Multiple Sclerosis: Strategies for Rehabilitation Counselors

Abstract

Vocational planning for persons with Multiple Sclerosis (MS) often creates a unique challenge for rehabilitation counselors due to the ambiguous nature of the disease and lack of information concerning the work potential of persons with this disorder. This article reviews the medical, psychosocial and vocational aspects of MS. Issues pertaining to difficulties in determining diagnosis and prognosis are discussed. Methods for assessment and vocational planning are presented to enable vocational rehabilitation counselors to make timely and appropriate interventions on behalf of clients with MS. Recommendations for rehabilitation practice and current program models are included. Introduction Vocational planning for persons with Multiple Sclerosis (MS) is complicated due to the progressive and unpredictable nature of the disorder. Counselors are often unclear about the work potential of persons with MS, and may lack sufficient knowledge concerning prognosis, course, psychological and vocational implications of the disease. To further complicate matters, physicians are often hesitant to refer persons with MS for vocational services due to their lack of understanding or knowledge about the vocational rehabilitation process (Scheinberg, Holland, LaRocca, Laitin, Bennett, & Hall, 1980). Although prevalence rates vary, it appears that there are approximately 5 cases per 100,000 in the southern and 30 cases per 100,000 in the northern portions of the United States (Muller-Rohland, 1987). While the cause has yet to be determined, the temperate zones of the northern United States place individuals at a greater risk for MS (Gross & Sinaki, 1987). Multiple Sclerosis is an acquired neurological disease and onset typically occurs in persons between the ages of 20 and 40. While approximately 90% of persons with MS have a work history prior to diagnosis, research indicates that only about 25% of individuals with MS remain employed during the course of the disease (LaRocca & Hall, 1990). The purpose of this article is to review the medical, psychosocial and vocational aspects of Multiple Sclerosis. In addition, recommendations are offered for rehabilitation practice and research concerning vocational planning and counseling. Medical Aspects Multiple Sclerosis is a demyelinating disease that effects the central nervous system. It is characterized by the destruction of the myelin sheath that insulates the nerve fiber (Muller-Rohland, 1987). Myelin covering the axons is a type of fatty insulation that promotes the rapid transmission of nerve impulses. Axons have varying degrees of myelin. If any segment of the axon loses its myelin coating, or becomes demyelinated, conduction slows. Messages sent through demyelinated axon segments arrive late producing an uncoordinated response within the neural chain which can produce specific symptoms such as paralysis and visual impairment or less specific symptoms such as fatigue (Wolf, 1984). As the myelin becomes destroyed, the patches of myelin are replaced by scar tissue which produces lesions or plaques; thus, further interruption of the conduction of nerve impulses occur (Wolf, 1984). Specific symptoms depend on the precise location of these plaques (Kraft, 1981). Consequently, no two persons with MS have the same symptoms which limits predictability about the course of the disease and makes diagnosis complicated. Diagnosis Diagnosis of MS is often a long and time-consuming process as there are currently no medical tests that can clearly identify it. Although various tests such as the CT Scan, Lumbar Puncture and Magnetic Resonance Imaging are useful in the diagnostic process (Swanson, 1989), many people with MS do not show evidence of abnormality on these tests. Thus, clinical evidence of objective neurological signs must be relied upon for diagnosis (Swanson, 1989). Although it is not possible to see and identify all the lesions that are developed in the brain and spinal cord due to MS, it is possible to locate lesions by using the information gained from the person with MS in terms of experiences and symptoms (Wolf, 1984). …

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