Multiple Sclerosis

A brief summary of the content from the Multiple Sclerosis MOOC (biology, symptoms, types, risk factors, disease factors, living with MS); a possible social work practice approach using problem-solving and solution-focused approaches

This page has three sections:

1. Background Material that provides the context for the topic

2. A suggested Practice Approach

3. A list of Supporting Material / References

Feedback welcome!

Background Material

Source: Understanding Multiple Sclerosis Massive Open Online Course (MOOC),

a free university accredited course accessible from https://ms.mooc.utas.edu.au/

Biology: MS occurs when the immune system attacks the central nervous system.

• Inflammation leads to formation of plaques or lesions on the brain, spinal cord or optic nerves

• Demyelination interferes with neuronal transmission and leads to neurodegeneration

• Remyelination is inhibited so neurons can’t recover

Symptoms:

• MS can impact anywhere in the body.

• Every person living with MS experiences MS differently, and may have a different set of symptoms.

• MS symptoms are variable, meaning that they change over time. They may worsen in response to the environment or situation, such as high heat. On occasions some symptoms will go away and others will emerge.

Types of MS:

• Relapsing-remitting MS (RRMS): 80%, relapses (lasting from a few days to a few months) followed by remissions. When in remission symptoms get better but are worse than they were before the relapse.

• Primary progressive MS (PPMS): 10 – 15%, gradual worsening of symptoms (progression) with no relapses or remissions.

• Progressive relapsing MS (PRMS): 5%, progression with relapses, but do not experience remissions.

• In some cases people diagnosed with RRMS move to progressive MS where relapses and remissions cease and MS gradually worsens. Alternatively some people experience gradual progression of symptoms but also experience relapses without remissions.

Demographics: there are about three times as many women living with MS than men, i.e. a ratio of 3 : 1.

Risk factors:

Non-modifiable factors

• Genetics – MS appears to be 50% heritable, so family history is the best way to determine genetic risk. However, in MS genetics are complex. Someone might carry hundreds of different genetic variants that increase or decrease their risk of developing MS. Those variants come together maybe to increase their risk slightly of MS. But you need some environmental exposure to develop MS. So, there's not a single genetic cause of MS, it's a complex disease.

• Age – people are most at risk of developing MS in their 30s.

• Biological sex – females have a threefold risk of developing relapsing-remitting MS than males; however males are two to three times more likely to develop primary progressive MS than females

• Exposure to certain viruses, e.g. Epstein-Barr (glandular fever) and infectious mononucleosis (mono).

Modifiable risk factors

• Being overweight increases the risk of MS onset; however there is little evidence to determine its effect on MS progression.

• Smoking increases both the risk of MS onset and progression

• Low (deficient) vitamin D level

• Low amounts of sun exposure

• Diet – some dietary patterns, such as diets that are generally very healthy and have a high amount of omega 3 fatty acids and are rich in nutrients, can reduce the symptoms of MS.

Modifiable risk factors depend on a healthy lifestyle, i.e. no smoking, eating a healthy diet, regular exercise, sufficient levels of essential vitamins such as vitamin D.

Management of risk factors: Risk factors can be managed by setting SMART goals (specific, measurable, achievable, relevant and timely).

Disease Management:

• Monitoring – check the progress of MS, especially effectiveness of treatments / strategies

• Symptom management approaches – exercise, brain and cognitive exercises, cognitive behavioural therapy (CBT)

• Behaviour changes – quit smoking, eat a healthy diet, exercise

• Disease modifying therapies - medications

• Support – create a support network (family, friends, healthcare providers, MS society, peer-to-peer, education). Communication (clear, honest and kind) is key to maintaining relationships and gaining good support.

• Resilience is the ability to recover from challenges.

Living with MS

The biggest monetary costs of MS are lost wages due to missing work and the cost of medications. Disease management is really important for maintaining employment. This includes making reasonable adjustments to the work environment to allow a person living with MS to do their job effectively.

Building resilience is important: have meaningful relationships, exercise, get enough sleep, manage stress, set goals, practice gratitude, practise mindfulness and active relaxation, use problem-focused coping.

Source: International Multiple Sclerosis: Management Practice

https://www.imsmp.org/services/social-work

Social workers can provide the following for patients and their families

• Psychosocial assessment

• Facilitating MS support groups around specific situations and topics such as newly diagnosed, coping with disease progression and others suggested by patients.

• Supportive counselling

• Assistance with navigating various applications, e.g. disability

• Employment issues: accommodations necessary to keep employed, how to ask for accommodations, mediation between person with MS and employer

• Referral to home care agencies, and other allied health professionals, e.g. occupational therapists

• Assistance with accessing meals-on-wheels and transportation services

• Family meetings

Practice Approach

0. [(If necessary), Establish a working relationship – with empathy

• Outline what I know about MS

  • Biology – demyelination in CNS

  • Symptoms – variable for individuals

  • Types – progressive or relapse/remission

  • Some risk factors are modifiable

  • Management by environmental approaches and medication

• Find out about the specific MS]

1. Explore the problem

• Ask about the specific reason for seeking assistance.

• Explore this

  • What is the issue?

  • When did it start?

  • How have they responded?

  • How do they normally respond to problems?

  • How has it affected them?

• Conduct BPPS assessment, especially around support (family, friends, medical, peer-to-peer, education), stressors, client’s strengths and protective factors

• Check Maslow’s Hierarchy

• Identify the problems so both client and social worker agree on this (single sentences)

2. Examine possibilities and solutions

Use Problem Solving / Task Centred / Solution Focused approaches. For example:

• Brainstorm tasks (What has worked before? What are your strengths that may help achieve the goals?)

• Consider obstacles to completion and how the client’s strengths can help manage these.

• Identify goals that are measurable, specific, concrete and achievable in a reasonable time frame (i.e. SMART goals). Frame them in positive language.

• Use miracle question – What would it look like if things were just the way you wanted them to be? Consider pros and cons of various strategies for achieving goals

• Scale these goals on a scale of 1 – 10, i.e. where things are now and where they would be if successfully achieved.

• Decide on a course of action and specify the responsibilities of worker and client with time lines (role playing may be appropriate)

3. Undertaking work together to resolve or address the problem or issue

• Carry out the plan and evaluate, alter, (i.e. adjust approach) and then move to another issue if necessary

4. Finishing the work together, often with a review

• Discuss progress to goals and finishing the relationship regularly during the process

• At the end of the process summarise client achievements, skills, positives and areas to be aware of. Discuss managing future problems that may arise.

Supporting Material

(available on request)

Understanding Multiple Sclerosis (2021). An online course. An initiative of Wicking Dementia Research and Education Centre and Menzies Institute for Medical Research. Duration: 6 weeks. Effort: 2 hours per week. https://ms.mooc.utas.edu.au/

International Multiple Sclerosis (2017). Management Practice. Retrieved from https://www.imsmp.org/services/social-work