what can our service offer an individual with advanced multiple sclerosis: the rehabilitation...
TRANSCRIPT
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