Multiple Sclerosis - A Practical Guide to Rehabilitation - 55

A Practical Guide to Rehabilitation
in
A PRACTICAL GUIDE TO IDIOPATHIC

MULTIPLE SCLEROSIS

* Provide oral and written information about
swallowing issues in MS, with explicit
instructions to notify the SLP or treatment
team
* Provide strategies to facilitate conversation at
home at home and at work, and to assist with
organization and planning.
* Encourage routine communication with the
SLP by telephone, to check in and troubleshoot
strategies
* Recommend proper vocal hygiene and use of a
voice amplification system in the classroom
* Explain how exercise can improve strength,
stamina, and balance, and how stretching can
improve spasticity; encourage follow up with
the PT
* Provide education about fatigue management,
including energy conservation strategies.
* Suggest an OT consult to help with dexterity
and coordination issues (however, Ashley
defers, citing challenges with co-payments and
child care)

FOLLOW-UP 3 MONTHS LATER
* Ashley reports improvements in swallowing
after her neurologist stopped the oxybutynin
and reduced the baclofen dose. She still
occasionally has difficulty with initiating a
swallow, but says that adding moisture to foods
seems to help. Her weight has remained stable,
so she has not consulted a dietitian.
* She purchased a wearable amplification system
and is using it in the classroom to protect her
voice and reduce strain. She chose to pay out of
pocket as she did not wish to involve her
employer at this time.

* She has been successfully using strategies to
organize her duties within the classroom and is
better able to determine important vs
irrelevant information in work-related written
communications. To allow more time to focus
on organizing and to manage her fatigue, she
has cut back on work-related extracurricular
commitments.
* She and her husband have been successfully
using strategies to help her remember
conversations at home, among them recording
important details and plans in a central
notebook and organizing activities using a
shared online calendar.
* Her balance and strength have not returned to
normal, but have improved.
* She has been consulting periodically with the
PT and now has an organized exercise routine
focused on balance, stretching, and strength.
* She is using energy management strategies
recently learned, and reports a marked decrease
in her fatigue.
* Her overactive bladder symptoms have
resolved.
* Impaired dexterity continues to interfere with
activities of daily living and work. She is again
encouraged to seek OT evaluation and
treatment.
* A baseline cognitive assessment is suggested,
but she declines, citing concerns about possible
employment implications and her husband's
reaction if deficits are documented

Listen to Carolyn Knoechel, MSc, SLP, R.SLP,
discuss key takeaways for this case

Case 3: Ashley

55



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
Multiple Sclerosis - A Practical Guide to Rehabilitation - 7
Multiple Sclerosis - A Practical Guide to Rehabilitation - 8
Multiple Sclerosis - A Practical Guide to Rehabilitation - 9
Multiple Sclerosis - A Practical Guide to Rehabilitation - 10
Multiple Sclerosis - A Practical Guide to Rehabilitation - 11
Multiple Sclerosis - A Practical Guide to Rehabilitation - 12
Multiple Sclerosis - A Practical Guide to Rehabilitation - 13
Multiple Sclerosis - A Practical Guide to Rehabilitation - 14
Multiple Sclerosis - A Practical Guide to Rehabilitation - 15
Multiple Sclerosis - A Practical Guide to Rehabilitation - 16
Multiple Sclerosis - A Practical Guide to Rehabilitation - 17
Multiple Sclerosis - A Practical Guide to Rehabilitation - 18
Multiple Sclerosis - A Practical Guide to Rehabilitation - 19
Multiple Sclerosis - A Practical Guide to Rehabilitation - 20
Multiple Sclerosis - A Practical Guide to Rehabilitation - 21
Multiple Sclerosis - A Practical Guide to Rehabilitation - 22
Multiple Sclerosis - A Practical Guide to Rehabilitation - 23
Multiple Sclerosis - A Practical Guide to Rehabilitation - 24
Multiple Sclerosis - A Practical Guide to Rehabilitation - 25
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 27
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 29
Multiple Sclerosis - A Practical Guide to Rehabilitation - 30
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 64
Multiple Sclerosis - A Practical Guide to Rehabilitation - 65
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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