TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

TR Interventions Write-up relevant to Multiple Sclerosis

Caroline Mager
RCLS 245
Eastern Washington University

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TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

There are a number of Recreational Therapy interventions that would be appropriate for a client
with the diagnosis of Multiple Sclerosis. One of these interventions would be Mobility;
specifically walking (Porter, 2006, p.99). This intervention looks at common techniques for
getting around and overcoming barriers by using specific devices (Porter, 2006, p.664). Common
settings this would occur in would be home settings, and every day real life settings.
Some of the tools that can be implemented to help assist in walking is canes, crutches, and
walkers. The type of equipment used would depend on the severity of the disability. In mild
cases where it would just be a matter of helping with stability until the client was able to
rehabilitate enough to no longer need assistance, the use of a cane would be very appropriate. In
severe cases where the client is no longer able to support themselves walking, a wheelchair
would be necessary to allow mobility to continue.
When implementing the use of a cane to help with walking the client should use the cane to help
on the side with the weaker leg. After the client gets use to using the cane on the weaker side
they should switch between putting the weight on the weaker leg and then the weight on the cane
(Porter, 2006, p.664). In the case with the MS client it would depend on whether the client was
experiencing a flare up or not. When an MS client is not in a period were rehabilitation can take
place it would probably be best not to use the weaker leg and let the cane take the majority of the
weight. This way the client will not wear themselves out and when the client is in a remitting
phase the client can start to regain some of the control they had lost in the weaker leg. The type
of program would need to be adapted to whatever stage the client was in, and the type of
equipment used would obviously have to be adapted to the level they were at. If they only
required minimal assistance they would just need a cane, but for more assistance crutches or a

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TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

walker would need to be used. In the case of crutches they would only be able to be use them if
the clients lower extremities were affected and not the upper extremities. Another thing to take
in to consideration with crutches is if they would be more tiring for the client than the other
options. It may be a better choice to just use two canes instead.
The second intervention that I would like to implement would be Lifestyle Style Changes;
specifically energy conservation techniques. In this technique the therapist is helping the client
learn how to keep energy requirements for activities within the appropriate limits. If the client
uses more than the amount of energy they have it can have some very serious consequences
(Porter, 2006, p. 550). That is why this is an extremely important technique to learn for Multiple
Sclerosis, because one of the main symptoms is fatigue and for an MS patient to become overly
fatigued could lead to a flare up and cause more damage instead of improvement.
The setting this would commonly take place in is a clinical setting so that the client will have an
idea of how to use this technique once they are able to return home. The first step is to
understand the clients limitations and what it is that they use to do before setting up a plan. Then
the therapist needs to talk to the client about what activities they wish to engage in once they
return home. This is also where we explain about why energy conserving techniques are so
important and what they need to do to achieve that. One way of explaining energy conservation
is the five Ps; Prioritize, Plan, Pace, Position, and Pounds (Porter, 2006, p.550).
Prioritizing means to make a list of all of the things that you want to get done and then prioritize
them according to deadline, needs or wants. Two important things to remind people when doing
this is that recreational time is an important thing that they need to do for themselves to help
recovery so dont put it last and also the need to get out and do things dont get into a habit of
letting others do it because you are afraid of getting tired. It is a balance, but it is doable.

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TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

The next P is Plan, which means just that, plan techniques to use for the activity so that they can
reduce the amount of energy expended to a level that is appropriate for them (Porter, 2006,
p.551). This is a very important technique for clients with MS to learn because of the fatigue
factor. This would mean taking in to account what time of day is better. Looking at not only
when are the times that they have the most energy, but also what does the weather look like. In
the case with MS if it is in the summer the best times to be running around are in the early
morning or evening when the weather starts to get a little cooler. Or planning activities that take
place in air conditioning or cool environments, such as pools, lakes, etc. This is due to the fact
that overheating is also a very important factor with MS (Porter, 2006, p.551).
The next P is pace which translates to dont rush, rushing around can create major fatigue and be
very dangerous. It is important to impress upon them to give themselves extra time and to be
willing to take the time. Dont try to keep up with someone else or try to get too much done at
one time. They need to just give themselves the leeway to take enough time (Porter, 2006,p551).
The fourth P is Position which has to do with posture. This means that good posture truly helps
with energy consumption. If your client carries the correct posture for the task they will use less
energy and therefore be able to accomplish what they want and not get fatigued (Porter, 2006,
p.552).
The last P is Pounds, this is explaining that carrying extra weight uses more energy. This can
apply to a client that needs to loose weight so that they are not carrying their own weight and
using extra energy, but also being conscious and aware of how much weight they are choosing to
carry when doing a task or activity. Some of the suggestions could be to place items on a scale so
that they can see how much they are carrying. It can also be suggested different means of
carrying the item, such as a cart or back pack (Porter, 2006, p. 552).

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TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

With this specific type of intervention no equipment is really necessary, more of an information
exchange needs to take place and then I would think supervised excursions to illustrate the
information that was trying to be conveyed. This way the client can have a clear understanding of
their limitations in a more controlled setting without going out on their own and running into a
situation where they may get hurt. The type of adaptations for an MS client would be minimal
because it would really be based on where they were at like everyone else. The only added would
be to explain that the disease has its ups and downs which means that the client would need to be
aware that there would possibly be constant adaptations to what they could do or not do without
getting too tired.

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TR INTERVENTIONS WRITE-UP RELEVANT TO MULTIPLE SCLEROSIS

References

Porter, H.R., Burlingame, J., (2006), Recreational Therapy Handbook of Practice; ICF-Based
Diagnosis and Treatment. Idyll Arbor, Inc.

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