The motor and sensory deficits of multiple sclerosis can steal patients independence and isolate them from family and friends. Not surprisingly, depression is the most common mood disorder affecting more than half of all these patients.
Healthcare professionals working with MS clients must address not only the physical deficits, but also the psychological ramifications of the disease. The interdisciplinary team at Kessler Institute for Rehabilitation in West Orange, N.J., treats MS patients striving to regain independence after exacerbations and medical interventions. In the past year, Kessler has treated 31 inpatients with a close to 90% discharge-to-home rate.
Depending on the extent of impairment and severity of the exacerbation, individuals have a variety of treatment options including medication, self-care management and rehabilitation. At Kessler, young adults with MS are typically referred for inpatient rehabilitation.
Kessler provides an integrated and individualized plan of care to help each patient achieve functional independence. Upon admission, a special team comprised of a physiatrist, rehabilitation nurse, physical therapist, occupational therapist and speech therapist, assess the young MS patient and initiate a treatment plan. The team approach draws on the expertise and experience of a range of specialists, such as psychologists, case managers, dietitians, recreation therapists and urologists.
Based on the persons history and evaluation upon admission, staff craft a program specific to the patients level of neurological involvement, functional impairments and rehabilitation needs with the goal of maximizing individual abilities. The team meets weekly to discuss the patients progress and plans for discharge. If the patient exhibits signs of depression, such as irritability, sadness, fatigue, suicidal thoughts and lack of concentration, the team works closely and carefully to address the issue.
Some long-term goals of the nursing and therapy departments for patients with MS include educating them on proper skin integrity, urinary and bowel management, managing depression and continuing activities of daily living.
Patients participating in Kesslers MS Rehabilitation Program, receive 24/7 skilled nursing care with at least three hours of therapy a day, five days a week. Throughout the patients stay, the therapy team assesses and orders appropriate durable medical equipment to help with functional activity training. The patient also may be referred to the orthotic clinic for lower extremity bracing to ensure safe ambulation.
Discharge planning is initiated the day the patient is admitted. The case manager leads the team in exploring resources at home and in the community to ensure a safe, appropriate discharge. If the patient will require care to function safely in the home environment, the case manager may pursue a combination of short-term home care (nursing and therapy) to optimize the patients abilities, and then outpatient rehabilitation with more aggressive therapy, if transportation is available. Home modifications are recommended, especially if a wheelchair is needed.
The nursing and therapy team members also contribute to discharge planning early in patients stays. Nursing staff train patients and their family members on bowel and bladder management, wound care and medication management. Physical and occupational therapists instruct patients and family members how to perform functional activities and provide an individualized home exercise program that focuses on core stability, extremity stretching and strengthening.
The team recommends and helps secure needed equipment for the patient, such as assistive devices. The discharge plan may include recommendations to attend outpatient psychology appointments and support groups to help the patient adjust to physical changes, cope with depression and improve his or her quality of life. At Kessler, an individualized Healthcare Profile is given to patients before discharge, which summarizes general information regarding medications, functional status, equipment needs, follow-up appointments and swallowing and speech issues. This information packet can be shared with other healthcare providers to ensure continuity of care.