A therapeutic approach to management

Abstract

First encounters between therapists and people with multiple sclerosis (MS) generally occur in some type of crisis situation, and in a variety of settings. Patients may be admitted to hospital for a series of tests to confirm diagnosis, or during an exacerbation needing neuro-medical management. They may be seen in departments of therapy, when new symptoms of MS require treatment, or in special clinics when it is necessary to provide, for instance, continence aids, communication aids or a wheelchair. Sometimes patients are seen in their homes, when adaptations are required to secure independent living. With all such situations, therapeutic intervention deals with the immediate needs of the MS patient to achieve a specific goal of treatment. Having achieved the goal of treatment, the MS patient is then discharged from therapy. This approach to therapeutic intervention is based on an acute care model (see Figure 3.1) and although useful in certain situations, such as the acute exacerbation of MS, if used exclusively it presents therapy as a series of unconnected episodes.