1. 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

2. Introduction Hypothetical case report Combination of real examples and interventions

3. Case Report 53-year-old man Admitted to an acute medical ward with aspiration pneumonia

4. Case Report 53-year-old man Admitted to an acute medical ward with aspiration pneumonia 6 weeks later…

5. Acute Medical Care

6. Referral to Rehabilitation Team Bed bound Incontinent Unable to swallow Bed sores Demented How do we discharge?

7. Taxonomy of Problems MS Physical: Tetraplegia Spasticity Seating Access Continence: Urinary infections Constipation Dysphagia: Nutrition Respiratory Cognition: Insight Safety Home: Access Family Carers

8. Interactions of Problems Physical: Tetraplegia Spasticity Seating Access Continence: Urinary infections Constipation Dysphagia: Nutrition Respiratory Cognition: Insight Safety Home: Access Family Carers

9. Interactions of Problems Physical: Tetraplegia Spasticity Seating Access Continence: Urinary infections Constipation Dysphagia: Nutrition Respiratory Cognition: Insight Safety Home: Access Family Carers

10. Interactions of Problems Physical: Tetraplegia Spasticity Seating Access Continence: Urinary infections Constipation Dysphagia: Nutrition Respiratory Cognition: Insight Safety Home: Access Family Carers

11. ICF Model Health Condition Body functionActivityParticipation EnvironmentPersonal factors

12. ICF Model Advanced Multiple Sclerosis Tetraplegia Dysphagia Incontinence Pressure sores Dementia Cannot sit Cannot eat Odour Unable to direct care Unable to return home AccessFamily and carers’ distress Health Condition Body functionActivityParticipation EnvironmentPersonal factors

13. Rehabilitation Interventions

14. Medical management Quality of life issues Family support Discharge planning

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

16. Bowel Management Disimpaction Regular bowel programme Referral to District Nursing team for monitoring

17. 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

18. 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

19. Family Support Explanation of impairments and interventions Behavioural and cognitive issues Guilt and distress Disruption of family life

20. 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

21. Rehabilitation Principles

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