A Systematic Review of Upper Extremity Orthosis Use for Symptom Management and Functional Activities in Individuals with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system effecting over 400,000 people in the United States with about 200 new cases diagnosed each week (1).  More common symptoms of MS include fatigue, numbness or tingling, spasticity, ataxia, and visual changes.  Collectively these symptoms significantly impact the hand dexterity and function in the majority of individuals with MS resulting in impairments in ADL, loss of work, and increased levels of care (2).

Customarily, individuals who have hand dexterity and functional impairments are referred to Occupational Therapy (OT) for evaluation and treatment.  Occupational therapists focus on maximizing upper extremity function to assist the individual in their “occupations” or activities requiring time and energy that provide meaning and focus in everyday life (3).  OT interventions may include provision of upper extremity orthotics to manage symptoms, preserve existing hand function, or replace functional grasp/pinch in order for individuals to complete ADL.

Objectives: There is limited documented evidence about the conventional use of upper extremity orthotics for treatment in MS, and their effectiveness on independence in completing ADL.  A systematic literature review was completed to gather information about this area of occupational therapy interventions.

Methods: A systematic literature search and review was completed to identify articles addressing upper extremity orthotic interventions for individuals with MS and other closely related neurodegenerative disorders.  Orthotics and interventions were categorized by type of orthotic, goals/purpose for use, specific symptoms being addressed, and outcomes if available. 

Results: This poster presents the findings of the systematic review, examples of commonly prescribed orthotics and rationale for their use with individuals who have MS.  Clinical screening and referral pathways are provided to assist MS interdisciplinary team members determine appropriate candidates for orthotic use.  Outcome measures to evaluate treatment effectiveness, and recommendations for patient education to maximize treatment adherence and reduce orthosis abandonment are will be provided.

Conclusions: not applicable

References:

1.      National  Multiple Sclerosis Society. (2015). Frequently Asked Questions  “How many people have MS?” Retrieved from: NIDNS/NIH website

2.      Kierkegaard M, Einarsson U, Gottberg K, et al. The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis. Mult Scler 2012; 18: 639–646.

3.      American Occupational Therapy Association. (2016). “What is Occupational Therapy?”  Retrieved from: AOTA website