What can our service offer an individual with advanced multiple sclerosis:The Rehabilitation Perspective

Rory O’Connor, Jane Pearce, Carolyn Zeyrek

Specialist Rehabilitation Service

AGH and BAtPCT

Introduction

• Hypothetical case report• Combination of real examples and

interventions

Case Report

• 53-year-old man• Admitted to an acute medical ward with

aspiration pneumonia

Case Report

• 53-year-old man• Admitted to an acute medical ward with

aspiration pneumonia

• 6 weeks later…

Acute Medical Care

Referral to Rehabilitation Team

• Bed bound• Incontinent• Unable to swallow• Bed sores• Demented• How do we discharge?

Taxonomy of Problems

MS

Physical:TetraplegiaSpasticitySeatingAccess

Continence:Urinary infectionsConstipation

Dysphagia:NutritionRespiratory

Cognition:InsightSafety

Home:AccessFamilyCarers

Interactions of Problems

Physical:TetraplegiaSpasticitySeatingAccess

Continence:Urinary infectionsConstipation

Dysphagia:NutritionRespiratory

Cognition:InsightSafety

Home:AccessFamilyCarers

Interactions of Problems

Physical:TetraplegiaSpasticitySeatingAccess

Continence:Urinary infectionsConstipation

Dysphagia:NutritionRespiratory

Cognition:InsightSafety

Home:AccessFamilyCarers

Interactions of Problems

Physical:TetraplegiaSpasticitySeatingAccess

Continence:Urinary infectionsConstipation

Dysphagia:NutritionRespiratory

Cognition:InsightSafety

Home:AccessFamilyCarers

ICF Model

Health Condition

Body function Activity Participation

Environment Personal factors

ICF Model

Advanced Multiple Sclerosis

TetraplegiaDysphagia

IncontinencePressure sores

Dementia

Cannot sitCannot eat

OdourUnable todirect care

Unable toreturn home

Access Family andcarers’ distress

Health Condition

Body function Activity Participation

Environment Personal factors

Rehabilitation Interventions

Rehabilitation Interventions

• Medical management• Quality of life issues• Family support• Discharge planning

Continence Management

• Full continence assessment– Bladder scan

• Continence nurse referral• First line medications and equipment

– Nurse prescriber role

• Suprapubic catheter if required

Bowel Management

• Disimpaction• Regular bowel programme• Referral to District Nursing team for

monitoring

Skin Care

• Pressure relief• Management of continence• Special seating and mattress• Manual handling equipment to prevent

shearing skin• District Nurse and Community OT

support for equipment at home

Dysphagia Management

• Speech and language assessment– Swallow assessment– Food consistency advice

• Dietician assessment– Macro and micronutrient advice– Advice on food and fluid consistency

• MDT assessment for PEG

Family Support

• Explanation of impairments and interventions

• Behavioural and cognitive issues• Guilt and distress• Disruption of family life

Discharge Planning

• Discharge liaison manager• Social service referral

– Nursing needs assessment– Level/banding for funding– Home care package

• Specialist nursing referral• Specialist rehabilitation team follow-up

Rehabilitation Principles

Rehabilitation Principles

• Patient at centre of care• Management of impairments• Promotion of independence and

quality of life