Multiple Sclerosis: Eval and Intervention

Question 1

List appropriate standardized evaluation tools for individuals with M.S

Answer 1

a. Modified Fatigue Impact Scale
b. Beck Depression Inventory–18
c. FIMTM
d. Nine-Hole Peg Test or Purdue Pegboard Test for manual dexterity and fine motor coordination
e. Semmes–Weinstein monofilament testing for sensory function
f. Modified Ashworth Scale for spasticity

Question 2

During questioning, Assess __, review ___ from the medical records, and screen for ___

Answer 2

pain
medications
cognitive deficits

Question 3

Always valuate further with appropriate diagnostic procedures based on the client’s ____

Answer 3

occupational profile.

Question 4

Goals should address both the exacerbation and remission stages and should be _____ because of the progressive nature of MS.

Answer 4

compensatory

Question 5

Contraindications to intervention for M.S:

Answer 5

hot temperatures, heat modalities such as moist heat or fluido-therapy, increased emotional or physical stress, excessive physical activity or overexertion; alcohol
use increases balance deficits and can be dangerous when mixed with medications used to treat the
symptoms of MS

Question 6

To address vision-related deficits for those with M.S perform home safety assessment and make recommendations to reduce risk of falls

Answer 6

including
removing clutter, clearing pathways, and using bright or contrasting tape to mark steps inside
and out of the home.

Refer the client to a low vision specialist or to an ophthalmologist or an optometrist as indicated.

Question 7

Adaptive equipment for vision-related deficits for those with M.S

Answer 7

b. Adaptive equipment may include optical devices, large-print reading material, large-button
technology, talking watches, raised-dot markings for technology, and audiobooks

Question 8

To address sensory disturbances in those with M.S

Answer 8

a. Provide sensory reeducation.
b. Introduce compensatory strategies such as relying on visual feedback to observe desensitized
limb and testing the temperature of water for dishwashing or bathing using an unaffected body
part.

Question 9

Pain (from spasticity)

Answer 9

a. Advise on a standing home program, such as using a standing frame.
b. Use resting splints.
c. Maintain hips at 90° or more of flexion to reduce extensor tone in the lower extremities.
d. Apply focal heat modalities on muscle trigger points

Question 10

Strategies for addressing muscle weakness and other motor difficulties in clients with M.S

Answer 10

a. Monitor body mechanics
b. Yoga and group exercise classes.
c. Stretch before beginning any exercise to decrease spasticity, improve flexibility and circulation,
and prevent injury; warm up and progress to activities with proximal musculature before those
with distal musculature
d. Therapeutic exercise can improve overall health and well-being, but the occupational therapist
should emphasize the importance of resting and avoiding fatigue; exercises are best completed
“at submaximal resistance with frequent repetition in order to avoid overuse”
e. Aquatic therapy
f. Instruct the client in use of assistive devices.
g. Provide seating and positioning consultation if the
client requires a wheelchair or power mobility.

Question 11

Strategies for addressing ataxia in clients with M.S

Answer 11

a. Encourage proximal stabilization for improved distal movements.

b. Modify tasks by promoting hand-over-hand techniques for fine motor tasks (e.g., using the unaf-
fected extremity over the hand with tremor when dialing a phone; Forwell et al., 2008, p. 1090).
c. Use orthoses.

Question 12

Common orthoses beneficial for clients with M.S

Answer 12

i. Cervical collar to reduce the travel of the head and neck

ii. Wrist splints to minimize travel and number of joints in motion in the presence of a tremor

Question 13

Strategies for addressing cognitive and emotional disturbances in those with M.S

Answer 13

a. Consider cognitive retraining, memory enhancement programs, cognitive–behavioral therapy,
visual compensation strategies, or group therapy.
b. Eliminate distractions.
c. Use external memory aids such as day planners or electronic devices.
d. Write step-by-step instructions, printed in a reader-friendly font and size and worded clearly.
e. Advise the client to allow for increased time, delegation, and repetition when learning new ideas
and perform difficult mental tasks earlier in the day.

f. Teach stress management and relaxation techniques; emotional and physical stress can tempo-
rarily worsen symptoms.

g. Explain coping strategies, which can help in handling exacerbations