Occupational Therapy

The goal of occupational therapy (OT) in MS is to help you maintain everyday skills needed for independent living and productivity at home and work. The areas of expertise of your occupational therapist will overlap to some extent with those of other members of the rehabilitation care team, in particular, the physical therapist. Occupational therapy and physical therapy can both address areas of concern related to fatigue, cognition, upper body strength and coordination, and use of assistive technologies. Additionally, your occupational therapist will offer you instruction on making environmental and behavioral adaptations to maintain and improve participation at home, work, and in the community.

Focus on occupational therapy in MS

One main focus of occupational therapy is occupation. However OT can help address any activity that requires time and energy and gives meaning to our lives, whether it be an activity at home, at work, or in the community. For persons with MS, occupational therapy typically focuses on three key areas.

Occupational Therapy: Three Major Areas of Focus

Self-care activities
  • Functional mobility
  • Dressing, bathing, and grooming
  • Eating
Productive activities
  • Paid work
  • Home management
  • Caregiving
  • Volunteer activities
Leisure activities
  • Social involvement
  • Recreational pursuits

Leisure activities

Occupational therapy interventions focus on removing or reducing the barriers that keep you from being fully involved in self-care, productivity at home and work, and leisure time activities. Your occupational therapist will use several approaches or tools to help you achieve your occupational goals, focusing on four major areas that are key to the ability to function independently:

  • Strength, movement, and coordination in upper body
  • Training in acts of daily living, which may involve use of adaptive equipment and assistive technologies to function safely and efficiently at home, office, and in the community
  • Strategies to compensate for impairments in cognition, sensation, and vision
  • Instruction in strategies for management of energy in daily activities to minimize fatigue

What to expect with the occupational therapy process

In MS, occupational therapy typically starts when you and/or your doctor recognizes the need for the help of a specialist and he or she gives you a referral. The occupational therapist may work out of a community or home care agency, a rehabilitation hospital or skilled nursing facility, an acute care facility, or private practice. During the first meeting, your occupational therapist will thoroughly evaluate your needs, focusing on specific activities or tasks that you want to be able to do again or continue to do. The next step will be to identify what factors are restricting or limiting you from the task or activity. These factors generally fall into one of three categories: personal factors, environmental factors, and occupational factors.

Occupational Therapy: Factors that Affect Functioning

Personal factors
  • Symptoms of MS (fatigue, pain, loss of balance)
  • Physical capacity (strength, range of motion)
  • Cognitive and perceptual capacity (memory, visual-spatial ability, attention)
  • Psychological and emotional state
  • Skills and knowledge related to specific task or activity
Environmental factors
  • Physical environment (accessibility, assistive technologies)
  • Social environment (availability of social supports)
  • Cultural environment
  • Socio-economic issues (cost)
Occupational factors
  • Physical demands of activity
  • Cognitive and perceptual demands of activity
  • Sequence of steps involved in task or activity
  • Temporal aspects of activity (when and for how long task is performed)
  • Need for specific tools and technology (computer, appliances, adapted devices or technologies)

Developing an intervention that addresses your needs

Once the occupational therapist has identified the factors that affect your ability to carry out a task or activity, he or she will work with you to develop an intervention strategy to help you achieve your goals. For instance, if you are having problems with vision, memory, and extreme fatigue which affect your ability to work at the office and function at home, your occupational therapist may recommend adjustments to office lighting and your computer monitor, as well as changing the default settings for screen contrast and font sizes. Use of a hand-held personal organizing device can help compensate for memory or organizational problems both at home and at work. Analysis of work and home activities can provide useful information about how to best modify those activities and to use assistive technologies to save energy and compensate for fatigue.

Occupational Therapy: Examples of Interventions to Address Problems in MS

Wheel chair bound with increased need for help with personal care
  • Help find and train personal care attendant
  • Help individual develop communication skills to express needs and cope with feelings about needing help in sensitive areas of personal care
  • Work out safe and efficient systems for dressing, transfers, bathing and train attendant
Fear of falling (diminished strength and balance) threatens to isolate elderly individual
  • Instruct in how to increase strength in lower extremities while doing everyday activities
  • Select walker and instruct in safe and efficient use
  • Evaluate home and community and identify and address fall risks, work with individual to build confidence
  • Work with individual to reconnect socially and continue to be active in community
Exacerbation has reduced function in left arm and hand and threatens independent living
  • Instruct in one-handed dressing and bathing techniques
  • Arrange for shower chair and grab-bar and other adaptive technologies to aid in personal care
  • Instruction in use of assistive technologies in kitchen (mounted jar opener, rocker knife) to help in preparation of meals: work with individual to prepare meals

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Written by: Jonathan Simmons | Last reviewed: May 2015.