Running head: ASSISTIVE TECHNOLOGY PAPER

Michelle Wilson
Assistive Technology Paper
Touro University Nevada

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The summer of my junior year of college, I was given the opportunity to be the caregiver
for a woman diagnosed with Multiple Sclerosis (MS). During that time, I was also exploring the
occupational therapy profession and deciding if it I wanted to further pursue it as a profession. I
knew very little about MS and personally had not spent much time with anyone diagnosed. As
her caregiver, I was responsible for driving to various appointments, assisting with meal
preparation, and running errands. I accepted the opportunity, and was ready to see lifes
perspective in the eyes of an individual living with MS.
Description of the Client
Joann was diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) in her early
forties and has experienced the regression for over 20 years. RRMS is clearly defined as acute
worsening of neurological function followed by partial improvement or stability between attacks
(Forwell, Copperman, & Hugos, 2008). She is 65-years-old, married, and lives in a single-story
home which is wheelchair accessible. Before being diagnosed with the disease, she and her
partner built a log style home in the mountains in North Idaho. As the disease progressed, she
has gone through multiple ambulation aids first using a cane, then walker, then a manual
wheelchair when needed, and currently utilizing an electric wheelchair full time. It was
impossible for Joann to maneuver through the log style home with an electric wheelchair and
modifying the home was financially impossible. The couple sold their dream home and found a
single-story home which was wheelchair accessible in a retirement community. She is extremely
independent in the morning, but once the afternoon approaches, she is becomes fatigued and has
a difficult time engaging in activities. To manage the RRMS symptoms, Joann attends physical
therapy to focus on ambulation with a front wheel walker, acupuncture for pain management,
and aquatic therapy to increase endurance.

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Description of the Diagnosis

MS is a neurological disease in which patches of the brain and spinal cord lose
myelination, specifically attacking the myelin sheath surrounding nerve fibers (National Multiple
Sclerosis Society, n.d.c.). The cause is unknown, and affects women two to three times more
often than men (Forwell, Copperman, & Hugos, 2008). There are many symptoms associated
with MS, making the diagnosis process extremely challenging. A few of the most common
symptoms associated with MS include fatigue, visual and oculomotor abnormalities, sensory
difficulties, weakness, spasticity, cognitive impairments, and psychosocial difficulties (Reed,
2014). The degree of symptoms vary amongst each individual based upon the type of MS they
are diagnosed with, time of day, and level of fatigue based upon time of day.
There are many avenues to manage the symptoms of MS. Disease management avenues
include comprehensive care, medication, rehabilitation, psychological support, and various
complementary and alternative medicines. In regards to comprehensive care, these individuals
are meeting with multiple medical professionals daily and the interdisciplinary team needs to
communicate constantly. Medication is available to further slow disease progression, but not
intended to modify the condition (Poole, 2011). Therapy suggestions include physical therapy to
address strength, range of motion (ROM), and ambulation, occupational therapy to teach
compensatory strategies through energy conservation and environmental modifications, as well
as aquatic therapy for light exercise (Foti, 2013). Complementary and alternative medicine
(CAM) is also very popular amongst this population. CAM includes meditation, tai-chi,
acupuncture, temperature regulation strategies, and stress management to better cope with the
symptoms.

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Joann would manage the MS symptoms in a variety of ways including physical therapy,
aquatic therapy, acupuncture, and cardiac rehabilitation. I attended aquatic therapy with her two
to three times weekly and drove her to the pool in a wheelchair accessible vehicle, assisted with
donning and doffing clothing as well as swimsuit, completed multiple transfers from the
wheelchair to the pool and shower, and assisted with the therapy process in the pool.
Description of the Intervention
Aquatic therapy is a traditional therapeutic management used to manage fatigue, maintain
ROM and maximize strength (Aquatic Therapist, 2008). By managing fatigue, maintaining
ROM, and maximizing strength one can cope with the symptoms and slow disease progression
of MS. Aquatic therapy allows an individual to use muscles that are not typically used
throughout the day if debilitated or in a wheelchair. Benefits of aquatic therapy include
decreasing spasticity, increasing functional mobility, decreasing pain during exercise, improving
breathing capacity, and ultimately improving ones quality of life. When completing aquatic
therapy with an individual diagnosed with MS it is important to consider time of day that session
takes place, the temperature of water, managing durable medical equipment, if needed, and
donning and doffing swimsuit after increased fatigue levels.
Literature Review
In a study done by Kargarfard, Etemadifar, Baker, Mehrabi, and Hayatbakhsh, the effect
of aquatic therapy on MS fatigue was completed to analyze an individuals quality of life after
engaging in this type of exercise routine (2012). Quality of life is an area minimally researched
in patients diagnosed with MS. Due to fatigue being one of the most common disabling
complaints in patients with MS, it is crucial to promote strategies to lessen the difficulties one is
faced with through various strategies. The buoyancy and viscosity of water facilitates physical

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activity for those faced with fatigue (Kargarfard et al., 2012). In this study, exercise training was
done three times per week with each session lasting 60 minutes with a warm up, exercise, and
cool down portion. After the eight week aquatic therapy research study was completed,
participants in the aquatic therapy group showed significant improvements in fatigue as well as
improvements in the health-related quality of life form.
Another study done by Broach and Dattilo was conducted to examine the effects of
aquatic therapy for individuals diagnosed with multiple sclerosis and their gross motor activity
and fatigue (2001). There is very little research on the benefits of aquatic therapy for patients
diagnosed with MS and it is important to highlight this therapy as a successful option to manage
symptoms. This study was different than the previous one mentioned because they focused on
the effects aquatic therapy had on further gross motor activities including walking up and down
stairs and using an exercise bicycle machine. Aquatic therapy is unique because it allows
patients who do not have the opportunity to walk on dry land the ability to weight bear and
ambulate when otherwise unable to do so. Following the study, patients expressed
improvements in both physical and mental fatigue through the mental and physical fatigue scale
(Broach & Dattilo, 2001). With fatigue being the most detrimental symptom of MS, research
supporting aquatic therapy in the improvement and management of fatigue is extremely
beneficial as a technique to manage symptoms.
Purpose of Adaptive Device
As stated before, Joann is independent in dressing, however, requires assistance with
donning and doffing her swimsuit due to an increased level of fatigue following aquatic therapy.
As her caregiver, it was constantly a mission to find the best swimsuit which would allow her to
dress independently at aquatic therapy. After countless visits to the local Good Will, that perfect

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swimsuit was never found and she continued to require assistance after exacerbation of
symptoms following activity exertion in the pool. For my assistive technology device, I wanted
to design a swimsuit that would better suit her needs and increase independence in donning and
doffing her swimsuit. I decided to adapt a one piece swimsuit utilizing Velcro on the seam to
ensure optimal performance and independence in dressing and undressing a swimsuit before and
after aquatic therapy.
Cost Analysis
The materials needed to make an adapted swimsuit include a swimsuit of choice, Velcro,
sewing needles, thread, a seam ripper, sewing pins, and scissors. I was able to purchase all of
these items, except the swimsuit, at Jo-Ann Fabric. One package of Velcro cost 3.98, sewing
needles were 3.99, thread cost 3.29, the seam ripper was 3.99, sewing pins were 3.99, and lastly
scissors were 5.99. The cost of the swimsuit will vary but the one I used was 30.00, making the
total cost for the project 55.23

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Comparison to Similar Devices

Location
www.buckandbuck.com

Description

Cost

This company does not design

22.00
swimsuits, however this
undergarment was designed to assist
individuals with independence in
dressing. There are adjustable hooks
on the shoulders and helps to restore
ones dignity. I think if the company
designed a swimsuit with similar
hooks located on the shoulder, it
could enhance independence in
donning and doffing a swimsuit. It is
cheaper due to use of cotton rather
than spandex.
www.adaptationsbyadria An adaptive swimsuit which
35.00
n.com/product-p/501contains a zipper in the front in order
505.htm
to make dressing and undressing
easier. This is not a typical one-piece
swimsuit style which Joann prefers.
Having the extra material on the legs
may increase difficulty when
donning and doffing swimsuit.

Picture

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Picture of Assistive Device

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9
References

Aquatic Therapist. (2008). Aquatic therapy precautions and contraindications. Retrieved from
http://www.aquatictherapist.com/index/2008/03/aquatic-thera-2.html
Broach, E., & Dattilo, J. (2001). Effects of aquatic therapy on adults with multiple sclerosis.
Therapeutic Recreation Journal, 35(2), 141-154.
Forwell, S. J., Copperman, L. F., & Hugos, L. (2008). Neurodegenerative diseases. In M. V.
Radomski, & C. A. Trombly Latham (Eds.), Occupational therapy for physical
dysfunction (6th ed., pp. 1080-1105). Baltimore, MD: Lippincott, Williams & Wilkins.
Foti, Diane. (2013). Section 4: multiple sclerosis. In H. M. H. Pendleton, & W. Schultz-Krohn
(Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (7th ed.,
pp. 936-940). St. Louis, MO: Elsevier/Mosby.
Kargarfard, M., Etemadifar, M., Baker, P., Mehrabi, M., & Hayatbakhsh, R. (2012). Effect of
aquatic exercise training on fatigue and health-related quality of life in patients with
multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 98, 1701-1708.
http://dx.doi.org/10.1016/j.apmr.2012.05.006
National Multiple Sclerosis Society (n.d.c). Definition of ms. Retrieved from
http://www.nationalmssociety.org/What-is-MS/Definition-of-MS
Pendleton, H.M. & Schultz-Krohn, W. (2013). Application of the occupational therapy practice
framework to physical dysfunction. Pedrettis occupational therapy: Practice skills for
physical dysfunction. (7th ed., pp.40). St. Louis, MO: Elsevier/Mosby.
Poole, J. L. (2011). Enabling performance and participation for persons with movement disorder.
In C. H. C. Christiansen, & K. M. Matuska (Eds.), Ways of living: Intervention strategies
to enable participation (4th ed., pp. 299-313). Baltimore, MD: AOTA Press.