Therapists in MS

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.

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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

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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.

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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.

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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

Wynia K, Middel B, van Dijk JP, et al. The impact of disabilities on quality of life in people with multiple sclerosis. Mult Scler 2008; 14 (7): 972-980.

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Study examined the relative impact of MS-related disabilities on quality of life. 530 people with MS completed the Multiple Sclerosis Impact Profile (MSIP) and two generic health-related QOL measures, the Medical Outcome study Short Form Questionnaire (SF-36) and the World Health Organization Quality Of Life-BREF (WHOQOL-BREF). Based on the results, the study recommends that treatment programmes target impairments in cognitive functioning, emotional functioning and sleep and that interventions are best evaluated using the WHOQOL-BREF

Turner AP, Kivlahan DR, Haselkorn JK et al. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. Arch Phys Med 2009; 90(3): 420-428.

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This study investigates the prevalence of engagement in exercise in a national sample of people with MS and its effect on health including physical health, mental health and participation in life. People who exercised reported they had better social functioning and better role functioning. Authors conclude that physical activity may represent an important opportunity to improve mental health and quality of life amongst people with MS.

Bishop M, Frain MP, Tschopp MK. Self-management, perceived control, and subjective quality of life in multiple sclerosis: an exploratory study. Rehab Counsel Bull 2008; 52(1): 45-56.

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Study explored the relationships between subjective and objective measures of MS impact, self-management, perceived control, and subjective quality of life (SQOL). 157 people with MS took part in the study, the findings of which suggest that self-management is strongly associated with perceived control and that both perceived control and self-management mediate the relationship between MS impact and SQOL

McCrone P, Heslin M, Knapp M, et al. Multiple sclerosis in the UK: service use, costs, quality of life and disability. Pharmacoeconomics 2008; 26(10): 846-860.

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Study investigated the links between service use, costs, QOL and disability for people with MS. The study shows that people with MS have high levels of service use but low quality of life in comparison with other conditions. There were significant associations between costs, quality of life, and disability.

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.

Montel SR, Bungener C Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis. Mult Scler 2007; 13(3): 393-401

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135 people with MS were tested for mental and cognitive states and given a semi-structured interview about clinical and socio-demographic information. Disease course had a strong effect on mental health and quality of life. People with secondary progressive MS use extensive emotional coping strategies and people with primary progressive MS use instrumental coping strategies

Beiske AG, Naess H, Aarseth JH, et al. Health-related quality of life in secondary progressive multiple sclerosis. Mult Scler 2007; 13(3): 386-92

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Used Nottingham Health Profile to analyse health-related quality of life in 345 people with secondary progressive MS participating in a trial of beta interferon. No beneficial effect of treatment was found. People with secondary progressive MS had significantly lower health related quality of life than controls and their quality of life was negatively affected by physical disability, disease progression and fatigue.

Johansson S, Ytterberg C, Claesson IM, et al. High concurrent presence of disability in multiple sclerosis: associations with perceived health. J Neurol 2007; 254(6):767-73

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219 people with a range of types of MS and levels of disability attending an outpatient clinic were screened for physical disabilities, energy, mood and social /lifestyle activities, together with their perceived physical and psychological impact. The most significant impact was felt with fatigue and depressed mood, regardless of other disabilities

Grytten N, Maseide P 'When I am together with them I feel more ill.' The stigma of multiple sclerosis experienced in social relationships. Chronic Illn 2006; 2(3): 195-208.

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Qualitative study of 14 people with MS and their relatives, about their experiences of living with MS. People with MS reported stigmatising, either through ignoring the MS or overemphasis in personal encounters.

Ennis M, Thain J, Boggild M et al. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis. Clin Rehabil 2006; 20(9): 783-92.

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32 people with MS and 30 control subjects attended an 8 week health promotion course. Outcomes measured success in health promotion activity and self-efficacy for health promoting activities, including some quality of life domains that were sustained after 3 months on treatment

Rousseaux M, Perennou D. Comfort care in severely disabled multiple sclerosis patients. J Neurol Sci 2004; 222(1-2):39-48.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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

Khan F, Pallant JF, Brand C, et al. Effectiveness of rehabilitation intervention in persons with multiple sclerosis: A randomised controlled trial. J Neurol Neurosurg Psych 2008; 79 (11) 1230-1235

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In this twelve-month study, 101 people with MS received an individualised rehabilitation program and where compared against people with MS who were on a waitlist. More than 70% of people on the program improved across a range of functional independence measures compared with the waitlist group. The study concludes that an individualised rehabilitation program reduces disability in people with MS, compared with no intervention

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis. Arch Phys Med Rehabil 2008; 89 (4): 652-659

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Study investigates effectiveness of the use of goal attainment scaling in inpatient rehabilitation for people with MS compared with standard measures used to evaluate progress in rehabilitation. Study concludes that goal attainment scaling (GAS) is a responsive and useful outcome measure for the rehabilitation of people with MS, providing added value to standardized outcome measurement.

Khan F, Turner-Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev 2007; 18(2): CD006036

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Systematic review of controlled trials found 'strong evidence' that inpatient MD rehabilitation can produce short-term gains in activity and participation for people with MS. ‘Limited evidence’ found that outpatient or home-based rehabilitation programmes improve symptoms and disability. Strong evidence was found that longer-term, low intensity programmes improve quality of life. No convincing evidence for cost-effectiveness, or for type or length of therapy was found. It highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials.

Chard S E. Community neurorehabilitation: a synthesis of current evidence and future research directions. Neuro Rx 2006; 3(4): 525-34

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Review of current evidence about multidisciplinary community neurorehab, with a focus on physiotherapy and occupational therapy.

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.

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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.

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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.

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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.

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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.

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Sets out proposed clinical standards for community rehab 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.

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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

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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.

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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.

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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

Brittle N, Brown M, Mant J, et al. Short-term effects on mobility, activities of daily living and health-related quality of life of a conductive education programme for adults with multiple sclerosis, Parkinson's disease and stroke. Clin Rehabil 2008; 22(4): 329-337.

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The aim of the study was to evaluate the effect of 10 sessions of conductive education on mobility, functional independence and health-related quality of life in adults with either MS, Parkinson’s Disease or stroke. Stroke patients demonstrated statistically significant improvement in the Nottingham Extended Activities of Daily Living Index, and non-significant trends towards improved physical and mental functioning were seen across all three diagnoses

Van Der Linden FAH, D’Hooghe MB, Nagels G, et al. Proxy ratings from multiple sources: disagreement on the impact of multiple sclerosis on daily life. Eur J Neurol 2008; 15(9): 933-939.

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MS patients, close relatives and healthcare providers completed the Multiple Sclerosis Impact Scale (MSIS-29) before and after a rehabilitation program. Comparison of ratings between patients and proxy respondents revealed low levels of agreement. Close relatives appeared to significantly overestimate the disease impact of MS whereas healthcare providers tended to underestimate the disease impact of MS.

Kalmar JH, Guadino EA, Moore NB, et al. The relationship between cognitive deficits and everyday functional activities in multiple sclerosis. Neuropsychology 2008; 22(4): 442-449.

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The purpose of this study was to examine the role of cognitive dysfunction in the functional status of individuals with MS. Participants were 74 adults with MS and 35 healthy comparison participants who underwent neuropsychological testing and completed the Executive Functions Performance Test (EFPT) an objective measure of everyday life activities. Significant differences in EFPT performance were revealed between individuals with MS, with and without cognitive impairment, and healthy controls.

Lexell EM, Iwarsson S, Lexell J. The complexity of daily occupations in multiple sclerosis. Scand J Occup Ther 2006; 13(4): 241-8.

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Study compared professionals’ assessment of self-care difficulties with patients’ perceptions, and whether these were related to sex, age, disease severity and living arrangements. No significant differences between domains were found, suggesting that individuals with MS find difficulty with occupations related to all aspects of daily life.

Hughes RB, Robinson-Whelen S, Taylor HB,et al. Stress self-management: An intervention for women with physical disabilities. Womens Health Issues 2006; 16(6): 389-99.

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78 people with a range of physical disabilities were randomised to stress self-management course or the waiting list control group. At 3 month follow up, the intervention group showed improvement on stress management, pain and role limitations compared with controls.

Paltamaa J, Sarasoja T, Wikstrom J, et al. Physical functioning in multiple sclerosis: a population-based study in central Finland. J Rehabil Med 2006; 38(6):339-45.

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Postal questionnaire to ascertain efficacy in self-care, mobility and domestic life. 200 respondents suggested a majority fully independent in self-care activities and domestic life, most able to walk without aid. Fatigue was the most commonly reported symptom

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.

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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.

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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.

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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.

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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

Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database Syst Rev 2009; (1): CD007256.

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Systematic review evaluated the effectiveness and cost-effectiveness of vocational rehabilitation programs compared to alternative programs or care as usual on return to work, workability and employment in people with MS. Authors conclude that there was inconclusive evidence to support vocational rehabilitation for people with MS. However, the review highlights some of the challenges in providing such programs and makes recommendations for implementation of and future research into vocational rehabilitation programs

Messmer Uccelli M, Specchia C, Battaglia MA, et al. Factors that influence the employment status of people with multiple sclerosis: a multi-national study. J Neurol 2009; Article in Press

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A multi-national questionnaire assessed aspects related to employment that facilitate or hinder job maintenance. Data was collected in 18 European countries. A total of 1,141 questionnaires were completed. Of those responding, 694 (61%) subjects were employed and 477 (39%) were unemployed. The items that significantly differentiated the groups were related to MS symptoms, workplace environment and financial considerations

McCabe MP, Roberts C, Firth L, et al. Work and recreational changes among people with neurological illness and their caregivers. Disabil Rehabil 2008; 30(8): 600-610

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The current study investigated changes in work and recreational activities among people with four different neurological conditions: 28 with multiple sclerosis; 27 with motor neurone disease; 31 with Parkinson's; and 24 with Huntingtons disease. In addition, 28 professionals who worked with these populations participated in the study. Individual interviews were conducted and the results are discussed in terms of proposed prevention and intervention programmes

Julian LJ, Vella L, Vollmer T, et al. Employment in multiple sclerosis: exiting and re-entering the work force. J Neurol 2008; 255 (9): 1354-1360

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This investigation evaluated patient and disease characteristics associated with work loss and work initiation using the NARCOMS patient registry. Patient and disease characteristics associated with transitions to unemployment or employment were evaluated. Specific physical and mental health limitations confer risk of employment cessation over time, as well as the likelihood of employment initiation

Townsend, G. Supporting people with multiple sclerosis in employment: A United Kingdom survey of current practice and experience. Br J Occup Ther 2008; 71 (3): 103-111.

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This article reports on one section of a larger project, which examined employment issues from the perspectives of people with MS and the professionals who may support them in retaining or regaining employment. A postal questionnaire was used to elicit a wide range of responses. The article identifies gaps in the provision of support and discusses the need to develop effective interventions targeted at supporting people with MS in work.

Sweetland J, Riazi A, Cano SJ, et al. Vocational rehabilitation services for people with multiple sclerosis: what patients want from clinicians and employers. Mult Scler 2007; 13 (9): 1183-1189.

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The aim of the study was to identify what people with MS require from a vocational rehabilitation service in terms of content and service delivery. Study concludes that people with MS need support in the workplace in two distinct ways. The study highlights the key needs of people with MS and the support that ought to be offered to help them address these needs

Ville I, Winance M. To work or not to work? The occupational trajectories of wheelchair users. Disabil Rehabil 2006; 28(7): 423-6.

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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.

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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.

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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.

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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.

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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.

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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

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Highlights the dilemmas that may be faced in disclosing a diagnosis of MS in the work environment.

Equipment and assistive technology

Sawatzky B, Denison I, Tawashy A. The segway for people with disabilities: meeting clients' mobility goals. Am J Phy Med Rehabil 2009; 88 (6): 484-490.

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The goal of this study was to determine how the Segway compares to clients' current method of mobility in meeting their specific mobility goals. It included 10 subjects with a wide range of disabilities including MS who were able to walk at least 6 m with or without assistance. Subjects navigated a 25m obstacle course with their current mobility devices and then the Segway

Johnson KL, Bamer AM, Yorkston KM, et al. Use of cognitive aids and other assistive technology by individuals with multiple sclerosis. Disability and rehabilitation: Assistive technology 2009; 4(1): 1-8

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Study investigated the use of assistive technology (AT), unmet needs for AT, and examines the correlates of use of memory aids and cognitive strategies among individuals with MS

Beer S, Aschbacher B, Manoglou D, et al. Robot-assisted gait training in multiple sclerosis: a pilot randomized trial. Mult Scler 2008; 14 (2): 231-236

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Pilot study investigated the feasibility and efficacy of robot-assisted gait training (RAGT) in MS patients with severe walking disabilities (Expanded Disability Status Scale [EDSS] 6.0-7.5). A group of 35 stable MS patients received 15 sessions over three weeks. Study concluded that RAGT may be an effective therapeutic option in MS patients with severe walking disabilities but urges further larger studies in this area

Gentry T. PDAs as cognitive aids for people with multiple sclerosis. Am J Occup Ther 2008; 62 (1): 18-27.

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This study evaluated the effects of an occupational therapy training protocol using personal digital assistants (PDAs) as assistive technology for people with cognitive impairment related to MS. The findings provide evidence of an association between an intervention providing training in the use of a PDA and improvements in the everyday function of people with cognitive impairment related to MS.

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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence. Arch Phys Med Rehabil 2009; 90 (4): 602-609

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Study set out to determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with MS. 16 people with MS took part in the study. Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population

Nilsagård Y, Lundholm C, Denison E, et al. Predicting accidental falls in people with multiple sclerosis - a longitudinal study. Clin Rehabil 2009; 23(3): 259-269

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Study investigated accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests. In clinical practice, looking at the use of walking aids, investigating proprioception and spasticity, rating Expanded Disability Status Score and using Berg Balance Scale or Timed Up and Go, all contribute when identifying fallers

Cattaneo D, Jonsdottir J, Zocchi M, et al. Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil 2007; 21(9):771-781

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Study evaluates the effects of balance retraining in a sample of people with multiple sclerosis. Particpants were divided between three groups: group 1 received balance rehabilitation to improve motor and sensory strategies; group 2 received balance rehabilitation to improve motor strategy; and group 3 received treatments not specifically aimed at improving balance. Balance rehabilitation appeared to be a useful tool in reducing the fall rate and improving balance skills in subjects with multiple sclerosis

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.

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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.

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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.

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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.

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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.

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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

Marcotte TD, Rosenthal TJ, Roberts E, et al. The contribution of cognition and spasticity to driving performance in multiple sclerosis. Arch Phys Med Rehabil 2008; 89 (9): 1753-1758.

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In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving. Assessment of these factors may help guide the clinician regarding the types of driving behaviours that would put people with MS at an increased risk for a car crash.

Diamond BJ, Johnson SK, Kaufman M, et al. Relationships between information processing, depression, fatigue and cognition in multiple sclerosis. Arch Clin Neurpsychol 2008; 23 (2): 189-199

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Study set out to determine the extent to which cognition affects information processing speed and how clinical depression and fatigue mediate this relationship. Forty-eight participants with confirmed MS participated. Slower processing was correlated with higher levels of depressed mood, fatigue, lower verbal fluency, fewer words and digits recalled and poorer recall of visual-spatial information. Depression and physical fatigue had the greatest influence on the association between processing speed and more effortful tasks.

Simioni S, Ruffieux C, Bruggimann L, et al. Cognition, mood and fatigue in patients in the early stage of multiple sclerosis Swiss Medical Weekly 2007; 137 (35-36): 496-501

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In this early MS group one third of the patients already exhibited cognitive deficits, which were usually apparent in an effortful learning situation and were generally mild. Mood disorders, fatigue, handicap and decreased QoL were all associated with the occurrence of cognitive deficits. Results confirm the existence of an interplay between cognitive, affective and functional changes and fatigue in early MS

Basso MR, Lowery N, Ghormley C, et al. Self-generated learning in people with multiple sclerosis. J Int Neuropsychol Soc 2006; 12(5):640-8.

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Tests of people with MS found that they remembered more information, particularly in relation to names, appointments and locations if they generated their own prompts rather than were presented with pre-set ideas. This finding held true through mild to moderate-severe memory impairment. Self-generated prompts also improved their performance in self-care and activities of daily living

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.

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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.

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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.

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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.

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Discusses studies to date and implications for therapists.

Mobility

Giesser B, Beres-Jones J, Budovitch A, et al. Locomotor training using body weight support on a treadmill improves mobility in persons with multiple sclerosis: A pilot study. Mult Scler 2007; 13 (2): 224-231

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Investigated the potential benefits and tolerability of locomotor training using body weight support on the treadmill (LTBWST) in persons with multiple sclerosis (MS). Methods: Four persons with primarily spinal cord MS and severely impaired ambulation (Expanded Disability Status Scale score 7.0-7.5) were enrolled in LTBWST. Subjects completed an average of 40 training sessions over several months. Subjects showed improvement in muscle strength, spasticity, endurance, balance, walking speed, and quality of life at the end of the training sessions, and could tolerate training without fatigue or other adverse effects

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.

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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.

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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.

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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

National Institute for Health and Clinical Excellence. IPG278 Functional electrical stimulation for drop foot of central neurological origin: public information. [Cited 21 September 2009]. Available from: URL: http://guidance.nice.org.uk/IPG278 X

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In January 2009, the National Institute for Health and Clinical Excellence issued guidance that FES can be "offered routinely as a treatment option for people with drop foot caused by damage to the brain or spinal cord" if the doctor feels it is appropriate

Barrett CL, Mann GE, Taylor PN, et al. A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis. Mult Scler 2009; 15 (4): 493-504.

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44 patients were randomized to receive FES or a physiotherapy home exercise program for a period of 18 weeks. The exercise group showed a statistically significant increase in 10m walking speed and distance walked in 3 min, relative to the FES group who showed no significant change in walking performance without stimulation. At each stage of the trial, the FES group performed to a significantly higher level with FES than without for the same outcome measures. Authors conclude that more research is required to investigate the combined therapeutic effects of FES and exercise for this patient group.

Paul L, Rafferty D, Young S, et al. The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis. Mult Scler 2008; 14 (7): 954-961

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Study investigated the effect of FES, in terms of speed and physiological cost of gait, in people with multiple sclerosis. Twelve people with MS and 12 healthy matched controls walked at their own preferred walking speed for 5 minutes around a 10m elliptical course. Subjects with MS completed the protocol with and without using their FES. Wearing FES lead to a significant improvement in walking and a significant reduction in the physiological cost of gait.

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.

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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.

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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

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. Arch Phys Med Rehabil 2009; 90 (3): 420-428

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Study investigated the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. Study concludes that the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain

Mutluay FK, Tekeoǧlu A, Saip S, et al. Group exercise training approach to multiple sclerosis rehabilitation. Nobel Medicus 2008; 4 (3):20-26.

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22 people with MS partook in the programme. Baseline and posttraining measures of Barthel index, fatigue severity scale, perceived exertion level (Borg), muscle strength, 10m and 20m walking times were recorded; the quality of life was assessed with MSQOL-54 survey. Group exercise training was shown to reduce motor impairments, increase mobility and improve the quality of life of MS patients of various disability levels

Motl RW, Gosney JL. Effect of exercise training on quality of life in multiple sclerosis: A meta-analysis. Mult Scler 2008; 14 (1): 129-135.

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Using meta-analytic procedures, this study examined the overall effect of exercise training interventions on quality of life (QOL) among individuals with MS. The cumulative evidence supports that exercise training is associated with a small improvement in QOL among individuals with MS

Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: Recommendations for the application of resistance-, endurance- and combined training. Mult Scler 2008; 14 (1): 35-53

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This review summarizes the existing knowledge regarding the effects of physical exercise in people with MS. Furthermore, recommendations are given regarding exercise prescription for MS patients and for future study directions.

Bjarnadottir OH, Konradsdottir AD, Reynisdotir K, et al. Multiple sclerosis and brief moderate exercise: A randomised study. Mult Scler 2007; 13 (6): 776-782

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Randomised control study to determine the effect of aerobic and strength exercise on physical fitness and quality of life in people with mild multiple sclerosis (MS). Sixteen outpatients with definitive MS, aged 18-50, with an Expanded Disability Status Scale (EDSS) < 4, completed the study. Study confirms that brief, moderate, aerobic exercise improves physical fitness in individuals with mild MS.

Mutluay FK, Demir R, Ozyilmaz S, et al. Breathing-enhanced upper extremity exercises for patients with multiple sclerosis. Clin Rehabil 2007; 21 (7): 595-602

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Study explored the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. The programme improved most pulmonary performance measures and had clinical significance

Rampello A, Franceschini M, Piepoli M et al. Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients With Multiple Sclerosis: A Randomized Crossover Controlled Study. Phys Ther. 2007 Apr 3; [Epub ahead of print]

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Compared 8 week aerobic training programme with neurological rehabilitation on 19 people with MS with mild to moderate disability. 11 completed the study. Aerobic training improved walking distances and speeds, but not in walking capacity compared with neurological rehabilitation. More disabled people benefited more from aerobic training. Suggests aerobic training is more effective than neurological rehabilitation in improving walking speed and distance in people with moderate disability and MS.

Taylor NF, Dodd KJ, Shields N, et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother. 2007; 53(1): 7-16.

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This review of reviews found that therapeutic exercise in a range of conditions is more beneficial if intense, targeted, and ideally individualised. No findings about one type of exercise over another were identified.

Newman MA, Dawes H, van den Berg M, et al. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler 2007; 13(1): 113-9.

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16 adults with MS undertook 12 sessions of up to 30 minutes, training on a treadmill at 55-85% of age-predicted maximum heart rate. Primary outcome was walking effort, measured by oxygen consumption, with associated changes in gait parameters and the Fatigue Severity Scale. Over time, all subjects improved their comfortable walking speed, oxygen consumption decreased, time spent in stance on the weaker leg fell. Reported fatigue remained constant. Aerobic treadmill training potentially reduces effort and fatigue for some people with MS

Motl RW, Snook EM, McAuley E, et al. Symptoms, self-efficacy, and physical activity among individuals with multiple sclerosis. Res Nurs Health. 2006; 29(6): 597-606

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196 people with MS completed symptoms, self-efficacy and physical activity measures for one week. Analysis of results showed that symptoms had a direct negative effect on self-efficacy and physical activity. It provides continued support for the need of regular physical exercise by people with MS.

Taylor NF, Dodd KJ, Prasad D, Denisenko S. Progressive resistance exercise for people with multiple sclerosis. Disabil Rehabil 2006;28(18):1119-26.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

Thomas S, Thomas PW, Nock A, et al. Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis. Pat Ed Couns 2009. Article in press.

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A manualised group-based fatigue management programme was developed and delivered by health professionals. Sixteen people with MS took part and there were significant improvements in perceived self-efficacy for managing fatigue. The next phase of the study aims to determine whether the programme transfers satisfactorily to other centres and to collect data in preparation for a randomised controlled trial.

Blaney BE, Lowe-Strong A. The impact of fatigue on communication in multiple sclerosis: the insider's perspective. Disabil Rehabil 2009; 31(3): 170-180.

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Study investigated the relationship between fatigue and communication in people with MS. In-depth interviews with 10 people with MS were used to gain insight into the lived experience of the interaction between MS fatigue and communication. An increase in the severity of communication symptoms and the onset of new communications symptoms when experiencing fatigue were reported as well as a range of strategies employed to manage fatigue and communication changes.

Hadjimichael O, Vollmer T, Oleen-Burkey, MK. Fatigue characteristics in multiple sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes 2008; 6 art no: 100.

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People with MS enrolled in the North American Research Committee on Multiple Sclerosis (NARCOMS) patient registry are invited to complete follow-up surveys every six months. One of the surveys was designed to focus on the severity and impact of fatigue. Article discusses survey findings

Fragoso YD, Santana DLB, Pinto RC. The positive effects of a physical activity program for multiple sclerosis patients with fatigue. NeuroRehabilitation 2008; 23 (2): 153-157.

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Article describes the development and delivery of a physical activity program for MS patients consisting of a 20-week series of gradual stretching, resistance and aerobic exercises, adapted to the individual clinical condition of each patient. The results showed significant improvement in cardio-circulatory parameters, as well as a significant decrease in scores on the fatigue scale.

Van Kessel K, Moss-Morris R, Willoughby E, et al. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med 2008; 70 (2): 205-213.

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Study assessed the efficacy of cognitive behaviour therapy (CBT) as a treatment for multiple sclerosis (MS) fatigue. 72 patients with MS fatigue were randomly assigned to eight weekly sessions of CBT or relaxation training (RT). The primary outcome was the Fatigue Scale. Secondary outcomes included measures of stress, mood, and fatigue-related impairment. Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT.

Holberg C, Finlayson M. Factors influencing the use of energy conservation strategies by persons with multiple sclerosis. Am J Occup Ther 2007; 61(1): 96-107.

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8 people who had attended a telephone energy conservation course were interviewed. Three themes directly affected use of energy conservation strategies: 1) experience with MS, 2) sense of self, 3) environmental factors, and is thus dependent on a range of inter-related contextual factors

Matuska K, Mathiowetz V, Finlayson M. Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue. Am J Occup Ther 2007; 61(1): 62-69

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123 participants completed a survey about their use of energy conservation strategies. All strategies were newly used by at least half of all participants and rate as effective. Rest and delegation were used most and seen as most effective, followed by changing priorities and standards

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.

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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.

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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.

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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.

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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

Chiara T, Martin D, Sapienza C. Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis. Neurorehabil Neural Repair. 2007; 21 (3): 239-249.

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17 people with MS were compared with 15 controls for expiratory muscle strength training as a method of improving voice production, dysarthria and voice-related quality of life issues in MS. 8 weeks of training were followed by 4 weeks of no training. People with MS scored more poorly than controls on all measures prior to training. Training improved maximal expiratory pressure but had no effect on voice production or voice-related quality of life, so this study was negative overall.

Yorkston KM, Baylor CR, Klasner ER, et al. Satisfaction with communicative participation as defined by adults with multiple sclerosis: A qualitative study. J Commun Disord 2006; 40(6): 433-51.

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8 people with MS were interviewed and asked to discuss their satisfaction with communication. A number of issues were raised including comfort, success of communication, and personal meaning of participation. This study confirms findings from other studies.

Arnott W, Jordan F, Murdoch B, Lethlean J. Narrative discourse in multiple sclerosis: an investigation of conceptual structure. Aphasiology 1997;11(10): 969-991.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

Giusti A, Giambuzzi M. Management of dysphagia in patients affected by multiple sclerosis: state of the art. Neurol Sci 2008; 29 (SUPPL. 4): S364-S366

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Article describes treatment plans of mild, moderate and severe dysphagia following a preliminary assessment of symptoms carried out according to the O'Neil dysphagia graduation scale.

Tassorelli C, Bergamaschi R, Buscone S. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci 2008; 29 (SUPPL. 4): S360-S363.

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Article describes how MS patients should be effectively evaluated and managed in order to recognize dysphagia before any medical complications such as aspiration pneumonia appear. Emphasis is placed on an integrated approach to define the severity of dysphagia and to devise the most appropriate therapeutic/ rehabilitative methodology.

Marchese-Ragona A, Restivo DA, Marioni G, et al. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci 2006; 27 Suppl 4:335-7

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More than 30% of people with MS develop swallowing problems, and complications of dysphagia such as dehydration and aspiration pneumonia are common causes of mortality and morbidity in late MS. Swallowing rehabilitation in MS-related dysphagia should start with a thorough evaluation of swallowing ability.

Restivo DA, Marchese-Ragona R, Patti F. Management of swallowing disorders in multiple sclerosis. Neurol Sci 2006; 27 Suppl 4:s338-40

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Management of dysphagia should focus on the specific dysphagic symptom. The management of dysphagia should be focused on treatment of the specific dysphagic symptom and the underlying pathophysiology

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.

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Analysed swallowing function in 143 people with progressive MS. 49 people had dysphagia; compensatory strategies restored function in 46 of these.

Ataxia

Gibson-Horn C. Balance-based torso-weighting in a patient with ataxia and multiple sclerosis: A case report. J Neurol Phys Ther 2008; 32 (3): 139-146

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The use of external body weights, although controversial, is occasionally employed to improve balance or mobility in patients with ataxia or tremor. This case report describes the effect of torso-weighting to counteract directional balance loss in a woman with relapsing/remitting multiple sclerosis. Authors conclude that placing small amounts of weight asymmetrically on the torso, based on directional loss of balance and alignment, assisted the patient in maintaining balance during static and dynamic activities.

Mills R, Yap L, Young C. Treatment for ataxia in multiple sclerosis. Cochrane Database Syst Rev 2007; 24;(1): CD005029

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Review of disabling tremor or ataxia in MS. 10 randomised controlled trials met the inclusion criteria, including three neurorehabilitation trials. Pharmacotherapies are described as unsuccessful and although promising the neurorehabilitation trials provided insufficient evidence to lead to a change in practice

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.

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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.

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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.

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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.

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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.

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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

Finlayson M, Garcia JD, Cho C. Occupational therapy service use among people aging with multiple sclerosis. Am J Occup Ther 2008; 62(3): 320-328.

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1,282 people with MS, ages 45 to 90, participated in telephone interviews to identify unmet health-related service needs. Occupational therapy was 1 of 22 services examined. 484 (38.2%) had used occupational therapy services at some point since their diagnosis; 211 had used these services in the year before the interview. Recent users identified occupational therapy services as important to health and well-being. Greater activity limitations and living in an urban or suburban area were associated with more recent use of occupational therapy services

Carmody S, Nolan R, Ni Chonchuir N, et al. The guiding nature of the kawa (river) model in Ireland: Creating both opportunities and challenges for occupational therapists. Occupational Therapy International 2007; 14 (4): 221-236.

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Article reports two case studies in which the kawa model was used to guide occupational therapy intervention with two individuals with MS in Ireland, with the aim of exploring the effectiveness of the recently emerged kawa model. Semi-structured interviews based on the kawa model were completed with two participants with MS before and after occupational therapy intervention. The authors also documented their experience of using the model in reflective diaries

Blank CW, Finlayson M. Exploring the impact of multiple sclerosis on couples: a pilot study. Can J Occup Ther 2007; 74(2): 134-42.

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3 couples with MS were interviewed together and separately about the impact of MS on their relationship. Two major themes emerged: increasing awareness of change, and use of coping strategies. Participants were especially concerned about the progression of MS and changes relating to progression. These findings offer OTs guidance with their treatment focus in clinical practice

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).

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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.

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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.

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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.

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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.

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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.

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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

Smedal T, Lygren H, Myhr KM, et al. Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept. Physiother Res Int 2006; 11(2):104-16.

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A case study of two patients with stable relapsing/remitting MS looked at physiotherapy at baseline, during treatment, immediately following treatment and two months later. The key feature of treatment was facilitation of postural activity and selective control of movement. Participants showed improved balance and quality of gait.

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.

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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.

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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)

Chitsaz A, Janghorbani M, Shaygannejad V, et al. Sensory complaints of the upper extremities in multiple sclerosis: relative efficacy of nortriptyline and transcutaneous electrical nerve stimulation. Clin J Pain 2009; 25 (4): 281-285.

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Evaluated the relative efficacy of nortriptyline and self-applied transcutaneous electrical nerve stimulation (TENS) in the treatment of pain and/or sensory complaints of the upper extremities. 59 people with MS aged 15 to 50 years were randomly allocated to receive an 8- week treatment course of either nortriptyline (10mg daily increment over 1 week to 50 mg) or self-applied TENS. Findings suggest TENS may have some benefits over nortriptyline.

Miller L, Mattison P, Paul L, et al. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler 2007; 13(4): 527-33

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32 people with MS and spasticity were randomised to two groups , comparing two weeks of 60 minutes and 8 hours daily of TENS applications. No statistically significant effect was seen on spasticity but the 8 hour application time led to a significant improvement in muscle spasm and pain.

Warke K, Al-Smadi J, Baxter D, et al Efficacy of Transcutaneous Electrical nerve stimulation (TENS) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial. Clin J Pain 2006; 22(9):812-819.

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90 people with MS were randomised to one of low-frequency TENS, high frequency TENS and placebo TENS. TENS was applied at least twice daily for 45 minutes at a time, over 6 weeks. No statistically significant effects were found on a range of outcome measures, however, clinically important differences were observed in some of the outcome measures in both active treatment groups during treatment and follow-up, which may have implications for clinical management of these patients.

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.

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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.

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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

Jensen MP, Barber J, Romano JM, et al. A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain. Int J Clin Hypn 2009; 57 (2): 198-221.

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Twenty two people with MS and chronic pain took part in this study comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up.

O'Connor AB, Schwid SR, Herrmann DN, et al. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 2008; 137 (1): 96-111.

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Systematic review summarizes current understanding of the association between MS and pain and provides a basis for the design and interpretation of future studies.

Pöllmann W, Feneberg W. Current management of pain associated with multiple sclerosis. CNS Drugs 2008; 22 (4): 291-324

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Article explores current management options for different types of pain encountered in multiple sclerosis.

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.

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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

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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.

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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.

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Basic introduction to major areas of OT intervention with MS

Edwards S, ed. Neurological physiotherapy. 2nd edition. London: Churchill Livingstone; 2002.

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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.

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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.

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This book provides an overview of the characteristics of motor speech disorders, including a chapter on dysarthria in MS.