Medical, Functional, and Legal Aspects of Vocational Rehabilitation for People with Multiple Sclerosis A majority ofindividuals with multiple sclerosis (MS) are not employed, even though most are at art" age of prime employability and have been successfully employed in the past. Factors that have been shown to decrease employment in these individuals include mobility impairment, bladder and bowel dysfunction, impairment in activities of daily living, cognitive dysfunction, social and family issues, lack of physical and functional access to the workplace, and attitudes of the patient, family, and employer about chronicity and disability in MS. This paper reviews the functional, psychosocial, and legal barriers to employment in these individuals and discusses effective interventions to maintain or regain successful employment in this population.

Catherine W. Britell, MD

RCH Technical Institute Seattle, WA

Laura D. Cooper, JD Nancy Law, LSW National Multiple Sclerosis Society Maintaining employment in individuals with multiple sclerosis (MS) presents a challenge to patients, their families, their employers, and to the medical and rehabilitative professionals who serve them. Employment is a major issue for this population. The onset of MS in 90% of cases is between the ages of 15 and 50 years. l This disease has, therefore, a major effect on individuals during their peak years of education, career development, and family life. The effect ofMS on employment seems to depend both on the characteristics of the disease and on the attributes of the person. Overall unemployment level has been variously reported as 60% to 80% in MS patients. l - 4 Multiple factors affect maintenance of employment or re-employment of individuals with MS. They include medical, psychosocial, legal, and functionaVrehabilitative issues.

FUNCTIONAL DETERMINANTS OF EMPLOYMENT STATUS A number of medical and functional variables have been reported to have an effect on employment of individuals with MS. Kornblith et al. 3 found mobility dysfunction to be the central factor in unemployment of men, though this was only NeuroRehabil1993; 3(4):39-47 Copyright © 1993 by Andover Medical.

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one of four factors important in determining employment status in women. These authors found that in women, activities of daily living (ADLs) were most important; probably due to the fact that women are often responsible for child care and household maintenance in addition to outside jobs, and so have a smaller margin of physical dysfunction that will allow them to maintain their multiple roles. In this situation, employment outside of the home is usually sacrificed first, since family management and child care are often more primary roles. The role of cognitive dysfunction in job maintenance has been studied extensively by Rao et al. 5 They found that MS patients with cognitive impairment have significantly less success at maintaining employment, and this also is a significant family stressor, making the patient seem less able in all areas than he or she actually is. Independence in ADLs and particularly bladder and bowel management are cited by LaRocca and associates Ui as important determinants of employment. Yet, in their studies, specific functional and demographic issues only accounted f

Medical, functional, and legal aspects of vocational rehabilitation for people with multiple sclerosis.

A majority of individuals with multiple sclerosis (MS) are not employed, even though most are at an age of prime employability and have been successfu...
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