Multiple Sclerosis and Epilepsy: Vocational Aspects and the Best Rehabilitation Practices
Bishop, Malachy, Tschopp, Molly K., Mulvihill, Michael, The Journal of Rehabilitation
As chronic and episodic neurological disorders, epilepsy and multiple sclerosis (MS) both present considerable rehabilitation challenges. The lack of predictability associated with both disorders complicates a traditional, linear approach to vocational rehabilitation. A review of the literature suggests that unemployment and underemployment are significant problems for people with MS as well as for people with epilepsy (Fraser, Glazer, & Simcoe, 1992; Hall, Rohaly, & Schneider, 1992; Long, Glueckauf, & Rasmussen, 1998). At the same time, a traditional state vocational rehabilitation (VR) model does not appear to be well equipped to deal with the specific problems encountered by people with these disabilities. The purpose of this paper is to review these problems and the rehabilitation practices that have proved effective in the vocational rehabilitation of people with MS and epilepsy. After discussing each of the disabilities separately, the following topics are addressed: (a) the current employment and rehabilitation situation, (b) vocational assessment, (c) job development, with special attention to the role of the Americans with Disabilities Act, and (d) job retention.
Multiple sclerosis is the most common acquired neurological disease in young adults in North America and Europe (Livneh & Antonak, 1997). It is a chronic degenerative disease characterized by destruction of the myelin sheath. Myelin is the fatty tissue that insulates nerve fibers in the brain and the spinal cord. The effect of this destruction is to slow the electrical impulses that pass along the nerve tracts. As patches of the myelin sheath are destroyed, they are replaced with scar tissue (i.e., scleroses, or lesions) which further interrupts the conduction of nerve impulses (Rumrill, Kaleta, & Battersby, 1996).
The functional limitations which may result from MS are variable and depend upon the site in the brain or spinal cord in which the lesions occur. Symptoms are also variable and may include numbness in the extremities, impaired mobility, paralysis, hand tremors, spasticity, fatigue, vertigo, sexual problems, problems with bladder control, and visual impairments (Livneh & Antonak, 1997). Multiple sclerosis most commonly affects people between the ages of 20 and 40 years and has a prevalence in the US ranging from 30 to 100 per 100,000 persons (Falvo, 1991; Livneh & Antonak, 1997).
Due to a lack of knowledge about MS, rehabilitation professionals may approach all individuals with this disease as similar (Gordon, Lewis, & Wong, 1994). It is important to understand, however, that MS may affect different people very differently. There are four general patterns or courses MS may potentially follow. The benign course, experienced by approximately 20% of people diagnosed with MS, is characterized by sudden onset, one or two mild attacks, near complete remission, and no long-term disability (Hall et al., 1992). The exacerbating-remitting course affects 20 to 30% of people with MS. This course is characterized by sudden onset, relapses and remissions, usually resulting in no permanent damage or restrictions in daily activities. Remissions are often lengthy (Hall et al., 1992). In the remitting-progressive form, experienced by 40% of people with MS, the exacerbating-remitting course is seen for the initial five years or more, and then a more progressive or chronic course is experienced (Hall et al., 1992). Finally, 10 to 20% of people with MS experience the progressive course which has a slow onset and in which slow worsening without remission is experienced (Hall et al., 1992). There is, as yet, no cure for multiple sclerosis, but treatments are available that offer symptomatic relief (Falvo, 1991; Livneh & Antonak, 1997).
Epilepsy is the most common of the chronic neurological conditions (Livneh & Antonak, 1997). Epilepsy may develop from a wide variety of causes. …