The Rehab Team
As MS strikes at the peak
years of career formation and family life, and because it can affect so many
different physical and psychological functions, a rehabilitative approach demands
the coordinated efforts of many professionals working together as a team. The
most important team member is the patient with MS and his or her family
or significant others. A physician, usually a neurologist
(a medical doctor who specializes in physical medicine and rehabilitation)
functions as the team leader. The physician works closely with the patient and
family to identify treatment needs and to initiate the treatment process.
A nurse often functions
as the teams coordinator. As the healthcare professional with the
closest and most sustained contact with the patient, the nurse is in ideal position
to identify the patients ongoing needs and to coordinate referrals to
and communication with, other team members. As a member of the team, the nurse
provides education about MS, and provides the patient and family with ongoing
encouragement and support. The nurse evaluates the patients overall health
status and identifies specific needs in the areas of MS education, medical symptom
management, self-care strategies, referrals to other members of the health care
team, treatment adherence, cognitive status, emotional well-being, psychosocial
adjustment, and need for personal assistance.
MS education includes providing
the patient and family with information about the disease, available treatments,
management strategies, and community resources. Medical symptom management focuses
on helping the patient implement interventions as prescribed by the physician.
The nurse is the key person in helping the patient learn self-care strategies,
including self-injection techniques and how to implement bladder and bowel regimens.
The nurse also focuses on the patients treatment adherence, focusing primarily
on the patients compliance with early treatment recommendations and adherence
to the disease-modifying therapy protocol. The nurse plays a key role in communicating
the patients status and needs with other members of the health care team.
For example, the nurse should alert other team members to early signs of cognitive
changes that might interfere with the treatment plan and rehabilitation. The
nurse is in a good position to assess the patients emotional well being,
including assessing for symptoms of depression. She or he can also assess the
psychosocial needs of the patients support system, family relationships
and communication, and the patients employment situation. The nurse also
determines that patients need for personal assistance in terms of the
need for help with personal care and/or household management.
The speech pathologist addresses problems resulting from impaired muscle control in the lips, tongue, soft palate, vocal cords, and diaphragm that interfere with speech production, voice quality and swallowing. Speech pathologists are also involved in assessing and managing cognitive dysfunction in people with MS, particularly in terms of communication abilities. Other rehabilitation team members may include neuropsychologists, dietitians, orthotists, social workers, and other professionals whose expertise can help MS patients and their families cope with the demands of the disease.
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