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Resources to Support Clinical Care

Successful Interventions

In order for interventions to be successful, they must:

  • Target the appropriate underlying impairment: A thorough and careful assessment should precede any intervention in order to ensure that the sources of the presenting complaint have been correctly identified.
  • Be consistent with the person’s goals: The person with MS is the focal point of the rehabilitation effort. His or her goals need to drive the rehabilitation process if the process is to succeed. When people understand the connection between their own goals and the recommended treatment interventions, they are more likely to follow through with treatment recommendations.
  • Be realistic, given the person’s goals, abilities, and resources: For example, prescribing a water exercise program for a person who dislikes the water, has no access to a swimming pool, or whose presenting complaint is overwhelming fatigue that prevents her from lasting a full day at work, is unlikely to prove beneficial. A successful intervention for this person would identify the possible source(s) of her fatigue, and evaluate and modify her home and work environment and energy effectiveness strategies. The intervention should also evaluate her need for assistive equipment, provide training in its use, and provide her with an aerobics exercise program that fits realistically into her lifestyle.

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Assessment & Intervention

Physical and occupational therapists utilize a variety of strategies to assess and address impairments

Complaints, Assessments, and Interventions*

Fatigue (PT and OT)

Modified Fatigue Impact Scale; 25-foot walk; Manual Muscle Test before and after 6-minute walk; aerobic fitness assessment (before prescribing aerobic program); equipment assessment; activity diary; Sleep Questionnaire; evaluation of medications for impact on fatigue level; depression instrument

Energy effectiveness strategies; aerobic exercise program; equipment modifications (mobility, self-care, and ergonomic); cooling strategies; environmental and behavioral modifications (home and job-site); transportation

Walking Difficulties (PT)

Manual Muscle Test; 25-foot walk; 6-minute walk; gait analysis; Tinetti Assessment Tool; Timed-Up and Go; Dynamic Gait Assessment; Functional Gait Assessment; analysis of environment and tasks; vestibular and sensory/proprioceptive assessments; safety evaluations

Gait training; gait assistive devices; behavioral and environmental modifications; powered mobility equipment; cooling strategies

Talking about Wheeled Mobility

Weakness (PT and OT)

Manual Muscle Test; Dynamometer; Pinch Meter; Five Times Sit to Stand; gait analysis; analysis of environment and tasks; assessment of transitional movements

Exercises for deconditioning; adaptive equipment; environmental modifications; cooling strategies

Poor Balance/Fall Risk

Vestibular, visual, proprioceptive, sensory, spasticity/range of motion, gait analyses; Manual Muscle Test; Berg Balance Scale; 6-minute walk; 25-foot walk; Timed Up and Go;  Dynamic Gait Index; Functional Gait Assessment; Dizziness Handicap Inventory; Tinetti Assessment Tool

Vestibular/balance rehabilitation; strength training; gait training – dynamic activities; supportive footwear; gait assistive devices; gait training; behavioral modification; environmental modification; cooling strategies; Fall Prevention Program

Stiffness, Spasms, Spasticity (PT and OT)

Range of motion; Modified Ashworth; consistent communication with neurologist regarding medical management (e.g., medications; intrathecal baclofen pump if severe)

Stretching exercise program; environmental modifications; cooling strategies; standing frame; AFO; positioning; baclofen pump

See spasticity overview

Cognitive Changes (OT)

Referral to a neuropsychologist; Modified Fatigue Impact Scale; Perceived Deficits Questionnaire; PASAT and possibly other neuropsychological screens

Instruction in compensatory strategies; assistive devices and environmental modifications

Reduced Manual Dexterity (OT)

9-Hole Peg Test; Box and Block; Dynamometer; Pinch Meter; Semmes-Weinstein Sensory Test; spasticity; coordination

Environmental modification; behavioral modification; voice-activated software; bigger grips; assistive devices; stretching; positioning

Pain (PT and OT)

Trigger point assessment; pain scales; posture assessment; equipment/seating assessment; central vs. peripheral symptoms

Equipment/seating modifications; relaxation; exercise; pain management techniques; behavioral/environmental modifications

Tremor/Ataxia (PT and OT)

9-Hole Peg Test; ADL assessment; 25-foot walk; Manual Muscle Test; safety evaluation; Canadian Occupational Performance Measure (COPM); Functional Independence Measure (FIM), or other ADL assessment

Gait assistive devices; powered mobility equipment; weighting; proximal stabilization; behavioral modification

Sensory Changes (including proprioception) (PT and OT)

Proprioception; Semmes-Weinstein Sensory Test; hot/cold discrimination

Larger grips; textured surfaces; supportive footwear; voice-activated software; sensory precautions

Poor Vision (OT)

Visual acuity; tracking; peripheral vision; visual-perceptual assessment

Behavioral modification; environmental modification

Decreased Functional Independence

COPM; Functional Independence Measure (FIM), or other ADL assessment; Seating and Mobility Assessment

 

Assistive equipment; powered mobility equipment; behavior and environmental modifications

 

*Examples presented should not be considered exhaustive.