Although there is no cure for multiple sclerosis (MS), occupational therapy can help a person manage the symptoms, perform daily activities, and retain as much of their independence as possible.
Occupational therapy for people with MS focuses on helping them accomplish daily tasks, such as folding clothes, driving to work, and walking.
Occupational therapy is different than physical therapy because it focuses on general function rather than physical capabilities. As a result, each person’s treatment plan prioritizes different goals depending on their lifestyle and the progression of their MS.
This article discusses how occupational therapy for MS works, including how occupational therapists create a treatment plan and the exercises that it might include. It also covers other treatment options and the outlook for people with MS.
Occupational therapy aims to help a person perform their usual activities, which means that the specific focus will vary among individuals. In most programs, occupational therapists focus on three specific domains:
- self-care activities, such as bathing and using the bathroom
- productive activities, which may include cooking, paid work, caring for children, or volunteering
- leisure activities, such as gardening, exercise, or other activities a person enjoys
Occupational therapy does not follow a single treatment course. Instead, it combines various activities and exercises, including:
- teaching a person to work around any weaknesses
- using assistive devices
- boosting strength
- identifying strategies that maximize a person’s energy and strength, such as working at certain times of the day
Occupational therapy can be very effective. A 2016 case report details the story of a middle-aged woman with MS who sought inpatient MS treatment, including occupational therapy.
At the start, she needed significant help with most daily activities, but after 8 days of treatment, she had largely attained independence.
On a seven-point scale of independence, she had a 4 in eating and grooming at the beginning of treatment and a 7 at the end.
She also reported significant improvements in satisfaction with her ability to perform all of the major life activities that the assessment measured.
Every person’s treatment plan is different, and not all occupational therapists are a good fit for all people with MS.
Before meeting with an occupational therapist, it is advisable to take the following steps:
- Make a list of the areas in which MS has affected daily life or performance.
- Make a list of all current MS symptoms.
- Identify the daily tasks that are most important, and list any barriers to completing them.
When the person meets with an occupational therapist to discuss the above, the therapist will have an understanding of what tasks to prioritize.
For example, people in paid jobs may prioritize continuing these tasks and then move on to cultivating the skills necessary for volunteer work or leisure activities.
Unlike traditional exercises or physical therapy, occupational therapy focuses on helping a person achieve specific goals, such as driving to work or sitting in a chair without pain.
There is no one-size-fits-all occupational therapy plan, and each person’s exercise regimen will vary. Treatment plans may change with time, depending on how the person’s priorities change and how the disease progresses.
These exercises provide a general idea of what to expect from occupational therapy for MS, but a person should discuss their symptoms and goals with an occupational therapist before trying them at home:
Improving physical function
Strengthening exercises focus on regaining or maintaining strength in specific regions of the body.
The right combination of exercises varies depending on a person’s needs. Some options to try include:
- Sit in a neutral position in a chair with the feet flat on the ground. Raise one arm toward the ceiling, with the hand extended straight out. Lower it back down and repeat on the other side. Repeat a few times.
- Sit in a neutral position in a chair with the feet flat on the floor. Place the hands next to each other on a weight (or soup can) so that both hands are supporting the weight. Slowly raise the hands up and over the head until the weight points toward the ceiling. Repeat a few times.
- Practice wrist control sitting in a chair with the feet flat on the ground. Hold an object in one hand with the palm facing down. Then place the forearm flat on a table or desk and keep it still while lifting the wrist up and back several times. Repeat on the other side.
- Start on all fours on the floor. Lift one arm and hold it straight out in front of the face for a few seconds. Repeat with the other arm. Then repeat the process with the legs, lifting each leg straight behind the body until it aligns with the back.
- Stand up straight on a stable surface. Lift one leg to the side, keeping it straight but not locked. Repeat on the other side. Do several repetitions.
Pelvic floor exercises
Many people with MS struggle with incontinence. Pelvic floor strengthening exercises can help a person become more aware of the need to use the bathroom, and they may improve symptoms of incontinence. A person can try the following:
- Sit in a chair or lie on the floor. Keeping the knees bent and the spine neutral, move the knees together from side to side for 1–2 minutes.
- Lie on the floor. Bend the knees and keep the feet flat on the floor. Push down through the legs and use the core to lift the pelvis off the floor, then lower it back down. Repeat a few times.
- Start on the floor on all fours, and tense the abdominal muscles to pull the bellybutton up and arch the back. Then hollow out the small of the back by lowering the stomach and slightly arching the upper back. Repeat this series of moves several times to improve core and pelvic floor strength.
Using assistive devices
Wheelchairs, canes, shower support bars, and other assistive devices can support more fluid movement, prevent falls, and compensate for lost mobility.
They also require some skill and practice to master. In some cases, a person may need to build strength in specific areas of the body to use these devices. A person may wish to ask an occupational therapist for help with selecting and using:
- a shower seat or shower bar
- a walker while walking in an upright position
- a wheelchair
- hearing aids
Adapting daily movements and activities
It is not always possible for a person to do tasks and activities in the same way that they always did previously. Indeed, trying to do so may make living with MS more difficult.
An occupational therapist can help a person adapt their usual movements and activities to suit the changes in their body. Some simple ways to modify daily activities include:
- sitting down when dressing
- lowering the clothing bar in the closet
- using the elbows to help support the body when eating
- using two hands to hold a drink
- turning down the water heater to avoid dangerously hot shower water
- investing in comfortable chairs throughout the house and sitting on them when doing activities such as cooking
- sliding or pushing objects rather than lifting them
- using support devices, such as an electric can opener, a shoehorn, a bedside toilet, and velcro shoe closures
Most people need to take MS medications. These drugs, which doctors call disease-modifying agents, can slow the progression of MS by reducing inflammation in the immune system.
Some people take several drugs at once. Most will need to adjust their specific medication over time in response to side effects and disease progression.
Some other treatment options include:
- physical therapy
- speech therapy
- pelvic floor physical therapy
- treating any underlying disease processes that worsen the effects of MS
- lifestyle changes, such as quitting smoking
- medications, such as corticosteroids
- pain relievers
- psychotherapy and support groups to help a person maximize their quality of life with MS
MS is a chronic illness. For many people, it is also progressive, which means that it gets worse with time. However, some people may experience periods during which their symptoms are temporarily better.
There is no cure for MS, but treatment can help slow the progression of the disease and ease symptoms. Some people go into remission with the right treatment, which means that they are free of symptoms.
Research suggests that the life expectancy of people with MS is only slightly shorter than that of those in the general population. However, the authors note that people with MS have higher mortality rates due to infectious diseases and diseases of the respiratory system.
Occupational therapy offers a way for a person to identify treatment goals specific to their life, values, and needs.
This customizable approach can help a person live better, feel more independent, and reduce their risk of injury.
A person with MS can ask a doctor for a referral to an occupational therapist. When discussing a treatment plan with the therapist, they should be honest and specific about their goals.