treatment. Understanding the syndromes related to MS can promote the initiation of an early intervention preprogram to slow the progression of the MS.
Conclusion
Multiple sclerosis (MS) affects various parts of the central nervous system which can lead to impairment of the patient’s body parts, for instance; it contributes to the weakness of the limb. It also subjects the victim to chronic pain that does not allow them to work. Patients presenting with an isolated syndrome such as lesions in the white matter are at risk of developing MS. Assessing outcomes of MS is challenging considering that its progression follows unpredictable course but the use of the Expanded Disease Status Scale, and the disease step can help predict the outcome and hence design an intervention. Occupational therapists can use the above information to help MS patients lead a productive life.
References
Brex, P. A., Ciccarelli, O., O’Riordan, J. I., Sailer, M., Thompson, A. J., & Miller, D. H. (2002). A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. New England Journal of Medicine, 346(3), 158-164.
Hohol, M. J., Orav, E. J., & Weiner, H. L. (1999). Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression. Multiple Sclerosis, 5(5), 349-354.
Loma, I., & Heyman, R. (2011). Multiple sclerosis: pathogenesis and treatment. Current neuropharmacology, 9(3), 409-416.
Shahrbanian, S., Auais, M., Duquette, P., Anderson, K., & Mayo, N. E. (2013). Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis. Pain Research and Management,18(5), e94-e100.
Steultjens, E. E., Dekker, J. J., Bouter, L. M., Cardol, M. M., Van den Ende, E. C., & van de Nes, J. (2003). Occupational therapy for multiple sclerosis.The Cochrane Library.
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