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

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What can our service offer an individual with
advanced multiple sclerosisThe Rehabilitation
Perspective

• Rory OConnor, Jane Pearce, Carolyn Zeyrek
• Specialist Rehabilitation Service
• AGH and BAtPCT

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Introduction

• Hypothetical case report
• Combination of real examples and interventions

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Case Report

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

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Case Report

• 53-year-old man
• Admitted to an acute medical ward with aspiration
  pneumonia
• 6 weeks later

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Acute Medical Care
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Referral to Rehabilitation Team

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

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Taxonomy of Problems
Dysphagia Nutrition Respiratory
Physical Tetraplegia Spasticity Seating Access
Continence Urinary infections Constipation
MS
Cognition Insight Safety
Home Access Family Carers
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Interactions of Problems
Dysphagia Nutrition Respiratory
Physical Tetraplegia Spasticity Seating Access
Continence Urinary infections Constipation
Cognition Insight Safety
Home Access Family Carers
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Interactions of Problems
Dysphagia Nutrition Respiratory
Physical Tetraplegia Spasticity Seating Access
Continence Urinary infections Constipation
Cognition Insight Safety
Home Access Family Carers
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Interactions of Problems
Dysphagia Nutrition Respiratory
Physical Tetraplegia Spasticity Seating Access
Continence Urinary infections Constipation
Cognition Insight Safety
Home Access Family Carers
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ICF Model
Health Condition
Body function
Activity
Participation
Environment
Personal factors
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ICF Model
Advanced Multiple Sclerosis
Tetraplegia Dysphagia Incontinence Pressure
sores Dementia
Cannot sit Cannot eat Odour Unable to direct care
Unable to return home
Access
Family and carers distress
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Rehabilitation Interventions
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Rehabilitation Interventions

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

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Continence Management

• Full continence assessment
• Bladder scan
• Continence nurse referral
• First line medications and equipment
• Nurse prescriber role
• Suprapubic catheter if required

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Bowel Management

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

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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

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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

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Family Support

• Explanation of impairments and interventions
• Behavioural and cognitive issues
• Guilt and distress
• Disruption of family life

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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

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Rehabilitation Principles
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Rehabilitation Principles

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