Mapping the vocational landscape: A scoping review of occupational therapy support for individuals with Myotonic Dystrophy
Year: 2026
Type: article
Abstract: Background: Adult-onset Myotonic Dystrophy is a multisystemic, progressive neuromuscular disorder that impacts functional independence and labour market affiliation. Despite the vocational disruption associated with the condition, occupational therapy protocols for job retention remain under-developed. Aims: To synthesize the vocational landscape for adults with Myotonic Dystrophy and identify the distinct occupational therapy interventions that facilitate employment, work adjustment, and long-term participation. Methods: A systematic search was conducted across five electronic databases for peer-reviewed literature published between 2015 and 2025. Fourteen studies met the inclusion criteria. Data were analysed using a thematic-analytical framework. Results: The review identified a vocational crisis characterized by high rates of disease-attributed attrition. Physical symptoms, such as systemic fatigue and mobility impairment, are primary drivers of withdrawal; however, "hidden" neurocognitive and behavioural barriers, including executive dysfunction and apathy, significantly impede workplace performance. An "accommodation gap" was observed, where workplace supports are predominantly equipment-focused rather than addressing the systemic policy changes required to manage fluctuating symptoms. Conclusion: Current vocational support is largely reactive. There is a critical need for occupational therapy to transition toward proactive, longitudinal support models that integrate physical rehabilitation with cognitive strategies and systemic workplace advocacy, aligned with the Employment Equity Act in South Africa, to bridge the accommodation gap and improve vocational longevity and social inclusion for this population. Implications for practice l Recognise apathy and executive dysfunction as core brain symptoms, not a lack of motivation1,2. l Move from one-off vocational assessment to longitudinal, life-course monitoring that anticipates decline3,4. l Advocate for policy-level flexibility, not equipment alone, to close the accommodation gap5,6. l In high-unemployment contexts, grade vocational activity toward the informal economy using the Vona du Toit Model of Creative Ability7,8. l Provide early hand-training and ergonomic intervention to extend work retention9,10. l Support renegotiation of occupational identity as work roles contract4,11.
Institution: University of West Attica
Language: English
Subfield: Occupational Therapy
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225814617