Understanding the Therapist’s Role in Managing Multiple Sclerosis

Nearly one million people in the United States live with multiple sclerosis (MS),¹ with 12,000 new cases diagnosed each year.²  The majority of these individuals will have average or near-average lifespans with various complications requiring the skills of a therapist throughout.

Here, we will explore neurological processes, as well as tools that therapists can use to understand the disease process and learn to competently treat this complex population of patients.

Multiple Sclerosis: A Case Study

Let’s introduce Steve. Steve has been living with MS for 30 years. Steve is from Vermont, which makes his presentation not unusual. There is a higher incidence of MS further north from the equator where temperatures are colder.³ People in the Northeast and Midwest have a higher incidence of MS. Steve is unusual, however, in that he is a male with MS when MS is two to three times more common in women.

Steve is struggling to live independently. To stay in his own home for as long as possible, he must consistently be able to cook, shop, be independent in ADLs, drive as long as possible, and do all the other activities required for independent living.

Steve also needs ongoing education to manage the many aspects of his disease throughout the year when he will have varying degrees of pain, fatigue, weakness, and other complications. This is challenging because the many aspects of his disease cause Steve’s level of functionality to be inconsistent.

The essential role of therapists is to help patients navigate the challenges of living successfully with MS. It is imperative that Steve has a good long-term relationship with his therapy team to prevent severe disability and help him live independently as he ages with MS.

Here are some of the factors that Steve and his therapists will most likely encounter to manage his disease:

Disease Process

The disease process can be one of relapses or gradual worsening of symptoms. Whatever the progression, managing MS is an ongoing process, beginning with the first symptoms, and continuing throughout the disease course.

Of the many complications that occur with MS, fatigue is the most common complaint.⁴ Other disease processes are significantly problematic, including:

• spasticity
• balance and gait problems
• progressive weakness
• ataxia
• pain
• cognition and depression

Outcome Tools

As the payment model for therapy services changes from fee-for-service to value-based reimbursement, it is critical to use disease-specific objective tests in our clinics. Therapists need tools specific to MS to measure:

• Fatigue
• Quality and quantity of walking
• Balance
• Ataxia
• Quality of life

Interventions

Due to the tumultuous nature of the progression of MS, therapists need to understand how to manage the underlying disease process (including secondary and long-term complications), ameliorate symptoms, and prevent disability.

Therapists must possess a level of understanding that will allow them to appropriately apply effective interventions that will improve outcomes and assist the patient in the management of the skills necessary for quality of life. Therapists can accomplish this by becoming proficient in:

• Correct dosage for strengthening
• Energy conservation within patients’ fatigue levels
• Patient education

Medications

Medications need to be skillfully balanced to properly treat the complicating factors of MS. Therapists are an integral part of the medication management team, which requires them to have a basic knowledge of the disease-modifying medications that hold the disease at bay, as well as other medications for the complications of MS.

In our course, “Treatment Insights for Persons Aging with Multiple Sclerosis“, Valerie Carter and I present up-to-date evidence as it pertains to each of the factors presented in this article, as well as applicable strategies for implementing disease-modifying treatment interventions to enable patients with MS to experience longer, higher-quality lives.