Various symptoms of multiple sclerosis
The unpredictable nature of multiple sclerosis (MS) presents challenges for both caregivers and patients who may wake in the morning with no symptoms and then find themselves fatigued and experiencing pain or cognitive problems in the afternoon. The best way for home health providers to help MS patients is to be aware of the variety of symptoms and understand that some affect some patients more than others, says Kent Griswold, PhD, president of Griswold Special Care in Erdenheim, PA.
Some of the more common symptoms are:
Loss of sensitivity or numbness
"MS patients may lose their 'ouch' factor," says Dorothy E. Northrop, MSW, ACSW, vice president of research and clinical operations for the National Multiple Sclerosis Society in New York, NY. The lack of sensation, especially in the lower extremities, makes it important for the patient and the home health staff member to be extra vigilant and look for cuts, infected insect bites, or other injuries. "The lack of sensation means that patients may not know they hurt themselves even if they need medical attention," she explains.
Depression and other emotional changes
The frustration and anger that a patient feels as a result of the unpredictable nature of MS often leads to depression, say Northrop. "About 50% of MS patients are diagnosed with clinical depression at some point in their disease," she adds. Home health workers should not, however, automatically assume that a patient's demeanor, fatigue, or lack of focus is related to depression because these changes can be part of the disease itself, she cautions.
"MS patients may have a limited quantity of energy," says Diane Walker, RN, MS, general manager of Griswold Special Care. "A home health worker should let the patient pick and choose which activities he or she wants to do," she suggests. For example, the home health aide may focus on laundry and washing dishes so the patient has energy to focus on her children, she explains. Because an MS patient does not know from day to day what her energy level might be, an aide should not assume that she needs to assist the patient with the same activities each time, she adds. "What would you like me to assist you with today?" is a question that should be asked each visit, she says.
"Physical therapists can offer helpful techniques with range of motion exercises and the use of heat or cold to treat pain," says Walker. If the patient is taking pain medication, home health staff members need to be aware that the medication may exacerbate cognitive problems so a task that is easy to accomplish one day may be impossible the next, she adds.
Gait problems are common in MS patients within 15 years of their diagnosis. The problems may be caused by the disease's damage to nerve pathways, which hampers coordination, or by fatigue. Physical therapists can often improve gait with exercise or assistive devices or medication may improve coordination.