Search, review, and discuss a current assistive technology (AT) used for adult clients who present with disability. Your findings (article) MUST be no more than 5 years old. What is the AT, how does it work, has been researched, funding, psychosocial impact. 3-4 paragraphs. Attach is the article
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1. Occupational Therapy Interventions for Adults With Multiple Sclerosis……………………………………………….
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Occupational Therapy Interventions for Adults With Multiple Sclerosis
Author: Preissner, Katharine; Arbesman, Marian; Lieberman, Deborah
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Headnote
MeSH TERMS
* evidence-based practice
* multiple sclerosis
* occupational therapy
* patient care planning
This Evidence Connection describes a case report of a woman with an exacerbation of multiple sclerosis (MS),
applying the evidence for intervention from the systematic reviews on MS that were conducted in conjunction
with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. The
occupational therapy assessment and treatment processes for an inpatient rehabilitation setting are described.
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with
the AOTA’s Evidence-Based Practice Project.
Management of chronic conditions is key to achieving the “Triple Aim” of health care: “(1) improving the
individual experience of care, (2) improving the health of populations, and (3) reducing the per capita costs of
care for populations” (Berwick, Nolan, &Whittington, 2008, p. 760). Occupational therapy practitioners have the
education and knowledge to provide occupational therapy interventions to people with various diagnoses and
chronic clinical conditions. Because of the increasing incidence and cost of chronic conditions, using evidence
to support the role of occupational therapy practitioners as leaders of care management makes sense. These
interventions enable clients to restore and maintain participation in a variety of occupations and can be
incorporated into comprehensive care systems (Arbesman, Lieberman, &Metzler, 2014).
The chronic clinical condition discussed in this Evidence Connection article is adults with multiple sclerosis
(MS). Findings from the systematic reviews on this topic were published in the January/February 2014 issue of
the American Journal of Occupational Therapy (AJOT; Yu &Mathiowetz, 2014a, 2014b) and in the American
Occupational Therapy Association’s (AOTA’s) Occupational Therapy Practice Guidelines for Adults With
Neurodegenerative Diseases (Preissner, 2014). Each article in this series summarizes the evidence from the
published reviews on a given topic and presents an application of the evidence to a related clinical case.
Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and
guide clinical decision making.
Clinical Case
Susan, age 49, was diagnosed with MS 9 yr ago with no other noteworthy medical history. She was recently
admitted to an inpatient rehabilitation unit after a 3-day acute hospitalization as a result of an exacerbation of
her MS. Ana, an occupational therapist, was assigned to work with Susan. Ana reviewed Susan’s electronic
medical record, which indicated that a few days before hospitalization, Susan had noticed that her left leg
dragged a little. Susan woke up the next morning and was so off balance that she was unable to walk. Her
husband took her to the emergency room, where she was diagnosed with an MS exacerbation and was
admitted to the hospital. Susan stayed on an acute neurology unit for 3 days, where she received medical
intervention and occupational and physical therapy evaluations. Both therapists recommended inpatient
rehabilitation. The following sections describe the assessment and treatment process that Susan underwent
while on the inpatient rehabilitation unit.
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Occupational Therapy Assessments and Findings
Assessment 1: Morning
Ana met with Susan in the morning to begin the assessment process. She started the session with an informal
interview followed by administration of the Canadian Occupational Performance Measure (COPM; Law et al.,
2014) to determine Susan’s occupational profile. Through the interview, Ana learned that Susan lives with her
husband and 19-yr-old daughter in a single-story home. Susan is home alone during the day while her husband
works and her daughter attends college. Susan is currently unemployed and on disability, having previously
worked as a paralegal. Before this MS exacerbation, Susan was independent with self-care activities and
shared household activities with her husband and daughter. However, she recently has been experiencing
fatigue, which has limited her ability to engage in self-care, household activities, shopping, and other community
activities.
Susan walked with a cane both in her home and in the community. She reported that she had been attending a
yoga class, which she enjoyed for both its physical benefits and social aspects, but that she stopped attending
about a month ago because of fatigue. She also reported a decline in memory, which affected her daily
activities, and some difficulty managing her emotions. Susan’s most immediate concerns were her current
inability to take care of herself and be home alone during the day.
When Ana administered the COPM, Susan identified the following five occupations as the most important (in
order of importance): toilet transfers, dressing, meal preparation, bathing, and returning to her yoga class. Ana
used the results from the occupational profile for the morning assessment session to administer the self-care
and bathroom transfer items of the FIM* (Uniform Data System for Medical Rehabilitation, 1997). See Table 1
for COPM and FIM scores.
Assessment 2: Afternoon
Ana used the afternoon session with Susan to finish the evaluation, specifically to evaluate performance skills
and client factors. She administered the Assessment of Motor and Process Skills (AMPS; Fisher &Jones, 2012)
to assess performance skills. Susan chose two tasks that were meaningful and relevant to her: making a grilled
cheese sandwich and washing dishes. The results of the AMPS indicated that Susan was unsafe performing
these tasks and required frequent physical assistance. She had difficulty stabilizing her body; reaching for,
grasping, lifting, and transporting task objects; and maintaining endurance during both tasks. Because fatigue
was a major client factor that limited Susan’s occupational performance, Ana administered the Fatigue Severity
Scale (Krupp, LaRocca, Muir-Nash, &Steinberg, 1989), a nine-item questionnaire. Susan received a score of
6.8, which indicated that she experienced substantial fatigue.
Using Susan’s interests and goals, the assessment results, and the discharge plan for returning home and
being alone during the day, Ana wrote treatment goals that focused on maximizing independence and safety for
self-care skills, bathroom transfers, and simple meal preparation and supporting Susan’s desire to return to her
yoga class. Ana reviewed the evidence from the January/February 2014 issue of AJOT (Yu &Mathiowetz,
2014a, 2014b) and AOTA’s Occupational Therapy Practice Guidelines for Adults With Neurodegenerative
Diseases (Preissner, 2014) and incorporated it into the occupational therapy interventions described next.
Occupational Therapy Intervention
Ana provided two daily sessions of occupational therapy during Susan’s 8-day rehabilitation stay. These
sessions included instruction in modified approaches to self-care to promote independence and safety,
instruction and guided practice in the use of adaptive equipment (e.g., sock aid) and durable medical equipment
(e.g., grab bars around the toilet), education about the energy conservation strategies included in the Managing
Fatigue program (Packer, Brink, &Sauriol, 1995), memory training to support activities of daily living and
instrumental activities of daily living, education about strategies for emotional regulation, and the creation of a
physical activity home exercise program in collaboration with Susan’s physical therapist.
Sample Intervention 1
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Susan identified toilet transfers, dressing, and bathing as occupations that were most important to her and
reported that fatigue limited her ability to participate in many activities. Therefore, Ana conducted daily morning
self-care sessions with Susan, with a focus on promoting Susan’s performance and satisfaction with these tasks
while also teaching fatigue management strategies from Packer et al.’s (1995) Managing Fatigue program. This
program includes 14 fatigue management strategies, of which Ana used the following to help Susan achieve her
goals:
* Change the position of body to do an activity. Ana taught Susan to sit while dressing and to use a tub transfer
bench to conserve energy.
* Simplify activities so they require less energy. Ana taught Susan to set her clothes out the night before so that
morning dressing would require less energy.
* Use adaptive equipment, gadgets, or energy-saving devices. Ana instructed Susan in the use of a sock aid,
reacher, raised toilet seat, and tub transfer bench to conserve energy.
* Rest before becoming fatigued. With MS fatigue, it is more effective to rest before an activity to “bank” energy
than to become overly fatigued and then try to recover. Therefore, Ana ordered an early breakfast tray everyday
so that Susan could eat her breakfast, rest, and have enough energy for her morning self-care routine therapy
session.
Sample Intervention 2
To address Susan’s memory changes, Ana trained Susan in the use of the Story Memory Technique (SMT;
Chiaravalloti, DeLuca, Moore, &Ricker, 2005). SMT involves the use of visualization (i.e., imagery) and context
(e.g., a story) to enhance memory in everyday life. For example, Ana taught Susan to create a story about five
items that she wanted to ask her family to bring to her in the rehabilitation unit.
Sample Intervention 3
To address Susan’s goal of returning to her yoga class, Ana asked Susan to describe the various poses
typically performed during the class, which Ana then analyzed and modified given Susan’s current level of
function. Susan then practiced each pose, and they adjusted each as needed. Together, Ana and Susan
created a home program of progressive modified poses for Susan to practice at home. In addition, Ana provided
recommendations in the use of fatigue management techniques that could enhance Susan’s ability to fully
participate again in her yoga class.
Sample Intervention 4
During the assessment process, Susan indicated that she had difficulty with the emotional aspects of living with
MS. She therefore participated in “Mood Masters,” a group on the rehabilitation unit that is led by an
occupational therapist. This group focuses on helping patients with emotional regulation through group
discussion, goal setting, and short practice assignments. Desired outcomes of the group include improved
mood, reduced levels of depression, reduced stress, and greater self-efficacy for managing emotions. During
one of the group sessions, Susan disclosed to the other group members that she sometimes feels depressed
and mourns the life that she had before her MS diagnosis. She received support from the other group members
and suggestions about how to manage her emotions, such as talking with other people with MS or writing a
gratitude journal.
Conclusion
Through the use of evidence-based, occupation-focused, and client-centered occupational therapy
interventions, Susan met her goals by the end of her 8-day inpatient rehabilitation stay. Her reported levels of
performance and satisfaction on the COPM improved several points for each of the occupations that she
identified as most important. Her FIM scores for the self-care items and bathroom transfers improved between 1
and 4 points each (see Table 1). Susan also achieved her overall goal of being able to be home alone while her
husband worked and her daughter was at school.
Ana’s discharge recommendations included outpatient occupational therapy to continue to maximize Susan’s
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participation in valued occupations. She also referred Susan to a 6-wk, group-based Managing Fatigue program
(Packer et al., 1995) offered by the local chapter of the local MS organization. s
Sidebar
Preissner, K., Arbesman, M., &Lieberman, D. (2016). Evidence Connection-Occupational therapy interventions
for adults with multiple sclerosis. American Journal of Occupational Therapy, 70, 7003395010.
http://dx.doi.org/10.5014/ ajot.2016.703001
References
References
Arbesman, M., Lieberman, D., &Metzler, C. A. (2014). Using evidence to promote the distinct value of
occupational therapy. American Journal of Occupational Therapy, 68, 381-385.
http://dx.doi.org/10.5014/ajot.2014.684002
Berwick,D.M.,Nolan,T.W.,&Whittington,J.(2008).The Triple Aim: Care, health, and cost. Health Affairs, 27, 759769. http://dx.doi.org/10.1377/hlthaff.27.3.759
Chiaravalloti, N. D., DeLuca, J., Moore, N. B., &Ricker, J. H. (2005). Treating learning impairments improves
memory performance in multiple sclerosis: A randomized clinical trial. Multiple Sclerosis, 11, 58-68. http://dx.doi.
org/10.1191/1352458505ms1118oa
Fisher, A. G., &Jones, K. B. (2012). Assessment of Motor and Process Skills (7th ed., Vol. 1). Fort Collins, CO:
Three Star Press.
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., &Steinberg, A. D. (1989). The Fatigue Severity Scale: Application
to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121-1123.
http:// dx.doi.org/10.1001/archneur.1989.00520460115022
Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., &Pollock, N. (2014). Canadian Occupational
Performance Measure (5th ed.). Ottawa, Ontario: CAOT Publications.
Packer, T., Brink, N., &Sauriol, A. (1995). Managing Fatigue: A six-week course for energy conservation.
Tucson, AZ: Therapy Skill Builders.
Preissner, K. (2014). Occupational therapy practice guidelines for adults with neurodegenerative
diseases.Bethesda,MD: AOTA Press.
Uniform Data System for Medical Rehabilitation. (1997). Guide for the Uniform Data Set for Medical
Rehabilitation (including the FIMTM instrument), Version 5.1. Buffalo, NY: Author.
Yu, C.-H., &Mathiowetz, V. (2014a). Systematic review of occupational therapy-related interventions for people
with multiple sclerosis: Part 1. Activity and participation. American Journal of Occupational Therapy, 68, 27-32.
http:// dx.doi.org/10.5014/ajot.2014.008672
Yu, C.-H., &Mathiowetz, V. (2014b). Systematic review of occupational therapy-related interventions for people
with multiple sclerosis: Part 2. Impairment. American Journal of Occupational Therapy, 68, 33-38.
http://dx.doi.org/ 10.5014/ajot.2014.008680
AuthorAffiliation
Katharine Preissner, EdD, OTR/L, is Clinical Associate Professor and Academic Fieldwork Coordinator,
Department of Occupational Therapy, University of Illinois at Chicago; kpreiss@uic.edu
Marian Arbesman, PhD, OTR/L, is Methodology Consultant, Evidence-Based Practice Project, American
Occupational Therapy Association, Bethesda, MD; President, ArbesIdeas, Williamsville, NY; and Adjunct
Assistant Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY.
Deborah Lieberman, MSHA, OTR/L, FAOTA, is Director, Evidence-Based Practice Project, and Staff Liaison to
the Commission on Practice, American Occupational Therapy Association, Bethesda, MD.
Publication title: The American Journal of Occupational Therapy
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Volume: 70
Issue: 3
Pages: 1-4
Number of pages: 4
Publication year: 2016
Publication date: May/Jun 2016
Year: 2016
Section: EVIDENCE CONNECTION
Publisher: American Occupational Therapy Association, Inc.
Place of publication: Bethesda
Country of publication: United States
Publication subject: Medical Sciences, Occupational Health And Safety
ISSN: 02729490
Source type: Scholarly Journals
Language of publication: English
Document type: General Information
DOI: http://dx.doi.org/10.5014/ajot.2016.703001
ProQuest document ID: 1782244383
Document URL: http://search.proquest.com/docview/1782244383?accountid=35796
Copyright: Copyright American Occupational Therapy Association, Inc. May/Jun 2016
Last updated: 2016-04-20
Database: Nursing & Allied Health Database,Health Management Database,Health & Medical Collection
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