Moving your body gets tricky when you have multiple sclerosis. Damaged nerves may cause problems using your hands, arms and legs. And while medication, exercise and physical therapy are important ways to help manage MS challenges, occupational therapy can also play a crucial role in keeping you functioning.
“Everyone is familiar with physical therapy, which helps you get somewhere. But I want someone to be able to do something when he gets there. Not just walk to the bathroom, but open the medicine cabinet, put toothpaste on a toothbrush and brush teeth,” says Aaron Nicka, an occupational therapist with Cleveland Clinic’s Mellen Center for MS Care.
MS Challenges
In MS, the immune system attacks the coating of the nerves (myelin) and the nerve fibers in the spinal cord, brain and optic nerves. That damage can lead to problems with cognition, vision, emotions, muscles and coordination, which can cause fatigue, trouble walking, weakness, poor balance, muscle stiffness or spasms, pain, tremors and reduced manual dexterity.
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If you have trouble using your hands, for example, it may be difficult to dress, groom, eat, write on a piece of paper or work on a computer.
Coordination and balance issues may make it hard to:
— Stand and cook while pushing a wooden spoon around a pot of soup.
— Bend down, grasp a sponge and scrub a bathtub.
— Open a car door, turn a key in the ignition and step on a gas pedal.
There’s no way to know when or if these problems will present after an MS diagnosis. “Everyone is different. It’s conceivable that even a newly diagnosed patient might have, say, numbness in the hands that might interfere with buttoning or holding a pen,” says Dr. Barbara Giesser, professor of clinical neurology and clinical director of the Multiple Sclerosis Program at the David Geffen School of Medicine at UCLA.
OT to the Rescue
Occupational therapy involves strategies to make everyday tasks easier, whether it’s grooming, bathing, eating, working or even playing. “Currently I’m helping a gentlemen continue to fish. We work on balance so he can stand on the edge of the river bed, and upper extremity strength so he can cast and rewind the lure,” Nicka says.
OT approaches may involve:
— Activity modification. The occupational therapist can evaluate your activities and find ways to make them less fatiguing or challenging. For example, when cooking, it may help to reduce the amount of steps to the refrigerator or garbage can. “Read the recipe ahead. Make a ‘garbage bowl’ and have less trips back and forth to the garbage can,” Nicka suggests. Or if you work as a cashier, you might sit down periodically while doing your job.
— Adaptive equipment. The occupational therapist can suggest equipment that may help you, and then train you to use it. For example, you might benefit from walking poles if you hike, a shower chair if you are unsteady when bathing, weighted utensils if your hand shakes while you’re eating, or tools to help you fasten buttons or pull on socks when you dress.
— Strength, stretching or balance exercises. The occupational therapist can come up with exercises to boost balance and prevent a fall, or build strength for specific activities. For example: opening a tube of toothpaste. “We can work on strengthening the thumb and fingers to maintain function,” Nicka explains. Or if someone is in a wheelchair, he may need to build trunk strength so he can shift in his chair.
[See: 14 Ways to Protect Seniors From Falls.]
— Cognitive training. The occupational therapist can help assess issues you might have with problem-solving, focus, attention and memory. From there, the therapist may suggest computerized cognitive training or teach you how to use tools to aid cognition, such as an alarm or calendar function on your cellphone.
Getting Started
When you feel your MS is making it tough to perform the activities you want, it may be time to ask your health care team if OT is right for you. A referral from your doctor will get you an appointment with the occupational therapist.
What happens in therapy? The occupational therapist will want to evaluate your needs. He or she may make an assessment in a medical setting or at your home or office. The therapist will then design an OT program tailored to the tasks you want to accomplish.
A course of OT may last for about a month, with follow-up visits. “Here at the Mellen Center, we tell patients that we have the ‘dentist model.’ We’ll see you for a short, intensive bout — one or two times a week for three or four weeks — and we may see you again in six months to a year to reevaluate how you’re doing,” Nicka says.
You can expect your occupational therapist and doctor to communicate about your progress. “The OT will send back a report and say we saw the patient and worked on these goals. If they need us to write a prescription for a device, they may ask us to do that,” Giesser says.
[See: 5 Ways to Cope With Mild Cognitive Impairment.]
Making a Difference
OT can be an important approach to maintaining your body function and protecting your independence. OT can also help keep you safe. “I’ve seen that, especially when it comes to cooking or pouring hot liquids. That can have a big impact,” Giesser says.
Nicka feels that OT is so important to functioning with MS that he recommends taking advantage of it sooner rather than later. “It’s much better to come in early in the challenge rather than waiting until there are all kinds of things you can’t do,” he says.
But Nicka doesn’t want you to think OT is only a tool to improve simple tasks. “People think of OT as help with dressing, bathing and grooming. But it’s much more in terms of your ability to live,” Nicka says. “It changes the perception of the disease and allows people to maintain their normal roles. My ultimate goal is to have MS be a part of your life, and not a defining factor.”
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The Role of Occupational Therapy in MS originally appeared on usnews.com
