Key points

Introduction

This article describes the types of activities of daily living (ADLs), assessment, treatment and training strategies, and adaptive equipment that are used with persons who have multiple sclerosis (MS). Because MS affects the central nervous system, it can result in both cognitive and physical changes, which affect the person’s function along a continuum of mild to very severe limitation. Limitations can affect single or multiple areas and include impaired vision, cognitive deficits, fatigue, impaired coordination, muscle weakness, and spasticity. Along with the broad spectrum of potential impairment, each individual brings their own abilities, priorities, resources, and unique style of performing ADLs.

Introduction

This article describes the types of activities of daily living (ADLs), assessment, treatment and training strategies, and adaptive equipment that are used with persons who have multiple sclerosis (MS). Because MS affects the central nervous system, it can result in both cognitive and physical changes, which affect the person’s function along a continuum of mild to very severe limitation. Limitations can affect single or multiple areas and include impaired vision, cognitive deficits, fatigue, impaired coordination, muscle weakness, and spasticity. Along with the broad spectrum of potential impairment, each individual brings their own abilities, priorities, resources, and unique style of performing ADLs.

ADLs

It is typically the role of the occupational therapist to address the evaluation and treatment of deficits in the area of ADLs. ADLs are generally grouped into 2 categories:

• 1.
  

  Basic ADLs (BADLs) also called personal ADLs (PADLs) are those things we do that are considered fundamental to taking care of ourselves.

  
  
• 2.
  

  Instrumental ADLs (IADLs) are those activities that may affect our ability to live on our own but are not necessary for personal daily functioning.

The American Occupational Therapy Association (AOTA) defines 12 BADLs and 11 IADLs :

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  BADLs/PADLs

  
  
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  Bathing and showering

  
  
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  Bowel and bladder management

  
  
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  Dressing

  
  
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  Feeding

  
  
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  Functional mobility

  
  
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  Personal device care, such as care for dentures or hearing aids

  
  
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  Personal hygiene and grooming

  
  
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  Sexual activity

  
  
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  Toilet hygiene

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  IADLs

  
  
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  Care of others

  
  
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  Care of pets

  
  
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  Child rearing

  
  
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  Communication management

  
  
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  Community mobility, including driving

  
  
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  Financial management

  
  
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  Health management and maintenance

  
  
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  Meal preparation and clean-up

  
  
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  Religious observations

  
  
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  Safety procedures and emergency responses

  
  
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  Shopping

Occupational therapists work as part of a team, which may include nurses, physical therapists, physicians, psychologists, recreational therapists, speech and language pathologists, and vocational counselors. Depending on the team and the setting, occupational therapists may be primarily responsible for evaluating and providing treatment and training for most of the ADLs. However, for some deficits in ADLs, responsibility for evaluation and treatment may be shared with other disciplines. For example, bowel and bladder management are frequently assessed and taught by nursing; however, occupational therapists may train in or adapt equipment to develop the person’s independence.

Adaptive devices

Occupational therapists frequently recommend adaptive equipment, assistive devices, and splints or other positioning devices to aid persons with MS in completing their ADLs. It is most beneficial that the individual be given the opportunity to trial the equipment during treatment sessions to ensure that the equipment is not only physically usable but also cognitively and emotionally acceptable to the person. Some persons with MS are more readily able to see adaptive equipment as a useful tool than others.

Adaptive devices specific to cognitive impairment:

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  Daily planners/calendars

  
  
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  Checklists/to-do lists

  
  
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  Medication sets

  
  
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  Electronic devices: smart phones, tablets, alarms

Adaptive devices specific to home safety and ADLs:

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  Personal medical alarms

  
  
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  Bathroom equipment (grab bars, raised toilet seats/commodes, bath/shower seats)

  
  
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  Mobility equipment (wheelchairs, walkers, canes, floor/ceiling lifts, stair lifts)

  
  
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  Dressing equipment (reachers, sock aids, shoe horns, elastic laces, button hooks)

  
  
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  Eating devices (large-handled utensils, rocker knife, u-cuff, lip plate)

  
  
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  Grooming devices

  
  
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  Toileting devices

  
  
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  Bathing devices

  
  
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  Kitchen/cooking devices

Evaluation of ADLs

The occupational therapist performs a comprehensive evaluation of persons with MS, including strength testing, measurement of range of motion, fine and gross motor assessment, vision screening, sensation, and cognition. ADLs are assessed through interview and performance of the activity. Activities are typically scored by the level of assistance that the person requires to complete the activities. An example of a functional measure is the Functional Independence Measure (FIM). Once the evaluation is complete, the occupational therapist and the person with MS devise treatment goals tailored to improve function in the areas of deficit and importance to the individual. For example, a person with MS may be unable to dress herself. She may choose to have her husband put on her socks but may want to work on becoming independent in putting on her brassiere and shirt ( Table 1 ).

Impairments related to movement

Persons with MS may have 1 or more impairments affecting movement, including weakness, spasticity, tremors, and incoordination. These symptoms subsequently affect performance of BADLs and IADLs. Occupational therapists can help assess, treat, and make recommendations based on the severity of the symptoms listed earlier.

Assessment

Self-care assessments often begin with determining the level and quality of a person’s movements. Once this key area is assessed, it helps the therapist visualize the individual at home and on a typical day.

Important areas to assess related to impairments of movement:

• 1.
  

  How does the person move through space (ie, use of power or manual wheelchair vs assistive device during ambulation vs independence with ambulation)? Are they able to stand or push up from the wheelchair for even short periods?

  
  
• 2.
  

  If nonambulatory, how does the person transfer from 1 surface to another (ie, from the wheelchair to and from the toilet)?

  
  
• 3.
  

  If ambulatory, does the person safely bend down, negotiate a walker in doorways, and use outside supports for stability when reaching or rising from a sitting position?

  
  
• 4.
  

  What position can the person safely assume while getting dressed, groomed, or washed?

  
  
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  If using a wheelchair, can the individual access the bathroom, kitchen, bedroom, and other living spaces?

  
  
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  To what extent can the person reach for, move, and handle objects?

These variables determine which assistive devices and compensatory strategies might be used to make daily living tasks less difficult.