Remitting Multiple Sclerosis

Karen Bailey is a 39 year old who was diagnosed with remitting Multiple Sclerosis 4 years ago.

Karen is married to Geoff, and they have 3 children aged 3, 5, and 9 years old respectively. They live in their own home which is spread across two levels. Geoff is Karen's primary carer - Geoff is a partner is an accountancy firm which involves a large amount of interstate travel. He is often not able to get home before 7.00 PM of an evening.

Karen now needs to use a walking frame to maintain her level of ambulation and is finding it increasingly difficult to mobilise easily. Karen's sister, Lisa lives nearby and visits often. Lisa is keen to be involved in looking after her sister; however Karen doesn't want Lisa to see the extent of her condition or her lack of independence.

Karen continues to look after the children on a daily basis, however some afternoons Karen finds this more difficult than others. Karen is finding that it is harder and harder to remain positive about her changing condition.

Karen has always enjoyed reading, however due to deteriorating eyesight and weaker arm muscles, Karen is no longer able to focus on the text or hold the book. Lisa has arranged some talking books for Karen, however increasingly the concentration required to use these has become too tiring.

Geoff is struggling with the joint responsibilities of work and increasing role in Karen's care. He goes into the office later in the morning after assisting her with a shower; however this results in him coming home later in the evening. He has indicated that he feels increasingly powerless in this situation and is concerned about what the future holds for them.

You are working in a community health centre when you get a phone call from Karen's husband, Geoff. Geoff tells you that Karen had a fall in the lounge room last night and he needed to ring the Ambulance Service to lift her off the floor as he did not know how to do this. He sounds very stressed stating "I just don't think I can do this anymore". Geoff is not able to take any more sick days from work to care for the children and asks about what help is available.

Given the urgency of this situation you visit Karen that afternoon to assess the situation. When you arrive Karen is home alone. Karen is concerned about Geoff and has encouraged him to go to work. She is worried about her family and how they are coping.

Karen has also noticed that she is now having some urinary dribbling. She tells you she had a fall last night and said this is happening on a regular basis as she needs to hurry to get to the toilet. Last night's fall has shaken her confidence considerably and she now feels less able to be at home on her own. When Karen discussed this with her husband, he said that he felt as if "their lives were falling apart". Karen indicated her two elder children were responsible for many of the household chores such as washing and cleaning whilst her husband did the cooking and help with her showering

Karen has developed a persistent dry cough and also has a fever. She has also been experiencing increasing symptoms such as blurred vision, difficulty with holding her walking sticks, is dragging her left foot as she walks and is now unable to hold heavy objects. Karen's voice is also becoming weaker and Karen is having difficulty being heard when she talks.

Question

Care partnerships required to maximize Karens independence and continued function

Physiotherapist in Multiple Sclerosis

Speech therapist in Multiple Sclerosis

As a physiotherapist, what you going to do?

As a speech therapist, what you going to do?

Rationale?

Recommendations?

Relate to her straight away

How it can improve?