Multiple Sclerosis - A Practical Guide to Rehabilitation - 54

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

ASSESSMENTS
Physical Therapy
* Records from her PT evaluation at an outside
agency were unavailable. When asked about it,
Ashley reported difficulty with getting time off
work and affording co-payments for services.
She said she "went one time" to PT, and was
given a list of exercises, but she has since
misplaced the list.
Speech Therapy
* Ashley was initially seen at the university
swallowing center, in the radiology
department, for an MBS
* During the interview, Ashley reported
occasional difficulties "getting the swallow
started" and "a feeling of choking"
* On evaluation of intra-oral structures, the SLP
noted very dry oral mucous membranes;
otherwise all was normal
* There was no history of aspiration pneumonia
* The MBS was unremarkable for safety concerns
(no penetration or aspiration observed).
Vallecular residue was observed, but cleared
with multiple swallows. Ashley had an overall
delay in initiation of pharyngeal swallow and
mildly reduced tongue base retraction
* Ashley was referred to a regional voice
program for visualization of her larynx to
further assess vocal changes. She was found to
have no structural changes in her larynx. She
declined further voice intervention and chose
instead to focus on other communication
concerns.
* Today, Ashley and her husband have a lengthy
conversation with the SLP regarding
frustrations and conflict between them at
home. Her husband feels she is ignoring things
he says. He complains that when they are with
friends, her stories go on and on and "she
never gets to the point." Ashley expresses fear
that won't be able to handle both work and
her kids' schedule this fall because she
struggled over the summer and had to check
details over and over.

54

* The SLP completes a high-level assessment of
Ashley's verbal reasoning and executive
strategy skills using the FAVRES. Results show
that Ashley is having difficulty filtering
important vs irrelevant information from large
bodies of text and uses organization strategies
inconsistently. She also has difficulty recalling
details of instructions during the assessment
and frequently refers back to the written
instructions; as a result, she exceeded the
typical time range for completion.

REHABILITATION GOALS
1. Develop and practice memory and
organization strategies for use in conversation
and at work and home
2. Practice in identifying relevant and irrelevant
information in text
3. Practice in conversational topic maintenance
4. Conversational coaching and communication
education for the family
5. Liaise with workplace regarding work
accommodations and modifications if Ashley
is agreeable

PLANS AND INTERVENTIONS
* Ask the neurologist about discontinuing or
decreasing doses of oxybutynin and baclofen,
which may be contributing to xerostomia; or
considering alternatives to treat her overactive
bladder; Ashley is given a urology referral
* Provide education about the role of xerostomia
in speech and swallowing; suggest strategies
for management, eg,
- Use of over-the-counter oral lubricants and
xylitol-containing chewing gum; alcohol
avoidance (beverages and mouthwashes)
and smoking avoidance.
- Add moisture to foods to improve bolus
lubrication, to include taking medications
in applesauce or yogurt swallowing multiple
times as needed.
* Advise consultation with a dietitian if she has
concerns about maintaining nutrition

Case 3: Ashley



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
Multiple Sclerosis - A Practical Guide to Rehabilitation - 6
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 8
Multiple Sclerosis - A Practical Guide to Rehabilitation - 9
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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