Medicine & Research

Comprehensive Care in MS: The Bridge to Wellness

By June Halper
           As a person with MS, you know that multiple sclerosis affects all areas of life, and requires constant adjustments to retain maximal and safe functioning. You may experience symptoms that limit your physical abilities, with implications for your work life, home environment, relationships, and physical and psychological well-being. Often, you may feel your quality of life and hope for the future are affected; each small change is magnified many times in its effect on quality of life and overall outcome.

            Because the effects of MS on your life are so wide-ranging, the best approach to MS treatment is a patient-centered approach that addresses all areas of the disease simultaneously. This requires a team of MS experts, with different areas of focus all working together with you and your family on a long-term basis. In response to this need, we have seen the rise of comprehensive care centers for MS.

            In an MS center, a multidisciplinary approach offers a broad base of support to you (the patient), your family, and to the team itself. This model, in addition to providing medical management of the disease, has proven to be effective in enhancing long-term outcomes.
What is Comprehensive Care?
            The comprehensive care approach to MS involves a number of healthcare professionals with expertise in the field of MS, including: neurologists, primary care physicians, nurses, social workers, mental health professionals, pharmacists, and rehabilitation specialists. Each member of the team becomes familiar with your needs and circumstances to create a realistic treatment program that is aimed at helping you reach your fullest potential for independent functioning within the context of the life you have always led. To achieve this, the team works collaboratively with you, your care partner, family, and even your work environment to advocate for you in ways that support your needs and wishes.  They help to educate you about the disease and your treatment options, and help you to optimize the medical therapies you receive to best meet your personal needs.
Outcomes of Comprehensive Care

            Experience has shown that a number of significant improvements can be achieved using the comprehensive care approach. Given this level of attention and support, people who use MS centers are generally better able to stick to their medication regimen, learn to manage nuisance side-effects, and achieve optimal results. They are more likely to take advantage of physical therapies and rehabilitation strategies, even though these can make demands on their stamina. Given the opportunity to continue working, many remain more physically active and psychologically healthier. Regular interaction by the team members with the person with MS and their family members provides opportunities to for these professionals to notice and intervene in a broad range of situations that can potentially damage the patient’s health, including reimbursement issues with insurance providers, work situations, physiological challenges, and difficult decisions about everyday function.
Where is comprehensive care available for MS?

            MS specialty treatment facilities and clinics are becoming increasingly available, but many people will still need to travel to reach one of these centers. When travel is necessary, most people will choose to be treated by their own primary care physician at home, and make annual or more frequent trips to a multidisciplinary center for a full evaluation of their treatment protocol. The success of this comprehensive care approach is being replicated in smaller facilities as the understanding of the needs of MS patients grows, and new MS centers are opening each year. 
Your role in comprehensive care
            Because of the chronic nature of multiple sclerosis, it is crucial for you and your family to be involved in the management of the disease and to consider yourselves part of the healthcare team. Ideally, your attitude and active role in self-monitoring and self-care – along with a wellness lifestyle – can contribute to a productive relationship with the healthcare team.
Defining the MS Professional Team
            Neurologists are physicians who are trained to specialize in diseases of the nervous system and who usually diagnose and treat multiple sclerosis. They have expertise in differentiating MS from other diseases, determining appropriate disease-modifying treatments, and symptom management.

            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 advise 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 healthcare 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. They perform a comprehensive assessment to ascertain neurologic status, physical function, psychological adjustment, community supports, and the need for rehabilitative services.

            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.

            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 for daily living, as well as modifications in the home environment — bathrooms, kitchens, entrances, and stairways — and motor vehicles. They also assist people to remain at work by recommending changes in the work environment.

            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, technology aids, and other compensatory strategies.

            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.