In this article
The associated training
The cited resources
Communication notebookThe notebooks to print — EDITH Collection
Multiple sclerosis in care facilities: activities, resources, and concrete arrangements to implement
In care facilities, multiple sclerosis is not only addressed during rehabilitation times. It plays out in the gaps of the day: the moment when one waits for a meal, the quiet hour of the afternoon, the journey to the activity room. It is precisely in these intervals that autonomy is built — or lost. This article brings together activities, resources, and concrete arrangements for multiple sclerosis in care facilities, designed to be implemented starting tomorrow, with the materials already available and without turning every moment into a work session.
This is not a theoretical course. It is a toolbox: fourteen precisely described activities, a daily and weekly organization, the arrangement of spaces room by room, free tools to print, and the role of digital technology. Whether you are a caregiver, an activity leader, or a relative of a resident, you will find ways to take action immediately, taking into account the two realities that govern everything in MS: fatigue and heat sensitivity.
The essentials in 30 seconds
A useful stimulation in multiple sclerosis relies on four principles: short, regular, at the right difficulty, and respectful of fatigue. We build around the day's capacities, not around a fixed program.
- Fatigue commands — we plan demanding activities when energy is at its peak, often late in the morning, and we stop before exhaustion, not after.
- Heat limits — a cool environment protects capacities; heat can temporarily bring back symptoms.
- The right level — the person must succeed in most attempts; repeated failure leads to abandonment.
- Written record — noting each day makes visible evolutions that team memory erases, and facilitates transmission.
- The environment — a few simple adjustments to common areas and the room facilitate participation and prevent falls.
Multiple sclerosis in care facilities: guidelines before any activity
Multiple sclerosis is a neurological disease whose progression and symptoms vary greatly from one person to another, and sometimes from one day to the next in the same person. In a facility, this imposes a simple rule: we do not follow a program, we follow a person. The guidelines below apply before each activity, whatever it may be.
Start from the day's abilities
A person capable of an exercise on Monday may not be on Thursday, without anything having worsened. We ask, we observe, and we adjust without comment.
Aim for success
The person should succeed in most of their attempts. If everything is too easy, we increase the difficulty; if failure repeats, we decrease it immediately.
Short rather than long
Ten to twenty minutes is enough. We stop before fatigue, never when it has set in: a session that ends poorly discourages the next one.
Note down every time
One line is enough: what was done, what caused fatigue, what worked well. This makes progress visible and smooths the transmission between teams.
The following activities are daily activities, not medical protocols. Some may be discouraged depending on the impairments: swallowing disorders, significant spasticity, balance disorders, major fatigue, cognitive disorders. Refer to the personalized project and consult the doctor, physiotherapist, occupational therapist, or speech therapist who follows the person: they are the ones who indicate what is appropriate. Observe, report, apply the instructions, and refer to the healthcare professional for any diagnosis or prognosis.
Fatigue and heat: the framework to respect
Two realities condition everything else. Ignoring them means proposing activities that fail and discourage; respecting them multiplies the chances that participation becomes a pleasure.
Fatigue is one of the most frequently reported symptoms in multiple sclerosis: the ARSEP Foundation and patient associations describe it as an exhaustion that is not proportional to the effort made and that rest does not always suffice to erase. Concretely, in a facility, this means three things. We schedule the most demanding activity when energy is highest — often late morning, sometimes otherwise depending on the person. We break it down: three ten-minute sessions are better than one thirty-minute session. And we ensure a real quiet time in the afternoon, without screens or stimulation, which is part of the program just like the activities.
Heat sensitivity is the other point of vigilance: in many people, an increase in body or environmental temperature can temporarily cause symptoms to reappear (blurred vision, heavy legs, increased fatigue). This phenomenon is reversible, but it hinders activity. Therefore, we ensure a temperate environment, avoid the hottest times of the day in summer, offer cool water, and do not hesitate to postpone or shorten when it is heavy.
Three questions in ten seconds: has the person slept well and recovered? Is the room cool? Do they want to, right now? If the answer is no, we lighten or reschedule. An activity canceled for good reasons is better than an activity endured.
Motor skills, balance and daily gestures
These activities maintain mobility, coordination and confidence. They complement physiotherapy and occupational therapy, they never replace them. Ask the rehabilitation team which ones best serve the current objectives, and always adapt to the day's fatigue level.
Folding and sorting laundry
- Objective — coordination of both hands, fine motor skills, sitting posture, participation in a useful task.
- Materials and duration — a basket of clean and light laundry, 10 minutes, sitting at a stable table.
- Procedure — start with large pieces that are easy to grasp: towels, dishcloths. The less skilled hand holds, the more skilled hand folds. Let the person do it, do not do it for them.
- Easier — fold in half only, with thick towels that slip less.
- Harder — pairing socks, folding clothes into quarters, sorting by color.
- Sign that it works — the less skilled hand participates spontaneously, without being asked.
Seated cooking workshop
- Objective — grip strength, hand-eye coordination, planning a task in steps.
- Materials and duration — a non-slip board (or a damp cloth underneath), wide-handled utensils, simple ingredients, 15 minutes, always seated.
- Procedure — wash, mix, garnish: prepare a fruit salad, assemble jars, decorate a cake. The person performs; the companion prepares and secures the station.
- Easier — a single step, broad movements (mixing, pouring).
- Harder — follow a recipe displayed in four steps, without oral reminders.
- Sign that it works — movements become more precise, fatigue sets in later than at the beginning.
Secure balance course
- Objective — balance, weight transfer, confidence in movement.
- Materials and duration — a clear corridor, a support bar or handrail, usual technical aid, 5 to 10 minutes.
- Procedure — same route every day, with a support point identified halfway. Move slowly, keeping the gaze on the horizon rather than on the feet. A companion always stays within reach.
- Easier — a short round trip with support possible all the way, several times a day.
- Harder — navigate around a light obstacle, or walk while holding a short conversation, which increases the load.
- Sign that it works — the same route requires fewer breaks, the gaze is lifted.
Gentle exercise in a chair
- Objective — joint range, muscle awakening, body awareness, without putting oneself in danger.
- Materials and duration — a stable chair, possibly a small lightweight ball or a scarf, 10 minutes.
- Procedure — slow and broad movements of the arms, hands, ankles, following a simple instruction and a regular rhythm. Strictly respect the ranges indicated by the physiotherapist and never force.
- Easier — movements of the upper body only, by imitation.
- Harder — chaining a small memorized sequence of three movements.
- Sign that it works — movements become broader and more fluid over the days.
❌ To avoid : pushing “ to progress ” when the person shows signs of fatigue (slower words, less precise gestures, blurred vision). In MS, too much effort does not gain ground, it loses it for the rest of the day.
Memory, attention and processing speed
Multiple sclerosis can be accompanied by cognitive disorders, particularly attention, working memory, and a slowdown in information processing. This does not mean giving up : it means allowing more time, reducing distractions, and valuing every success.
The reconstructed list
- Objective — working memory, categorization, memorization strategies.
- Materials and duration — paper, pencil, 10 minutes, in a quiet space.
- Procedure — state a shopping list of five or six items, talk about something else for a minute, then the person recalls. Allow as much time as needed, without prompting the answer too quickly.
- Easier — three items, immediate recall.
- Harder — ten items to group by section before recalling.
- Sign that it works — the person invents their own tricks (grouping, associating, visualizing).
The adapted pairs game
- Objective — visual attention, memory, spatial scanning.
- Materials and duration — a deck of cards or large printed images, 10 minutes.
- Procedure — lay the cards face down, turn over two cards at a time to find pairs. Limit the number of cards according to fatigue and maintain a pace without time pressure.
- Easier — six cards, in a single row, well contrasted.
- Harder — twenty cards, spread widely on the table.
- Sign that it works — the number of attempts needed decreases from week to week.
The agenda for the next day
- Objective — prospective memory, temporal markers, sense of control over one's day.
- Materials and duration — a large box agenda or a whiteboard in the room, 5 minutes each evening.
- Procedure — write down together the two or three appointments or activities for the next day, then check off the next evening what took place.
- Easier — the caregiver writes, the person reads aloud.
- Harder — the person writes alone and anticipates the week.
- Sign that it works — they consult their agenda spontaneously during the day.
The sorting by themes
- Objective — sustained attention, mental flexibility, reasoning, with a concrete support.
- Materials and duration — a set of image cards (food, animals, objects), or magazine photos, 10 to 15 minutes.
- Procedure — sort the images according to an announced criterion (what can be eaten / what cannot be eaten), then change the criterion (by color, by size) to work on flexibility.
- Easier — two very different categories, few cards.
- Harder — three categories, or find the common criterion oneself.
- Sign that it works — the change of instruction is followed without confusion.
Understanding MS to adjust each activity at the right time
Knowing why fatigue and heat weigh so heavily, spotting the signs of a bad day, adapting one's posture : the DYNSEO training “ Multiple Sclerosis in institutions ” dedicates short and concrete lessons to this. 32 lessons, 100 % online, unlimited access, at your own pace. Certified organization Qualiopi (N° 11757351875), certificate of completion.
Discover the training — 20 €Language, communication and social connection
Depending on the impairments, MS can affect the articulation, breath, or rhythm of speech. These activities maintain communication and connection; they complement speech therapy when it exists, without replacing it. Ask the speech therapist what best serves the current objectives.
Reading in two voices
- Objective — articulation, breath, comprehension, and pleasure of reading.
- Material and duration — a short article or a text in large print, 10 minutes.
- Procedure — the companion reads a sentence, the person reads the next one. We stop at the end of a paragraph, never in the middle of an effort. We do not correct every mistake.
- Easier — the person only reads the last word of each sentence.
- Harder — summarize the paragraph in one sentence after reading.
- Sign that it works — the read sentences get longer, the pace becomes regular.
Guided memory workshop
- Objective — old memory, spontaneous speech, valuing life history.
- Material and duration — objects, photos, or period music, 15 minutes, in a small group or individually.
- Procedure — we present a trigger (a song, a photo, an everyday object from the past) and let whatever comes come, without correcting or questioning in rapid succession. An open question is enough: “What does this remind you of?”
- Easier — a single very familiar trigger, short time.
- Harder — build a small chronological narrative from several memories.
- Sign that it works — speech becomes more fluid, the exchange turns into a conversation.
Prepared connection with loved ones
- Objective — maintain family connection and regain confidence in remote exchange.
- Material and duration — a phone or tablet, a sheet with two or three prepared sentences, 5 to 10 minutes.
- Procedure — we choose a kind and informed interlocutor, we write together what we want to say to them, then we call on speakerphone with the companion next to us, without intervening.
- Easier — a recorded voice message, which can be replayed and redone.
- Harder — a call without a sheet, then a video call.
- Sign that it works — the person themselves asks to contact a loved one.
Well-being, mood, and sensory stimulation
MS can weigh on mood, and mood conditions adherence to everything else. These three activities do not aim for any performance: they maintain pleasure, calm, and the feeling of existing as a person, not as a patient. For any lasting sadness, withdrawal, or loss of momentum, we talk to the doctor or psychologist: moral suffering can be treated.
Personal playlist
- Objective — mood, evocation of memories, relaxation. Familiar melodies often remain very accessible.
- Material and duration — a speaker or headphones, a selection of music from the person's 15-30 years, 15 minutes.
- Procedure — listen together, then let the speech or silence come. Many people hum, keep the beat, share a memory.
- Variant — associate a photo from the same era with each piece.
- Sign that it works — the face relaxes, the person requests “their” music.
The calming sensory time
- Objective — relaxation, grounding in the moment, reduction of tension and mental fatigue.
- Materials and duration — soft materials to touch, scents to smell (with the team's agreement), dim light, 10 minutes.
- Procedure — offer, without imposing, a slow exploration: touch a fabric, smell a familiar scent, listen to soft sounds. Respect refusals, which are also a form of choice.
- Easier — only one sense engaged at a time.
- More difficult — associate an emotion or a memory with each sensation and name it.
- Sign that it works — breathing slows down, the person extends the moment on their own.
The adapted creative workshop
- Objective — expression, pleasure of doing, pride in a visible result, fine coordination.
- Materials and duration — simple materials to handle (large markers, gluing, modeling clay, indoor gardening), 15 to 20 minutes.
- Procedure — a short project with a concrete result on the same day. Adapt tools to grip (thick handles, non-slip supports) and value the gesture more than perfection.
- Easier — participate in only one step of the collective project.
- More difficult — carry out a small project from start to finish over several sessions.
- Sign that it works — the person shows their work, talks about it, wants to do it again.
A typical day and a typical week
The classic trap: wanting to offer everything every day. One activity per domain and per day is more than enough, as long as it takes place and respects the available energy. Here is a framework that places demands when energy is high and protects the calm time of the afternoon.
| Moment | What we put in | Duration |
|---|---|---|
| End of morning | The most demanding activity of the day — motor skills or cognition | 15-20 min |
| Before the meal | A time for connection: reading aloud, exchange, prepared call | 10 min |
| Beginning of afternoon | Mandatory calm time, without screens or stimulation | 45-60 min |
| Mid-afternoon | Gentle digital session or board game | 15 min |
| End of afternoon | A pleasure activity — music, creative workshop, sensory | 15-20 min |
| Evening | Agenda for the next day, in the room | 5 min |
Throughout the week, we rotate the main focuses to vary the stimuli without overloading, and we keep one truly free day. Rest is not an absence of program: it is part of the program.
| Day | Main focus of the day |
|---|---|
| Monday | Motor skills — laundry, gentle gymnastics |
| Tuesday | Cognition — reconstructed list, pairs game |
| Wednesday | Communication — reading aloud, memory workshop |
| Thursday | Independence — cooking workshop from start to finish |
| Friday | Social connection — prepared call or visit, group game |
| Saturday | Pleasure — music, creative workshop, short outing |
| Sunday | Nothing imposed. Rest is part of care. |
This typical week is a base, not an obligation. On a day of great fatigue, we keep only the pleasure activity at the end of the day and the evening agenda. We never catch up: we simply resume the next day where we left off.
Arrange the spaces of the establishment
A well-thought-out environment does half the work: it reduces unnecessary fatigue, secures movements, and makes participation possible. Many adjustments cost almost nothing. For others, an assessment by the occupational therapist is the best investment.
| Space | What is problematic | What we change |
|---|---|---|
| Room | Bed too low, switch far away, nighttime getting up | Adjusted bed height, switch accessible from the bed, illuminated path to the toilet |
| Bathroom | Wet floor, prolonged standing, transfers | Grab bars fixed to the wall, non-slip mat, shower seat, equipment approved by the occupational therapist |
| Activity room | Heat, background noise, insufficient light | Temperature-controlled and ventilated room, noise sources turned off during the activity, enhanced lighting without glare |
| Dining room | Heavy dishes, table unsuitable for wheelchair | Lightweight dishes and ergonomic cutlery, table at the right height, quiet place for fatigable individuals |
| Hallways and circulation | Carpets, clutter, long distances | Clear and non-slip floor, continuous handrails, regular resting benches along the routes |
| All spaces | Fatigue related to movement, disorientation | Bring activities closer to the rooms when possible, clear and contrasting visual markers |
Prefer materials in large print, with high contrast (dark text on light background), without information overload on the same page. Space out the lines, limit the number of items per exercise, and always allow the person to take a break as soon as their vision blurs: this is often a sign of fatigue, not disinterest.
Free printable materials
These DYNSEO tools are freely downloadable and printable from the catalog of free tools. Three of them are enough to structure the entire routine described here and to facilitate communication between the team and the family.
- Progress tracking chart (visual) — one mark per day, one line per activity. This is the tool that makes progress visible and reignites motivation when it wanes. Displayed in the room, it also becomes a useful time marker.
- Session tracking sheet — what was worked on, what was tiring, what worked well. To be filled out in one minute after each activity, it ensures continuity between caregivers and days.
- Communication notebook — to relay your observations to the care team, the doctor, or the family without forgetting anything. It links what is seen daily to care decisions.
- Skills tracking chart — to visualize over several weeks what is maintained, what progresses, and what needs to be adapted.
- Word notebook — a communication tool to personalize with familiar photos, useful as soon as speech becomes fatigued.
The principle is always the same: write little, but write every day. A one-line observation, noted at the moment, is better than a long summary reconstructed from memory a week later.
The role of digital technology and the application JOE
A tablet does not replace rehabilitation or real activities. It provides two things that paper does not: automatic adjustment of the level of difficulty, which avoids failure as well as boredom, and a record of results that objectively tracks progress without discussion.
For the adult affected by multiple sclerosis, the JOE application is the reference tool: short games of memory, attention, logic, and language, with an adaptable level. It is used in brief sequences, at a fixed time, like a ritual.
| Application | For whom | Usage type |
|---|---|---|
| CLINT | Adult concerned with MS | 15 minutes a day, 2 to 3 memory, attention, and logic games |
| SCARLETT | Senior, simplified interface | Same principle, with navigation designed for seniors |
| MY DICTIONARY | Difficult communication, visual support | Helps with daily communication |
The right dosage: about fifteen minutes a day, at a fixed time, rather than a long weekly session. Keep the screen away from late evening, which disrupts sometimes already fragile sleep, and stop at the end of the scheduled time, even when everything is going well. To complement, the cognitive tests catalog helps to establish a starting point, always to be interpreted with a professional.
The 5 mistakes to avoid
- Ignoring fatigue. Continuing "to finish" when signs of fatigue appear wastes the session and compromises the rest of the day. In MS, we stop before, never after.
- Neglecting heat. An overheated room, a time slot in the summer heat: and symptoms reappear, completely skewing the activity. A cool environment is part of the setup.
- Doing instead. Out of kindness or to save time, we deprive the person of what they can still do. This is a major cause of avoidable loss of autonomy.
- Choosing a level that is too difficult. Repeated failure discourages and leads to giving up. Better too easy for a week than too hard for two days.
- Not taking notes. Without written records, slow developments become invisible, communication is lost between teams, and one wrongly concludes that nothing is changing.
To go further
In-depth guideMultiple sclerosis in institutions: the complete guide to understanding what is at stake
Support & contactsWho to contact, what support is available, and how to sustain over time
TrainingProgram, content, and who the DYNSEO MS training is for
Frequently asked questions
How often should these activities be offered?
Every day, but little by little. One activity per domain and per day is enough, provided it really takes place and respects the available energy. Regularity matters more than intensity: fifteen minutes every day nourish abilities better than a long weekly session. On days of great fatigue, we do not eliminate everything: we keep a short, enjoyable activity to protect the ritual itself. And we plan at least one truly free day per week, as rest is part of care in multiple sclerosis.
How long should a session last?
Between ten and twenty minutes for a given activity, and rarely more than an hour in total throughout the day, in split sequences. Beyond that, the characteristic fatigue of MS takes over and the activity becomes counterproductive. The golden rule: we stop before fatigue sets in, not when it is already there. Observe the subtle signs — slower words, less precise gestures, blurred vision — and conclude the session on a success. An activity that ends well encourages wanting to start again; an activity pushed too far discourages the next one.
How to motivate a person who refuses?
Three levers work better than insistence. First, lower the difficulty until successes are achieved, as it is often the fear of failure that blocks. Next, replace the exercise with an activity that makes sense to the person: cooking, listening to their music, calling a loved one. Finally, make progress visible with a displayed tracking chart. Negotiate the duration rather than the principle: "let's try for five minutes and stop if you want" almost always yields more. And respect the refusal of the day: it may simply signal fatigue that is better to heed.
What equipment is really needed?
Almost nothing specialized. Most activities rely on what the institution already has: linen, kitchen utensils, cards, photos, music, a calendar. Three useful investments make a difference: non-slip supports and wide-handled utensils for gripping, documents in large, highly contrasted fonts for vision, and a tablet for games that automatically adjust difficulty. DYNSEO tracking supports are free to print. For safety adaptations (grab bars, shower seats), it is the occupational therapist who indicates the appropriate equipment for each person.
Are these activities suitable for all ages?
Multiple sclerosis often begins in young adults, but it affects people of all ages in institutions. The activities presented here can be adapted by modulating difficulty, duration, and theme, but never the requirement to respect the person. For a young adult, we prioritize supports in line with their interests and history; for an older person, we can simplify the digital interface with an application like SCARLETT. In all cases, we start from what makes sense for the person. For any questions about evolution or abilities, refer to the doctor who follows them.
These activities are general everyday suggestions. They do not replace prescribed rehabilitation or medical advice. Have what is suitable for each person validated by the doctor and the rehabilitation team (physiotherapist, occupational therapist, speech therapist) who are following them. In case of new symptoms or emergencies, contact the emergency services in your country.
Implement these activities, supports, and arrangements for multiple sclerosis in a facility
The DYNSEO training “Multiple Sclerosis in a Facility: Understanding the Disease and Adapting Professional Practice” covers all of this step by step: understanding the disease, adjusting activities to fatigue, arranging the environment, supporting over time. 32 lessons, 100% online, unlimited access, at your own pace. Certified organization Qualiopi (No. 11757351875), certificate of completion.
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