Key references on therapy interventions in MS
This reading list is not exhaustive. It focuses on evidence for MS specific therapy interventions. Some topic areas will have a wider range of references available. If you wish to explore a particular topic in greater detail or cannot find what you are looking for, please contact the MS Trust Information Service
The list is continually in development, if you have any suggestions for additions please email therapists@mstrust.org.uk
Topic Areas
- › Multidisciplinary team working
- › Quality of life
- › Rehabilitation
- › Activities of daily living
- › Employment and vocational rehabilitation
- › Equipment and assistive technology
- › Wheelchairs and seating
- › Balance
- › Cognition
- › Mobility
- › Functional Electrical Stimulation
- › Exercise
- › Fatigue
- › Communication
- › Swallowing/dysphagia
- › Ataxia
- › Occupational therapy
- › Physiotherapy
- › Transcutaneous electrical nerve stimulation (TENS)
- › Pain
- › Text books (text books are not available through the MS Trust Information Service)
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Makepeace R W, Barnes M P, Semlyen J K, Stevenson J. The establishment of a community multiple sclerosis team. Int J Rehabil Res 2001; 24(2):137-41
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First author: Makepeace R W
Title of the article: The establishment of a community multiple sclerosis team
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Multidisciplinary team working
Pozzilli C, Brunetti M, Amicosante AM, Gasperini C, Ristori G, Palmisano L, Battaglia M. Home based management in multiple sclerosis: results of a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002;73(3):250-5.
Compared effectiveness and costs of multidisciplinary care at home with hospital care, with one year’s follow up. 201 people with MS were randomised to home or hospital care. At follow-up, costs to the Italian NHS were analysed. There were no significant differences in functional ability between home or hospital based groups. There were some benefits to home based care and it was slightly cheaper than hospital care, mainly as a result of fewer hospital admissions.
Makepeace R W, Barnes M P, Semlyen J K, Stevenson J. The establishment of a community multiple sclerosis team. Int J Rehabil Res 2001; 24(2):137-41
Describes the establishment of an interdisciplinary community MS team in Newcastle, issues involved, type of patients referred, and established a cost saving of around £6000 over a six-month period to the local health service, implying a more substantial cost saving for the whole MS population.
Sitzia J, Haddrell V, Rice-Oxley M. Evaluation of a nurse-led multidisciplinary neurological rehabilitation programme using the Nottingham Health Profile. Clinical Rehabilitation 1998; 12(5): 389-94.
33 people with MS received inpatient, adapted, multidisciplinary rehabilitation. Scores on a range of assessments showed a significant improvement on physical mobility and other symptoms, particularly in relation to quality of life.
Roush S E. Examining the relationship between physical and occupational therapists and their patients with multiple sclerosis. Int J Rehabil Health 1996 Apr; 2(2):125-37.
A study of 78 therapists and their patients looked at how far therapists’ attitudes towards people with disabilities affected their patients’ satisfaction. Therapists with a positive attitude were more likely to have satisfied patients.
Quality of life
Miller A, Dishon S.Health related quality of life (HRQOL) in multiple sclerosis: the impact of disability, gender and employment status. Qual Life Res 2006;15(2):259-71.
HRQOL was assessed in 215 outpatients using MSQOL-54 and Fatigue Severity Scale (FSS) and 172 controls using EDSS. Highlights the complex relationship between quality of life and disability and examines the factors that affect perceptions
Holland NJ, Northrop DE.Young adults with multiple sclerosis: management in the home. Home Health Care Management and Practice 2006:18(3):186-95.
Examines the profile of informal care givers of young adults with MS and the support required by family members including both children and elderly parents of adult children with MS. Highlights goals of proactive homecare management of MS related issues such as health related quality of life, optimal health and cost containment
Fong T, Finlayson M, Peacock N. The social experience of aging with a chronic illness: perspectives of older adults with multiple sclerosis. Disabil Rehabil. 2006 Jun 15;28(11):695-705.
27 interviews with people with MS aged 55-81 revealed that the social experience is influenced by social needs, experience of MS, values and expectations, characteristics of the social support system, and accessibility of the social environment.
Shevil E, Finlayson M. Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life. Disabil Rehabil 2006;28(12):779-788.
Qualitative study of four people with MS interviewed over time. Highlighted issues of social participation and other life roles which cognitive problems impinge on, leading to reduced quality of life.
Sutherland G, Andersen MB, Morris T. Relaxation and health-related quality of life in multiple sclerosis: the example of autogenic training. J Behav Med 2005; 28(3): 249-56.
Pilot project: 11 people assigned to autogenic training for 10 weekly sessions, and 11 to the control group with no intervention. Post-test scores showed the intervention group reported more energy and vigour, and more able to deal than the control group with physical and emotional problems.
Rousseaux M, Perennou D. Comfort care in severely disabled multiple sclerosis patients. J Neurol Sci 2004; 222(1-2):39-48.
Authors argue that discomfort is underestimated in disability assessment and quality of life. Requests a systematic assessment of discomfort in: dressing, washing, maintaining posture in a wheelchair and bed, food intake, chewing and swallowing, bowel control, bladder and bowel evacuation, and sexual function. Enhancing and improving comfort in these areas are discussed.
Hemmett L, Holmes J, Barnes M, Russell N. What drives quality of life in multiple sclerosis? QJM 2004; 97(10): 671-6.
Survey of over 3000 people with MS used the SF-36 to identify major health-related quality of life issues in people with MS. Found fatigue is the major symptom that disrupts occupational and social functions, but pain and mobility issues are significant for over 75% of the people involved.
Rumrill PD, Roessler RT, Fitzgerald SM. Vocational rehabilitation-related predictors of quality of life among people with multiple sclerosis. J Vocat Rehabil 2004; 20(3): 155-63.
Evaluated ill-health, work and psychosocial variables as predictors of quality of life in MS. Positive quality of life was related to level of education, whether in work or not, and negatively related to number and persistence of symptoms, and perceived stress levels.
Reynolds F, Prior S. "Sticking jewels in your life": Exploring women's strategies for negotiating an acceptable quality of life with multiple sclerosis. Qualitative Health Research 2003; 13(9), 1225-51
Qualitative research with women with MS discusses meaningful roles and occupations and identity when living with MS.
Devitt R, Chau B, Jutai JW. The effect of wheelchair use on the quality of life of persons with multiple sclerosis. Occup Ther Health Care 2003; 17(3-4): 63-79.
Pilot study of 16 people with MS found that wheelchair use has a positive impact on their quality of life. Discusses the outcome measure ‘psychosocial impact of assistive devices scale’ and how it can be used to support other clinical assessment.
Klugman TM, Ross E. Perceptions of the impact of speech, language, swallowing and hearing difficulties on quality of life of a group of South African persons with multiple sclerosis. Folia Phoniatrica et Logopaedica 2002; 54(4): 201-21.
Over half of 30 people asked stated that difficulties with speech, language or swallowing impacted negatively on their quality of life. Findings are discussed with implications for practice.
Patti F, Ciancio MR, Reggio E, Lopes R, Palermo F, Cacopardo M, Reggio A. The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J Neurol 2002;249(8):1027-33.
Study group of 58 people with MS received comprehensive outpatient rehabilitation 6 days a week for 6 weeks, compared with 53 people who were given exercises to do at home. The study group improved on all quality of life measures and in fatigue and depression, compared with the home exercise group.
Meyers A, Gage H, Hendricks A. Health-related quality of life in neurology. Arch Neurol 2000; 57(8): 1224-7.
This article attempts to explain the difference between health related quality of life as measured through various standardised measures such as the SF36, and quality of life as assessed and interpreted by the individual. It highlights the complexities of the concept of quality of life, but emphasises its importance in working with people with neurological conditions.
Lundmark K, Branholm IB. Relationship between occupation and life satisfaction in people with multiple sclerosis. Disabil Rehabil 1996; 18(9): 449-53.
A small survey of 30 people with MS found that 14 were satisfied with life and 16 dissatisfied. Satisfied people had less fatigue and were more independent, happier with their leisure and housekeeping ability. All of these domains are significant for occupational therapists.
Rehabilitation
Grasso MG, Troisi E, Rizzi F, Morelli D, Paolucci S. Prognostic factors in multidisciplinary rehabilitation treatment in multiple sclerosis: an outcome study. Mult Scler 2005; 11(6): 719-24.
230 people admitted to an inpatient rehab ward were assessed using a range of outcome measures. Poor prognostic indicators included severe sphinteric disturbance and severe cognitive impairment. Results of the study show intensive rehab benefits most people with MS and early treatment may aid functional recovery.
Rasova K, Krasensky J, Hardova E, Obenberger J, Seidel Z, Dolezal O et al. Is it possible to actively and purposely make use of plasticity and adaptability in the neurorehabilitation treatment of multiple sclerosis patients? A pilot project. Clin Rehabil 2005; 19(2): 170-81.
Compared people with MS receiving rehatbilitation with a control group, on a range of assessment measures and fMRI scans. Clinical and symptomatic improvements were observed in the treatment group but these were not associated with any clear changes in fMRI observations.
Craig J, Young CA, Ennis M, Baker G, Boggild M. A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment. J Neurol Neurosug Psychiatry 2003; 74(9): 1225-30.
Compared people receiving IV steroids and multidisciplinary rehabilitation with those receiving IV steroids and normal care. Found that combining multidisciplinary rehabilitation with steroids improved outcomes on a range of assessment measures.
Slade A, Tennant A, Chambelain MA. A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. J Rehabil Med 2002; 34(6): 260-6.
Compared intensive inpatient therapy with normal therapy on a mixed group. People who received intensive therapy showed an average 14-day reduction in length of stay compared with the normal group.
Turner-Stokes L, Williams H, Abraham R. Clinical standards for specialist community rehabilitation services in the UK. Clin Rehabil 2001; 15(6): 611-23.
Sets out proposed clinical standards for community rehab services.
Turner-Stokes L, Williams H, Abraham R, Duckett S. Clinical standards for inpatient specialist rehabilitation services in the UK. Clin Rehabil 2000; 24(5): 468-80.
Sets out proposed clinical standards for inpatient specialist rehabilitation services.
Freeman JA, Langdon DW, Hobart JC, Thompson AJ. Inpatient rehabilitation in multiple sclerosis: do the benefits carry over into the community? Neurology 1999; 52(1): 50-6.
Followed 50 patients after discharge into the community. Benefits from rehabilitation were partly maintained but declined over time, reinforcing the need for continuity of care between inpatient and community settings.
Mathiowetz V, Matuska KM. Effectiveness of inpatient rehabilitation on self-care abilities of individuals with multiple sclerosis. Neurorehabilitation 1998; 11(2): 141-51
1 week of rehabilitation improved people’s ability to self-care; equipment use continued in the majority of patients, and all expressed satisfaction with occupational therapy services.
Solari A, Fillippini G, Gasco P, Colla L, Salmaggi A, LaMantia L, et al. Physical rehabilitation has a positive effect on disability in multiple sclerosis patients. Neurology 1999; 52(1): 57-62.
25 people with MS received inpatient rehabilitation compared with exercises at home. Over time, the inpatient group showed more improvement in disability on a range of assessment measures and on health-related quality of life.
DiFabio RP, Soderberg J, Choi T, Hansen CR, Schapiro RT. Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. Arch Phys Med Rehabil 1998;79(2):141-6.
20 people with progressive MS received treatment compared with 20 controls, of 1 day per week rehabilitation over 1 year. Receiving treatment was found to be a predictor of reduced symptom frequency at 1 year follow-up, and to improve fatigue. Functional loss was less in the treatment group compared with the control group.
Activities of daily living
Navipour H, Madani H, Mohebbi MR et al. Improved fatigue in individuals with multiple sclerosis after participating in a short term self care programme. NeuroRehabilitation 2006;21(1):37-41.
34 people with MS who were able to walk without assistance and independent in ADL performed self managed graded exercise programme for 6 weeks Recommends programme as alternative to rehabilitation for non-disabled patients.
Mansson E, Lexell J. Performance of activities of daily living in multiple sclerosis. Disabil Rehabil 2004; 26(10): 576-85.
Study assessed the abilities of 44 people with MS in relation to ADL. Suggests level of disability affects someone’s ability to deal with activities of daily living, and makes recommendations about types of assessment.
Feys P, Romberg A, Ruutiainen J, Ketelaer P. Interference of upper limb tremor on daily life activities in people with multiple sclerosis. Occup Ther Health Care 2003; 17(3-4): 81-95.
Reviews the problems encountered with ADL by people with upper limb tremor and aids and strategies to counter this particular problem.
O’Hara L, Cadbury H, De SL, Ide L. Evaluation of the effectiveness of professionally guided self-care for people with multiple sclerosis living in the community: a randomised controlled trial. Clin Rehabil 2002; 61(2): 119-28.
169 people with MS took part in the trial, comprising a discussion of self-care issues and an information booklet about self-care. At follow-up, intervention group members had increased levels of independence, compared with the control group who showed lowered levels of independence.
Employment and vocational rehabilitation
Ville I, Winance M. To work or not to work? The occupational trajectories of wheelchair users. Disabil Rehabil 2006; 28(7): 423-6.
Found working and not working less dependent on wheelchair status than on person with MS’s adjustment and attitude to using a wheelchair. Interventions should focus on this adjustment as much as on return to work.
Johnson KL, Fraser RT. Mitigating the impact of multiple sclerosis on employment. Phys Med Rehab Clin America 2005;16:571-582.
Identifies societal/social policy barriers as well as MS specific barriers faced in employment
Pompeii LA, Moon SD, McCrory DC. Measures of physical and cognitive function and work status among individuals with multiple sclerosis: a review of the literature. J Occup Rehabil 2005; 15(1): 69-84.
Review of literature shows that ability to work is dependent on a range of factors, not just level of physical and cognitive ability, which are in themselves poor indicators of work status.
Rumrill R, Roessler R, Vierstra C, Hennessey M, Staples L. Workplace barriers and job satisfaction among employed people with multiple sclerosis: an empirical rationale for early intervention. J Vocat Rehabil 2004; 20(3): 177-83.
Difficulties with getting to work and barriers to some essential functions prevent more people from working than other, symptom-based, problems. Early intervention to anticipate some of these issues is suggested.
Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The costs and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004; 85(2): 201-9.
Qualitative study of benefits and drawbacks people with MS experience in relation to work. All involved valued work but were aware of the costs of being employed. Suggests that decisions to work or not work are complicated and that there are critical periods of intervention to stabilise the cost-benefit balance.
Dyck I, Jongbloed L. (2000). Women with multiple sclerosis and employment issues: A focus on social and institutional environments. Canadian Journal of Occupational Therapy, 67(5), 337-346.
This is written by OTs and is a mixed methods study of women and work discussion of how women’s employment may be impacted by non-MS issues e.g. support with child-care and domestic activities. Issues of identity and costs and benefits of employment are also discussed.
Fitzgerald MH, Paterson KA. The hidden disability dilemma for the preservation of self. Journal of Occupational Science 1995;2(1):31-21
Highlights the dilemmas that may be faced in disclosing a diagnosis of MS in the work environment.
Equipment and assistive technology
Verza R, Carvalho ML, Battaglia MA, Uccelli MM. An interdisciplinary approach to evaluating the need for assistive technology reduces equipment abandonment. Mult Scler 2006;12(1):88-93.
Equipment prescription and use was analysed over a period of time depending on whether it had been recommended by a doctor alone or by a multidisciplinary team. The team approach improved patient retention of equipment although around 10% of people continued to discard equipment within one year.
Blake DJ, Bodine C. An overview of assistive technology for people with multiple sclerosis. J Rehabil Research Development 2002;39(2):299-312.
Reviews equipment currently available for people with MS.
Wheelchairs and seating
Savage,FS. Maximizing comfort and function:positioning intervention. International Journal of MS Care 2005;7(3):93-100.
Review of positioning for people with MS in wheelchairs, describing posture issues, seating angles, orientation in space, wheelchair frame features, and power-wheelchair options. Good overview of points to consider when assessing someone with MS for a wheelchair.
Eberhardt K, Finlayson M. Wheeled mobility for people with MS: environmental and lifestyle considerations. Int J MS Care 2005; 7(3):101-106.
OT consideration of housing adaptations and financial support required to make living with a wheelchair viable for people with MS, eg ramps, doorways, turning circles and so on. Good overview of an otherwise neglected area of the literature for people with MS.
Wheelchair outcome tool briefs. Int J MS Care 2005;7(3):111-114
Brief description of four outcome measures that may be used in assessing and fitting someone with MS with a wheelchair.
Boss TM, Finlayson M. Responses to the acquisition and use of power mobility by individuals who have multiple sclerosis and their families. Am J Occup Ther. 2006 May-Jun;60(3):348-58.
Small qualitative study of 7 people with MS and 4 of their family members about adjusting to using power mobility. Themes emerged around recognising the need for power mobility, the process of deciding and obtaining the power mobility. Use of power mobility produced uneven outcomes, positive, negative and neutral. The study revealed an overall lack of resources and some problems within family environments, which occupational therapists may work to overcome.
Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil 2005; 86(12): 2316-23.
Evaluated wheelchair skills training in 25 wheelchair users. Found it improved wheelchair use and confidence of users compared with control group.
Crawford SA, Stinson MD, Walsh DM, Porter-Armstrong AP. Impact of sitting time on seat-interface pressure and on pressure mapping with multiple sclerosis patients. Arch Phys Med Rehabil 2005;86(6):1221-5.
Compared wheelchair and non-wheelchair users to assess the length of time needed before recording changes in pressure. Identified changes in pressure continue for up to 8 minutes with wheelchair users.
Marks LJ. Specialised wheelchair seating: national clinical guidelines. London: British Society of Rehabilitation Medicine; 2004.
Dewey A, Rice-Oxley M, Dean T. Qualitative study comparing the experience of tilt-in-space wheelchair use and conventional wheelchair use by clients severely disabled with multiple sclerosis. Br J Occup Ther 2003;67(2):65-74.
People with MS who had tilt-in-space wheelchairs reported greater comfort, improved postural support, enhanced seating stability, pressure relief, and time out of bed, compared with those in conventional wheelchairs. Concludes that benefits outweigh drawbacks of tilt-in-space wheelchairs.
Balance
Hammer A, Nilsagard Y, Forsberg A, Pepa H, Skargren E, Oberg B. Evaluation of therapeutic riding (Sweden)/hippotherapy(United States). A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiother Ther Pract 2002;21(1):51-77.
This small study suggests that therapeutic riding can positively benefit balance and some elements of quality of life.
Karst GM, Venema DM, Roehrs TG, Tyler AE. Center of pressure measures during standing tasks in minimally impaired persons with multiple sclerosis. Journal of Neurologic Physical Therapy 2005;29(4):170-80.
Study demonstrates that balance problems are evident early on in people with MS, however, they are able to compensate for this. Center of pressure measures are identified as a useful assessment of changes in postural control in people with MS.
Frohman EM, Kramer PD, Dewey RB, Kramer L, Frohman TC.Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler 2003;9(3):250-5.
Discusses frequency, causes and treatment of people with MS who experience vertigo. Review of patients seen over 4 years discusses success of particle repositioning manoeuvres, particularly the Epley and Semont manoeuvres.
Cattaneo D, Marazzini F, Crippa A, Cardini R. Do static or dynamic AFOs improve balance? Clin Rehabil 2002;16(8):894-9.
14 people with MS with balance disorders were fitted with dynamic and static ankle foot orthoses. Static AFOs were found to worsen dynamic balance problems, but dynamic AFOs improved static balance and had a less negative impact on dynamic balance.
Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of awareness through movement improves balance and balance confidence in people with multiple sclerosis: a randomized controlled study. Neurology Report 2001;25(2):39-49.
Compared a structured group of balance exercises, conducted over 8 classes, with no balance training. The exercise group improved on several measures, particularly in relation to centre of pressure measures.
Cognition
Shevil E, Finlayson M. Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life. Disabil Rehabil. 2006 Jun 30;28(12):779-88.
Qualitative, descriptive study of four people wtih MS to explore the impact of cognitive changes on their lives. Participants described the cognitive changes and how these affect their ability to participate and engage in desired activities and maintain their primary roles, and how these affect their quality of life. The study highlights the importance of addressing cognitive issues in rehabilitation.
Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Systematic Review. 2006;(1):CD004431.
Comprehensive review of the literature suggests some benefit from cognitive rehabilitation, and for depression, cognitive behavioural therapy. Suggests cognition impairment has been shown to affect functional impairment and therefore has implications for ataxia, balance, exercise and mobility.
Birnboim S, Miller A. Cognitive strategies application of multiple sclerosis patients. Multiple Sclerosis 2004;10(1):67-73.
Comparison study of 76 people with MS with healthy subjects on ability to adapt and develop working strategies when faced with new tasks. Around three-quarters of people with MS were found to have impairments that did not correlate with depression, fatigue, disability level or ability to perform activities of daily living. May have implications for people with MS’s ability to cope with routine daily tasks.
Foley G, McDermott M.Cognition and multiple sclerosis: a literature review. Irish J Occup Ther 2001;31(1-2):47-52.
Discusses studies to date and implications for therapists.
Mobility
Wiles CM, Newcombe RG, Fuller KJ, Jones A, Price M. Use of videotape to assess mobility in a controlled randomized crossover trail of physiotherapy in chronic multiple sclerosis. Clin Rehabil 2003; 17(3): 256-63.
A trial to see whether videotapes of mobility can be assessed as successfully as an interactive session with a patient. Video evidence suggested physiotherapy had less clear benefit than ‘live’ assessments. More objective measures of habitual mobility were also required.
Wiles CM, Newcombe R, Fuller KJ, Shaw S, Furnival-Doran J, Pickersgill TP, Morgan A.Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis.J Neurol Neurosurg Psychiatry 2001;70(2):2174-9.
Trial of home-based physiotherapy, hospital-based physiotherapy or no therapy, measured by a range of assessments including the Rivermead Mobility Index. Any physiotherapy was better than no therapy, and patients improved significantly on all measures. Hospital physiotherapy was cheaper than home therapy, and no difference in benefit was discerned by therapists or patients depending on where physiotherapy was received.
Lord SE, Wade DT, Halligan PW.A comparison of two physiotherapy approaches to improve walking in multiple sclerosis: a pilot randomized controlled study. Clin Rehabil 1998;12(6):477-86.
Compareda a facilitation (impairment-based) approach with a task-oriented (disability-focused) approach to physiotherapy for people with MS. Outcomes were measured on a range of assessments. Following treatment, patients in both groups showed significant overall improvement, but there was no clear difference between approaches.
Functional Electrical Stimulation
Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, Singleton C, Swain ID. Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking. Arch Phys Med Rehabil 1999; 80(12):1577-83.
Retrospective study of 151 patients over 4 months who had used an FES device and had an upper motor neuron lesion. 21 patients with MS experienced increase in walking speed and reduction in physiological exertion whilst moving when wearing the device, but, unlike stroke patients, there was no ‘carry-over’ to normal walking when not wearing the device.
Burridge J, Taylor P, Hagan S, Swain I. Experience of clinical use of the Odstock dropped foot stimulator. Artif Organs 1997;21(3): 254-60.
Initial data on 56 patients, including 5 with MS, showing that the FES device increased walking speed, decreased effort of walking and improved functional mobility.
Exercise
Taylor NF, Dodd KJ, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil 2006;28(18):1119-26.
A small qualitative study of 9 people to determine whether participation in a progressive resistance exercise programme would increase muscle force and endurance and functional activity. Completed over a 14 week period (4 weeks of familiarization followed by 10 weeks of twice-weekly gym attendance), this study found a progressive programme of resistance exercise brought significant improvements in arm strength, leg endurance and fast walking speed, without adverse events.
Karpatkin HI. Multiple sclerosis and exercise: a review of the evidence. Int J MS Care 2005;7(2):36-41.
Reviews trials into exercise as an intervention for people with MS, including strength training, aerobic exercise and respiratory training. Suggests that more research could be focused on the specific types of exercise appropriate for people who have MS.
Heesen C, Romberg A, Gold S et al. Physical exercise in multiple sclerosis: supportive care of a putative disease modifying treatment. Expert Rev. Neurotherapeutics 2006; 6(3):347-55
Reviews clinical trials that examine use of exercise in people with MS. Concludes that exercise training studies demonstrate a consistent beneficial physical effect in people with modest disability and positive effects on psychological well being. Suggests exercise training should be considered for everyone with MS with use of feedback strategies to enhance adherence.
Smith RM, Adeney-Steel M, Fulcher G et al. Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis. Arch Phys Med Rehabil 2006;87(5):723-7.
Pilot study of 34 people with MS referred to physiotherapy and exercise program. Individually prescribed exercise sessions include strengthening, stretches and fitness exercises. Whilst 40% of people experienced temporary increase in sensory symptoms and 44% increase in intensity of sensory symptoms, study concluded that exericse is unlikely to produce negative changes in fatigue and function.
Van den Berg M, Dawes H, Wade DT et al. Treadmill training for individuals with multiple sclerosis: a pilot randomised trial. J Neurol Neurosurg Psychiatry 2006; 77(4):531-3.
Pilot study of 19 people wtih MS, showed that aerobic treadmill training is feasible and well-tolerated. Walking speed and endurance increased following training with no increase in reported fatigue. Detraining occurred in the period following, these findings suggest the need for a larger randomised trial.
Stuifbergen AK, Blozis SA, Harrison TC, Becker HA. Exercise, functional limitations and quality of life: a longitudinal study of persons with multiple sclerosis. Arch Phys Med Rehabil 2006; 87(7): 935-43.
A sample of 611 people with MS studied over 5 years to examine the interrelations between functional limitations, exercise and quality of life. Results suggest that people who exercise regularly experience fewer functional limitations over time, with correlating positive effects for quality of life.
Gutierrez GM, Chow JW, Tillman MD, McCoy SC, Catellano V, White LJ. Resistance training improves gait kinematics in persons with multiple sclerosis. Arch Phys Med Rehabil 2005;86(9): 1824-9.
Evaluation study of an 8 week lower-body resistance-training programme on people with MS’s walking. At end point, there were significant improvements in step length, stride length, food angle, and percentage of stride time in the swing phase. Fatigue and self-reported disability also improved.
Kileff J, Ashburn A.A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis. Clin Rehabil 2005;19(2):165-9.
Intervention was bi-weekly 30 minute sessions of cycling on a static bicycle, in 6 people with MS, over 12 weeks. Results showed significant improvement on the Guys Neurological Disability Scale and the 6-minute walk.
Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M et al. Randomised controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004;62(11):2058-64.
69 people with MS were randomised into 3 groups: yoga group, exercise using a static bicycle, or no treatment group, over a 6-month period. Both active interventions produced improvements in fatigue compared with the no treatment group. No effect was seen on other outcome measures of mood and cognitive ability.
Petajan JH, White AT. Recommendations for physical activity in patients with multiple sclerosis. Sports Medicine 1999; 27(3): 179-81.
Known leading expert discusses assessment of people with MS, types of exercise, and incorporating exercise into activities of daily living.
Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol 1996;39(4): 432-41.
54 people with MS randomised into aerobic exercise or no exercise groups. The treatment group showed improvements in fatigue, depression and anger, compared with the non-treatment group.
Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database Sytem Rev 2005. 25(1): CD003980.
Comprehensive literature review. Exercise therapy improves muscle power function, exercise tolerance functions and mobility-related activities, with some evidence for enhancing mood. Does not find more evidence in favour of one type of exercise therapy over another.
Romberg A, Virtanen A, Ruutiainen J, Aunola S, Karppi SL, Vaara M et al. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomised study. Neurology 2004; 63(11): 2034-8.
A 6 month exercise programme group was compared with a group receiving no treatment. Change in the treatment group was significant in tests of walking and increased upper extremity endurance. No other noteworthy changes were observed.
Surakka A, Romberg A, Ruutiainen J, Aunola S, VirtanenA, Karppi SL, Maentaka K. Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis:a randomised, controlled trial. Clin Rehabil 2004; 18(7): 737-46.
Study investigated effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in people with MS. The intervention group received 6 months’ exercise programme compared with no treatment. Findings were that motor fatigue lessened in women but not men in the treatment group.
Fatigue
Mathiowetz VG, Finlayson ML, Matuska KM, Chen HY, Luo P. Randomised controlled trial of an energy conservation course for persons with multiple sclerosis. Mult Scler 2005;11(5): 592-601.
169 people were randomised to either immediate intervention or control group of delayed therapy. Results showed significant effects on physical and social measures on the Fatigue Impact Scale, reducing fatigue impact and increasing self-efficacy and some measures of quality of life.
Lamb AL, Finlayson M, Mathiowetz V, Chen HY. The outcomes of using self-study modules in energy conservation education for people with multiple sclerosis. Clin Rehabil 2005;19(5):475-81.
Compared self-study modules on fatigue management with attending an energy conservation class. No significant differences were found between the groups, using a range of outcome measures.
Vanage SM, Gilbertson KK, Mathiowetz V. Effects of an energy conservation course on fatigue impact for persons with progressive multiple sclerosis. Am J Occup Ther 2003;57(3):315-23.
37 people with progressive MS took part in an energy conservation course over 8 weeks, compared with 8 weeks of traditional treatment, as a control. Results from the energy conservation course reduced fatigue impact on a range of outcome measures, and the improvement continued over a period following completion of the course.
Mathiowetz V, Matuska KM, Murphy ME. Efficacy of an energy conservation course for persons with multiple sclerosis. Arch Phys Med Rehabil 2001;82(4):449-56.
54 people with MS received six 2 hour sessions of energy conservation course taught by occupational therapists. Participants reported improvements in fatigue management, increased self-efficacy and improved quality of life, using a range of outcome measures.
Communication
Arnott W, Jordan F, Murdoch B, Lethlean J. Narrative discourse in multiple sclerosis: an investigation of conceptual structure. Aphasiology 1997;11(10): 969-991.
Study compared people with MS with controls and found differences in narrative discourse relating to the production of less essential information and differences in the nature of information conveyed by people with MS.
Foley FW, Dince WM, Bedell JR, et al. Psychoremediation of communication skills for cognitively impaired persons with multiple sclerosis. J Neurol Rehabil. 1994;8:165-176.
Describes a cognitive-behavioural approach to treating communication skills in people with MS who are cognitively impaired.
Hartelius L, Theodoros D, Cahill L, Lillvik M. Comparability of perceptual analysis of speech characteristics in Australian and Swedish speakers with multiple sclerosis. Fol Phoniat et Logopaedica 2003;55(4):177-88.
Compared Australian and Swedish people with MS to determine whether judgments of dysarthria differ depending on the language spoken. Study found that perceptual assessments of speech difficulty can be made irrespective of the speaker’s language.
Hartelius L, Lillvik M. Lip and tongue function differently affected in individuals with multiple sclerosis. Folia Phoniatrica et Logopaedica 2003;55(1):1-9.
77 people, with and without dysarthria, and 15 control subjects, were compared in tests of lip and tongue function. Found that tongue function can be detected clinically using a dysarthria test and should be an early target in therapeutic interventions.
Hartelius L, Wising C, Nord L. Speech modification in dysarthria associated with multiple sclerosis: an intervention based on vocal efficiency, contrastive stress and verbal repair strategies. Journal of Medical Speech-Language Pathology 2997;5(2):113-39.
Tested a therapeutic intervention based on increased vocal efficiency with contrastive stress and verbal repair strategies on 7 people with MS and dysarthria. 5 of the 7 showed improved outcomes and those with negative outcomes were able to improve their ability to indicate stress and make improved verbal repairs compared with before the therapeutic intervention.
Hartelius L, Buder E, Strand E. Long-term phonatory instability in individuals with multiple sclerosis. J Speech Lang and Hear Res 1997;40:1056-72.
Describes and quantifies phonatory instability of individuals with MS compared with controls.
Hartelius L, Runmarker B, Anderson O. Prevalence and characteristics of dysarthria in a multiple sclerosis incidence cohort: relation to neurological data. Folia Phoniat et Logopedica 2000;52:160-177.
This article summarises findings related to 11 participants examined by a speech pathologist and a neurologist. It discusses the relationship between dysarthria and neurological impairment.
Sapir, S., Pawlas, A., Ramig, L., Seeley, E., Fox, C., & Corboy, J. (2001). Effects of intensive phonatory-respiratory treatment (LSVT) on voice in two individuals with Multiple Sclerosis. J Med Speech-Lang Path, 9(2), 141-151.
Case report of two individuals taking part in a specific treatment programme to improve weak voices. Results showed a significant improvement in sound pressure level and perceptual rating of voice loudness.
Yorkston K, Klasner E, Swanson K. Characteristics of multiple sclerosis as a function of the severity of speech disorders. J Med Speech-Lang Pathol 2003;11(2):73-84.
Discusses the relationship between the level of speech problem and other variables such as physical/function, sensory and other symptoms. Moderate to severe speech disorders tend to co-exist with other symptoms.
Yorkston K, Klasner E, Swanson K. Communication in context:a qualitative study of the experiences of individuals with multiple sclerosis. Am J Speech-Lang Path 2001; 10: 126-137.
Qualitative study of seven people with MS and their everyday experiences of life and how MS impacts on this. The study discusses the need to develop relevant assessments and outcome measures.
Swallowing/dysphagia
Calcagno P, RuoppoloG, Grasso MG, DeVincentiis M, Paolucci S. Dysphagia in multiple sclerosis – prevalence and prognostic factors. Acta Neurol Scand 2002;105(1):40-3.
Analysed swallowing function in 143 people with progressive MS. 49 people had dysphagia; compensatory strategies restored function in 46 of these.
Ataxia
Thoumie P, Lamotte D, Cantalloube S, Faucher M, Amarenco G. Motor determinants of gait in 100 ambulatory patients with multiple sclerosis. Mult Scler 2005;11(4):485-91.
Compared 100 people with MS with 20 healthy controls and assessed that the average velocity and strength of the hamstring and quadriceps was lower in people with MS than the control group.
Gillen G. Improving mobility and community access in an adult with ataxia. Am J Occup Ther 2002;56(4):462-6.
Case study of OT intervention with one person with ataxia, including assistive technology, positioning and orthotics.
Armutlu K, Karabudak K, Nurlu G. Physiotherapy approaches in the treatment of ataxic multiple sclerosis: a pilot study. Neurorehabil Neural Repair 2001;15(3):203-11.
Investigated efficacy of neuromuscular rehabilitation in 13 people with MS & ataxia compared with Johnstone Pressure Splints in the same number. Some differences between the two approaches were observed but overall physiotherapy approaches are deemed effective rehabilitation.
Jones L, Lewis Y, Harrison J, Wiles CM. The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk. Clinical Rehabilitation 1996; 10(4): 277-82.
28 of 37 patients with ataxia received eight half-hour sessions of OT & physiotherapy over 8 consecutive working days, compared with 9 control subjects who received no intervention. Using a range of outcome measures, the treatment group showed significant improvement compared with the control group, providing support for intervention in these clients.
Albrecht H, Schwecht M, Pollmann W, Parag D, Erasmus LP, Konig N. Local ice application in therapy of kinetic limb ataxia. Clinical assessment of positive treatment effects in patients with multiple sclerosis Nervenzart 1998; 69(12): 1066-73.
Article is written in German.
Examined 21 people with MS at several points from one to 45 minutes after cooling the most affected forearm, using six tests. At each stage, skin temperature and nerve conduction velocity were recorded. All tests were videoed for later analysis, and standardized evaluation was performed by the investigators and an independent team. After local cooling, all patients showed positive benefits, especially a fall in intention tremor. This effect lasted 45minutes or longer. Suggests that patients may be able to self-treat with ice when short-term reduction of intention tremor is required.
Occupational therapy
Steultjens EMJ, Dekker J, Bouter LM, Cardol M, Van de Nes JCM, Van den Ende CHM. Occupational therapy for multiple sclerosis. The Cochrane Library 2006, no1 (CD003608).
Major review of research into OT draws no conclusions about its efficacy and calls for more randomised controlled trials in this field. Cochrane Reviews are seen as a gold standard in medicine and focus only on randomised controlled trials, which raises questions for therapy research.
Reynolds, F. Reclaiming a positive identity in chronic illness through artistic occupation. OTJR:Occupation, Participation and Health 2003;23(3):118-127.
A study of 10 chronically ill women, including one with MS, showed how they positively reconstructed self and identity through engaging in textile artwork. Findings suggest that meaningful artistic occupation may provide a source of positive identity for people with chronic illness.
Finlayson M, editor. Occupational Therapy practice and research with persons with multiple sclerosis. Binghamton: Haworth Press Inc., 2003.
A collection of articles showing the different types of research into OT with people with MS.
Baker NA, Tickle-Degnen L. The effectiveness of physical, psychological and functional interventions in treating clients with multiple sclerosis: a meta-analysis. Am J Occup Ther 2001;55(3):324-31.
Review of the literature finds OT interventions are useful in treating capacity and ability deficits in MS, task and activity levels. Authors highlight the need for more rigorous research i to understand treatment effectiveness and into areas such as life roles as well as functional goals.
College of Occupational Therapy (2000) Standards for Practice - For Occupational Therapists Working with People Having Chronic and/or Progressive Neurological Conditions London COT.
Can be used to audit OT service
Finlayson ML, Peterson EW, Cho CC.Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil. 2006 Sep;87(9):1274-9.
A survey of 1089 people aged between 45 and 90 with MS, using a self-report of falling to the ground in the past six months. 52.2% of participants reported falling, increased risk factors included being male, fear of falling, deteriorating MS status, never or occasional use of a wheelchair, problems with balance and mobility, poor concentration or forgetfulness, and bladder problems.
Physiotherapy
Crippa A, Cardini R, Pellegatta D, Manzoni S, Cattaneo D, Marazzini F. Effects of sudden, passive muscle shortening according to Grimaldi’s method on patients suffering from multiple sclerosis: a randomized controlled trial. Neurorehabil Neural Repair 2004;18(1):47-52.
Randomised trial of Grimald’s method to improve hip abductor use. 20 people with MS received active treatment and 20 controls. Findings show statistically significant improvement in hip movement in people receiving treatment.
Feys P, Helsen WF, Liu X, Lavrysen A, Nuttin B, Ketelaer P. Effects of vision and arm position on amplitude of arm postural tremor in patients with multiple sclerosis. Arch Phys Med Rehabil 2004;85(6): 1031-3.
16 people with MS were compared with 16 controls to identify whether arm tremor was affected by flexing or extending the arm, or by closing their eyes. In people with MS, amplitude of arm postural tremor was found to be independent of vision and arm position.
Transcutaneous electrical nerve stimulation (TENS)
Al-Smadi J, Warke K, Wilson I, Cramp AG, Noble G, Walsh DM, Lowe-Strong A. A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Clin Rehabil 2003; 17(7):742-9.
15 people with MS were randomly assigned to either a low-setting of TENS, a high setting of TENS or placebo TENS as a treatment for low back pain, over a 6 week treatment period with 4 weeks follow-up. No statistically significant results were found in any group, though a trend towards improvement was shown in both active treatment groups.
Armutlu K, Meric A, Kirdi N, Yakut E, Karabudak R. The effect of transcutaneous electrical nerve stimulation on spasticity in multiple sclerosis patients: a pilot study. Neurorehabil Neural Repair 2003; 17(2):79-82.
10 people with MS were given TENS over 4 weeks. At the end of treatment, their spasticity showed statistically significant improvement on some outcome measures, although no significant different was made to walking ability.
Pain
Newland PK, Wipke-Tevis DD, Williams DA, Rantz MJ, Petroski GF. Impact of pain on outcomes in long-term care residents with and without multiple sclerosis. J Am Geriatr Sco 2005;53(9):1490-6.
Retrospective study of long-term care residents found that people with MS were more likely to experience pain, pressure ulcers and depression than other residents. Pressure ulcers were a particular risk after moving into long-term care.
Ehde DM, Osborne TL, Jensen MP. Chronic pain in persons with multiple sclerosis. Phys Med Rehabil Clin N Am 2005;16(2):503-12
Discusses range of pain that may be experienced by people with MS and different models for understanding this, as well as need for more research into access to and efficacy of pain treatments.
D’Aleo G, Sessa E, D’Aleo P, Rifici C, Di Bella P, Petix M, Bramanti P. Nociceptive R3 reflex in relapsing-remitting multiple sclerosis patients. Funct Neurol 1999;14(1):43-7.
Compared healthy subjects with people with MS to see whether people with MS are more susceptible to pain, using the R3 component of the blink reflex. A significant difference was found between people with MS and healthy controls for R3 threshold and pain threshold.
Text Books
(Not available from the MS Trust Information Service)
Silcox L. Occupational therapy and multiple sclerosis. London: Whurr publishers; 2003.
Basic introduction to major areas of OT intervention with MS
Edwards S, ed. Neurological physiotherapy. 2nd edition. London: Churchill Livingstone; 2002.
Good overview of neurological conditions, with specific discussion of MS in chapter 11.
Murdoch B, Theodoros D, eds. Speech and language disorders in multiple sclerosis. London: Whurr publishers; 2000.
Comprehensive overview and discussion of common speech problems.
Yorkston K, Beukelman D, Strand E, Bell K. Management of motor speech disorders in children and adults. Austin, Texas: Pro-Ed publishers;1999.
This book provides an overview of the characteristics of motor speech disorders, including a chapter on dysarthria in MS.