Managing multiple sclerosis (MS) typically takes a team of doctors and health care professionals who will work closely with you to determine the best course of care.
Neurologists are physicians who are trained to specialize in diseases of the nervous system and who usually diagnose and treat multiple sclerosis. People can see them in private practices, in community-based MS centers, in academic settings, and in general clinical settings. They have expertise in differentiating MS from other diseases and determining appropriate disease modifying as well as symptomatic treatments.
Nursing professionals are registered nurses who have had basic nursing education, advance practice training, or have special expertise in multiple sclerosis. They assist the patient to adjust to their diagnosis, support them as they begin therapies, and counsel them when changes are required throughout the course of the disease.
Social workers are trained to assist people in identifying and accessing community services programs, resources, and entitlements. They are also trained to provide counseling and emotional support, along with crisis intervention.
Psychologists are experts in diagnosing and treating issues related to mental health and cognitive problems. Interventions can include specialized testing and ongoing counseling and support for MS patients and their families.
Case managers are usually employed by insurance carriers to guarantee appropriate services, assistive devices, and care, as covered by health care plans. Case managers are either nurses or social workers.
Physiatrists are physicians who have specialized training in rehabilitation medicine. They are knowledgeable about physical and occupational therapy, as well as in the use of assistive devices to aid physically challenged patients. (The specialty known as physiatry was founded by Dr. Howard Rusk in New York City during World War II, when many servicemen experienced disabling injuries during the war and required services to allow them to return to fuller and more productive lives.) Physiatrists care for patients in both inpatient and rehabilitation settings and in MS clinics and centers throughout the United States. They perform a comprehensive assessment to ascertain neurologic status, physical function, psychological adjustment, community supports, and the need for rehabilitative services. They work in close collaboration with the rehabilitation team to set achievable goals, assess outcomes, and plan for ongoing programs, services, and modifications, both personal and environmental.
Physical therapists (PTs) treat problems involving ambulation, balance, coordination, strength, and mobility. They provide services and education to strengthen muscles, teach the appropriate use of rehabilitation equipment and mobility devices, measure for and apply braces and other orthotic supports, and guide people to maintain a fitness-oriented lifestyle. Physical therapists emphasize the delicate balance between exercise and fatigue, and can be helpful in suggesting the most appropriate recreational activities. The assessment by a PT includes muscle strength, range of motion, proprioception (the perception of your location in space—is the toe up or down, for example), muscle tone, gait, balance, transfers, and mobility.
Occupational therapists (OTs) deal with energy conservation issues, activities of daily living, upper extremity function, sitting balance, wheelchair selection and cushions, and other mobility devices. They are knowledgeable about aids to daily living and modifications in the home environment—bathrooms, kitchens, entrances, and stairways—and motor vehicles. Occupational therapists also assist people to remain at work by recommending changes in the work environment. The focus of an OT is to improve the quality of a person’s life by developing or maintaining those abilities that are essential to productive living. An OT evaluation should be done initially and repeated every six to 12 months to assess for change. The assessment should include current living situation and responsibilities, vocational status, hand dominance (which hand the patient thinks is more functional and whether this has changed since the onset of the disease), previous therapy, adaptive equipment used, and ambulation status. Additionally, formal tests of grip and pinch, coordination, and activities of daily living can be performed.
Speech and Language Pathologists
Speech and language pathologists (SLPs) work with people who are having problems with breathing, swallowing, speech, and cognition. These therapists teach people to overcome these deficits through exercises and other compensatory strategies. Modern technology may be incorporated into therapy sessions (computers, communication devices). A clinical speech/swallowing and mental status assessment can be accomplished in approximately one hour. Best results are achieved when the person being tested is well rested. The assessment will include speech, an oral peripheral examination, and the adequacy of facial or mouth structures. In addition, speech quality will be assessed: sustained speech, counting on one breath, reading, and spontaneous conversation. The swallowing assessment will focus on the severity of the swallowing problem, types of food or fluid that cause the problem, and taste. Foods such as nectar, peaches, crackers, puddings, and water may be used for a swallowing evaluation. If complex problems are identified, a swallow study using an X-ray may be prescribed. This study (a modified barium swallow) will allow the therapist to determine which consistency of food causes the most difficulty. Using this information, the therapist will then develop an individualized plan of care for food preparation and eating. Speech and language pathologists also evaluate people for language, cognitive, or memory deficits.
Recreational therapists (RTs) help people with MS find diverse activities appropriate to their level of functioning and give them a quality of life beyond the work-a-day world. They help people expand their daily activities to include creative and enjoyable outlets. Activities such as swimming, yoga, tai chi, hippotherapy (horseback riding), meditation, and other fitness programs have been found beneficial in MS. Reading, computer use, board games, and other mind-stimulating programs are very important for recreation with others and for relaxation.