A thorough neuromusculoskeletal evaluation provides baseline information about the person’s physical status and present level of function. The initial evaluation should include assessment of all symptomscurrently affecting the individual’s performance. The evaluation focuses on the following areas:
Early intervention: Early intervention, particularly in relapsing-remitting MS, can help people continue to function effectively in their life roles and prevent premature retirement from the workforce. The increased stability provided by disease-modifying therapies allows more opportunities for therapists to intervene to preserve a person’s individual activities and overall participation.
Modification and compensation more than restoration: While some restoration of function may occur following an acute exacerbation, the primary emphasis in OT and PT is on teaching the person effective ways to compensate for existing impairments and make the necessary adaptation to behavioral and environmental modifications. It is these adaptations that will allow the person to remain functionally independent and productive, regardless of the extent of impairment.
Education, support, and motivation: A major focus of the interaction between the therapist and the person with MS is motivational. The therapist helps the person to understand the connection between the intervention being prescribed (e.g., exercise regimen, assistive device, environmental modification, etc.) and the person’s own goals. Only with this understanding will the person develop the motivation and commitment necessary to follow through with changes and adaptations that optimize function and mobility.
Self-management via skills training and the use of adaptive equipment: A primary objective of PT/OT interventions is to help people with MS learn to manage their own disease as comfortably and effectively as possible. Skills training and the proper use of adaptive equipment will make it possible for people to keep their lives as full, active, and satisfying as they want them to be. In general, PT focuses on impairments involving gross motor skills, while OT focuses on impairments involving fine motor skills, fatigue, cognition, and adaptive equipment. However, PT and OT are discussed together in this section because there is considerable overlap in the evaluation and treatment strategies used by these two specialty areas. Furthermore, the same problem that is treated with PT in one setting may well be treated by OT in another setting. The following factors are likely to determine which of these specialists evaluates/treats a particular person with MS:
The person’s insurance plan, which may cover one specialty but not the other
The particular background and training of the OT and PT at a given facility
The availability of only one of these specialists in a given facility or geographic area