Staff training & patient education · Multiple sclerosis

MS Training Sheet

One project, two audiences: a quick reference that helps therapists treat the symptoms of MS, and a large-print handout patients and families can use at home.

Audience: Therapists, patients and families
Setting: Inpatient rehab (IRF)
Format: Staff sheet + large-print handout
Pairs with: Executive Function in IADLs

The project

Problem

MS symptoms change from day to day and are often invisible: fatigue, heat sensitivity, slowed thinking. Therapists who see MS less often aren't sure how to adjust a session, and patients leave with general advice that's hard to use at home.

Solution

A staff sheet that links each common symptom to what OT can do, tells heat effects apart from a relapse, and names the measures to track. A matching patient handout covers saving energy, staying cool and when to call, in plain language and large print.

How it's evaluated

The handout is checked for reading level, taught with teach-back, and revised from patient and staff feedback. The staff sheet gets a short usefulness survey after use.

The project · MS training sheets

MS Training

MS quick reference for OT

Adjusting sessions for multiple sclerosis

Staff

Common symptoms and what OT can do

Symptom	What you may see	OT approach
Fatigue	Worse as the day goes on; out of proportion to activityOne of the most common and disabling symptoms	Energy conservation (4 Ps), activity diary, schedule therapy at the patient's best time
Heat sensitivity	Symptoms flare with exercise, hot showers or fever, then settle with cooling	Cool room, cooling vest or towels, cool drinks, shorter bouts with rest
Cognition	Slower processing, attention and memory problems, trouble planning	Strategies for real IADLs, written routines, reduced distractions (see the executive function in-service)
Weakness & spasticity	Foot drop, stiffness, cramps, poor endurance	Stretching and positioning, task-specific strengthening, refer for bracing as needed
Tremor & ataxia	Shaky reaching, spills, poor handwriting	Stabilize the arm on a surface, adaptive utensils, try weighted options
Sensory loss	Numb hands or feet, poor sense of position	Check water temperature by thermometer, visual checks of skin and grip
Vision	Blurring, double vision, poor contrast	Good lighting, high contrast, large print, reduce clutter
Bladder	Urgency, night trips, fall risk	Bathroom plan, clear night path, commode or urinal as needed
Mood	Low mood, anxiety, loss of interest	Screen and share with the team; meaningful activity in the plan

Heat effect, pseudo-relapse or relapse?

Heat effect

Old symptoms briefly worse after heat or exercise (Uhthoff's phenomenon). Settles within hours of cooling down.

Cool down and rest. Not new damage.

Pseudo-relapse

Old symptoms worse because of infection (often a UTI), fever, stress or poor sleep. Improves when the cause is treated.

Tell the nurse or provider so they can check for infection.

Possible relapse

New or clearly worse symptoms lasting 24 hours or more, without fever or infection, such as new vision loss, weakness or numbness.

Report to the provider the same day.

Session tips

Ask about today's fatigue and sleep before starting.
Keep the room cool and have water ready.
Build in rest breaks; stop before exhaustion, not at it.
Aerobic and strength exercise help: start low and progress slowly.
Teach strategies inside real tasks: dressing, cooking, work.
Include the care partner in teaching.

Report to the team

New or worsening symptoms lasting 24 hours or more
Sudden vision loss or eye pain
Signs of infection, especially urinary
A fall, or new trouble swallowing
Low mood, hopelessness or thoughts of self-harm

Measures to track

Modified Fatigue Impact ScaleEffect of fatigue on daily life

Nine-Hole Peg TestHand dexterity, each side

Symbol Digit Modalities TestProcessing speed

Timed 25-Foot WalkWalking speed, with the PT

Developing and evaluating it

Reading level

Handout written at about a 6th-grade reading level, with large print and one idea per section.

Teach-back

Patients and care partners explain the 4 Ps and when to call in their own words before discharge.

Feedback

A three-question survey for patients and a usefulness survey for staff, with changes made each round.

Team review

Reviewed by OT, PT, nursing and the neurology team before use.

Clinical guidance follows current National MS Society education and the treating team's plan. Measures and red flags may be adjusted to match the clinic's protocols.