June Accessibility
“Intelligence is the ability to adapt to change.”
- Stephen Hawking

Multiple sclerosis can present ongoing changes to the person with MS and support partners. Changes to strength, balance, coordination, dexterity, and other physical abilities are not uncommon (as well as cognitive, occupational, and mood-related changes). What doesn’t change, however, is our innate need for independence, especially in our homes. Therefore, making intelligent changes to your home to improve environmental accessibility is important to compensate for these changes, while promoting as much independence as possible and, most importantly, ensuring the safety of the person with MS, as well as the whole family.

Accessibility is variable rather than static, which can create frustration and challenges. Accessibility in MS is particularly challenging because of the unpredictable and fluctuating nature of the disease. Your abilities and needs may change from week-to-week, day-to-day, or even hour-to-hour. Therefore, your accessibility arrangements may need to be adapted depending on the day or situation. You should periodically reassess your accessibility needs and arrangements- with the help of your healthcare team- especially if you find yourself unreasonably challenged with your daily functional mobility or activities, such as cooking, completing your work, or going to dinner with friends or family. Because your healthcare team may not be aware of your struggles at home, it is important that you initiate the conversation and ask questions.

As key members of your healthcare team, occupational therapists (OT) and physical therapists (PT) are trained to compassionately answer these questions and work with you to solve your functional challenges. While physical therapists and occupational therapists often work in conjunction with one another, there are key differences in their roles. Understanding these differences can help guide you to the best source of support in helping you to manage your specific challenges.

An occupational therapist is a rehabilitation professional who specializes in adapting and modifying environments, teaching alternative approaches to tasks, facilitating physical skills, and educating people on how to best work within their limitations. Occupational therapists are able to analyze a task and determine the barriers posed in that situation. They are then able to determine appropriate equipment, techniques, and exercises to increase independence with that task.

A physical therapist helps people and support partners living with MS improve gross mobility to optimally access the home and community. Gross mobility may include complex “large muscle” movements such as walking, sitting, standing, balancing, or transferring. For example, if you are challenged with getting in to or out of a low chair or onto/off of a toilet, then a physical therapist can prescribe exercises to help with strengthening muscles and improving balance/coordination to allow you to complete the task more effectively. Physical therapists can also help you improve the safety, comfort, and efficiency of a wide-range of tasks by recommending durable equipment, such as grab bars or a raised toilet seat.

We also encourage you to encourage your PT and OT to communicate with each another so that your healthcare team can develop comprehensive strategies and provide complementary accessibility resources, exercises, and equipment. Keep in mind that there is an appropriate time to use strategies to encourage rehabilitation (generally through exercise) and a time to encourage compensation. In other words, considering your unique, individual circumstances, an exercise program may be most suitable to help improve your accessibility at one time, but in another situation, modifying your approach to your environment or modifying your environment with equipment may be essential. Most of the time, this is a very “gray” area. Often, effective accessibility is a combination of the two approaches. Your therapists can work together to help you best solve your specific challenges and determine the best strategies to tackle it.

Communicating with your therapists- and having them communicate with one another- is not only necessary to improve your overall wellness and quality of life; it is crucial to making the best uses of your time, energy, and money. In the current healthcare environment , money allotted for PT or OT, as well as for durable medical equipment, may be limited. You do not want to waste your money- whether it’s out-of-pocket or from your insurance company- on equipment or services that may not be the most appropriate for you, now or in the long-run. Ask questions, educate yourself, and do not hesitate to ask a PT or OT.

You can find a physical therapist or an occupational therapist who understands MS by calling 1-800-FIGHT MS to speak with a MS Navigator from the National MS Society. They can place you in contact with local professionals. The American Physical Therapy Association or the American Occupational Therapy Association (the professional organizations for physical therapists and occupational therapists respectively) also would have lists of providers who specialize in neurological rehabilitation or other specialties that may be appropriate to help you with your specific needs.