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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 or physiatrist (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 team’s coordinator. As the healthcare professional with the closest and most sustained contact with the patient, the nurse is in ideal position to identify the patient’s 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 patient’s 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 patient’s treatment adherence, focusing primarily on the patient’s compliance with early treatment recommendations and adherence to the disease-modifying therapy protocol. The nurse plays a key role in communicating the patient’s 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 patient’s emotional well being, including assessing for symptoms of depression. She or he can also assess the psychosocial needs of the patient’s support system, family relationships and communication, and the patient’s employment situation. The nurse also determines that patient’s need for personal assistance in terms of the need for help with personal care and/or household management.

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Nurses play a key role in communicating the MS patient’s needs to other members of the rehabilitation team.

The primary goal of physical and occupational therapy is to minimize the impact of existing impairments on a person’s ability to carry out activities of daily living and to participate in desired life activities. By assessing neuromusculoskeletal function, therapists can develop treatment plans that focus on early intervention. Particularly in relapsing-remitting MS, early interventions can help patients continue to function effectively and potentially prevent premature withdrawal from the work force. Physical and occupational therapy focus more on modification and compensation than on restoration. Although some functional restoration may occur following an acute exacerbation, the primary emphasis in physical and occupational therapy is on teaching the person effective ways to compensate for existing impairments and make the necessary adaptation to behavioral and environmental modifications. By making adaptations, the person with MS can remain functionally independent and productive, regardless of the extent of impairment. Therapists provide vital education, support, and motivation for the patient with MS and his or her support system. Therapists play an important role in helping the patient to understand the value of the specific interventions prescribed, such as exercise regimens, assistive devices, and environmental modifications and the individual’s own goals. Therapists also teach self-management skills and how to safety and effectively use adaptive equipment.

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Early rehabilitation interventions can help patients continue to function effectively, especially in relapsing-remitting MS.

The physical therapist on the team focuses on evaluating the patient’s movement abilities, with a particular emphasis on physical mobility, balance, posture, and fatigue and pain management. The team’s occupational therapist helps the patient maintain the everyday skills that are essential for independent living and that promote productivity at home and work. Major focal areas for occupational therapy include upper body strength, movement, and coordination, the use of assistive technology to promote independent living, fatigue management through energy conservation, work simplification and stress management, and compensatory strategies for impairments in thinking, sensation, and vision.

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.