Defy MS: How Occupational Therapy Can Empower You

Multiple Sclerosis (MS) is a chronic condition that affects the central nervous system, which includes the brain and spinal cord. In MS, the immune system mistakenly attacks the protective sheath (myelin) around nerve fibres, causing inflammation and damage. This disrupts the normal flow of electrical signals along the nerves, leading to a variety of symptoms that can differ widely from person to person.

Here are the main types of MS:

1. Relapsing-Remitting MS (RRMS): This is the most common type, featuring episodes of new or worsening symptoms (relapses) followed by periods of recovery (remissions). During remission, symptoms may improve or disappear.
2. Secondary Progressive MS (SPMS): Often a progression from RRMS, SPMS involves a gradual worsening of symptoms over time, with fewer or no clear periods of remission.
3. Primary Progressive MS (PPMS): Characterised by a steady decline in function from the start, PPMS shows a gradual worsening of symptoms without distinct relapses.
4. Progressive-Relapsing MS (PRMS): This type features a continuous progression of symptoms from the beginning, with occasional relapses adding to the overall decline.

Understanding the type of Multiple Sclerosis can help tailor treatment and management strategies to improve quality of life and occupational therapy treatment.

Physical Impairments: Multiple sclerosis often impacts individual physical capacity, these are some of the more common challenges:

• Fatigue: A persistent and often debilitating feeling of extreme tiredness or exhaustion. This is one of the most common symptoms in MS and can really make everyday life difficult.
• Weakness: Reduced muscle strength due to nerve fibre damage, impacting physical capacity of the upper and lower limbs. 
• Ataxia: Reduced coordination of the upper and lower limbs that can impact walking and everyday function tasks like eating and dressing.
• Spasticity: Abnormal increase in muscle tone which can cause stiffness and/or make movements difficult.
• Tremors:  Involuntary, rhythmic shaking movements caused by damage to the brain regions that control motor function.
• Incontinence: Loss of control over bladder or bowel functions, resulting in involuntary leakage of urine or stool due to disruption in nerve signals that regulate these processes.
• Thermoregulation challenges: Sensitivity to heat, causing a worsening of MS symptoms. 

Cognitive Impairments: Cognitive challenges can be common in MS, people with Ms will often explain a feeling of "brain fog" but specific cognitive functions can become impaired. This may include challenges with:

• Attention/Concertation: Is the cognitive process of focusing effort on specific stimuli or tasks while filtering out distractions to effectively perform and achieve goals.
• Memory: Is the cognitive process of encoding, storing, and retrieving information and experiences, allowing individuals to recall past events and knowledge.
• Planning: Is the ability to organise and outline the steps required to achieve a specific task or goal that involves anticipating future needs or challenges. 
• Problem-solving: Is the ability to identify, analyse and resolve obstacles and challenges. 
• Decision-making: Is the ability to evaluate options based on desired outcomes and different contexts to select the most suitable decision. 

Sensory Impairments

Your brain processes all the sensory information from the world around you, such as sight, sound, taste, touch, and your sense of where your body is in space (proprioception). As Multiple Sclerosis is a condition of the nervous system (brain and spinal chord) the sensory system can be impaired. The following sensory impairment are common for persons with MS:

• Vertigo: A sensation of spinning or dizziness caused that disrupts the brain's ability to process balance and spatial orientation signals. 
• Double vision: Vision that create two overlapping images of a single object.
• Blurred Vision: Vision that is unfocused or hazy, making it difficult to see details clearly.
• Pins and needles/numbness: Is a tingling or loss of sensation in the skin, often feeling like your body part is "asleep," and can be caused by nerve irritation or damage.

Emotional and Psychological Impact: Multiple Sclerosis can impact a persons emotional and psychological functioning. Mood swings, anxiety and depression are common amongst those with MS. These challenges can further impact on their daily functioning and impact motivation.

Occupational therapy (OT) is all about helping people lead full, meaningful lives by addressing challenges in performing daily living activities. Occupational Therapists implement a combination of person, environment and task based approaches aiding individuals to overcome barriers to their independence and enhance their quality of life.

In the early stages of Multiple Sclerosis (MS), occupational therapy focuses on capacity building, working to improve and maintain strength, balance, and upper limb coordination to support independence. As MS progresses, the role of the occupational therapist shifts to include adaptive strategies and assistive technology to help manage functional challenges, while still aiming to maintain existing abilities. In the later stages of MS, capacity building becomes less effective, and the emphasis generally shifts to using adaptive strategies to better support daily living and functional needs.