ASSESSMENT OF THE INDEPENDENCE IN PERFORMING DAILY ACTIVITIES AND THE NEED FOR OCCUPATIONAL THERAPY IN PERSONS WITH MULTIPLE SCLEROSIS

Abstract

Every hour someone receives a diagnosis of multiple sclerosis. Although it is not most common disease, or biggest threat to the huma­ni­ty, its chronic, variable and unpredictable course can have a devastating impact on all those who have it, or care about someone who does. 

Being diagnosed with multiple sclerosis is an incident, which brings big challenges and changes in the life course, especially if there are relapses and exacerbations of the symptoms. Depending on the clinical course of the illness, the persons with MS need to adapt to the new situation and undergo multidisciplinary rehabilitative treatment; also it is necessary to make  appropriate  adaptations of homes,which in general will enable maximal utili­zation of the remaining patient’s abilities.

The main goal of our research is to provide a clear review of the disease, determining the repercussions which it causes in the life cour­se of the patients, especially directing to­ward the assessment of the independence in per­forming daily activities and the need of occupational therapy in persons with multiple sclerosis, knowing that they are coping with prob­lems in the realization of their basic duti­es and responsibilities.   

The main goal of the research generates the main tasks: determination of the types of treatment which persons with MS receive in our country, determination of the secondary and tertiary consequences of the disease, detection of the way of performing the daily activities and home adaptations, deter­mi­na­tion of the need for organization and imple­men­tation of the occupational therapy and comparison of the functioning of the persons with acquired (persons with MS) and persons with inborn disability (persons with cerebral palsy).

The sample of the research was convenient, inclu­ding subjects with MS and CP available and open for cooperation. 32 examinees with multip­le sclerosis older than 18 years, 12 ma­les and 20 females and 25 examinees with cere­bral palsy, older than 18 years and with nor­mal IQ were included. The sex distri­bu­tion of the examinees in the control group was presented by 11 males and 14 female sub­jects.  

The methodological structure is based on the met­hods of structural, descriptive and functio­nal analysis, method of generalization and comparison method, and documentation, sca­ling and the survey were used as techni­ques. A questionnaire composed of a com­bi­na­tion of several assessment scales and indexes: Multiple Sclerosis Impact Scale  MSIS-29, Barthel Index, Berg balance scale, Functio­nal status questionnaire - FSQ, Disa­bility index and Frenchay Activities Index - FAI, was used for data collection, and it was adapted to the specificities and the characteristics of the sample.

Collected data were grouped and tabled, and then processed by standard statistical program SPSS 11 for WindowsHP, where the nature of the notifications imposed usage of the chi square tests (Pearson chi square test, Likelihood-ratio and Linear by linear association).

The analysis of the results confirmed our assumption that the symptoms and the course of the disease influence the limitation of the functional capabilities of the persons with MS, reducing their independence in the realization of the activities. As a result of the increased disability index, which grows proportionally with the increase of the age, a number of respondents reported reduced frequency of performing basic life enga­ge­ments in the domain of home acti­vi­ties, work and leisure.       

Comparing the results of the persons with multiple sclerosis and the control group, it was noted that persons with MS have bigger problems and difficulties in dealing with the disease and in the adaptation to the remaining abilities, which leads to the psychic barrier, apathy and withdrawal from the cultural-societal and social life.  

According to the structure of the obtained results, it can be concluded that there is a need for multidisciplinary treatment of the persons with multiple sclerosis, which will cover the complete personality of the patient. The problems and difficulties in everyday functioning impose the need for organization and implementation of the occupational therapy process, which will increase the degree of independence and productivity of persons with MS.