Multiple sclerosis center provides variety of services
Depression, caregiver services also offered
Just over a decade old, the MS Center at Shepherd Center in Atlanta provides multidisciplinary care and a variety of services to patients with multiple sclerosis.
Having services for multiple sclerosis patients in one location is a great benefit for patients and their caregivers.
"Objective data show that a person going to a multidisciplinary center is more likely to be offered early medical treatment, as well as multi-modality therapy, than someone who goes to piecemeal treatment," says Ben Thrower, MD, medical director of the MS Center.
The center, which is primarily outpatient-driven, has six exam rooms and a physical therapy site in the same hallway. Two floors below the center is an Olympic-size pool that offers an aquatics program for MS patients. "It was the site of the 1996 Paralympics," Thrower says.
There are six RNs, one medical assistant, a clinical research coordinator who also is an RN, a neuropsychologist, and Thrower, who is a neurologist. The center also shares five rehab physicians with Shepherd’s traumatic brain injury and spinal cord injury programs. The center’s physical and occupational therapists, totaling about eight people, mostly are devoted to multiple sclerosis patients, and there are speech therapists available to patients.
Here are the services offered by the MS Center:
• Initial evaluation: The initial appointments are lengthy, lasting up to three hours, and case managers are involved from the start.
Many patients self-refer
The evaluation is either for diagnosis confirmation or to make the diagnosis because patients sometimes refer themselves to the center, Thrower says.
"We have a tremendous word-of-mouth in the MS community," Thrower says. "If you do something good for the MS community, they’ll advertise for you."
Evaluation includes obtaining a history of symptoms, which for MS typically include bouts of numbness, tingling or weakness in arms or legs, and blurring or loss of vision in an eye.
• Pool therapy: The rehab facility’s pool has its temperature dropped three days a week for multiple sclerosis patients.
"Most of our folks with MS are heat-sensitive as their core body temperature goes up," says Thrower. "They are more likely to have fatigue and weakness, and it can limit their exercise potential."
• Pharmaceutical treatment: New patients typically are started on a long-term immune modulator drug, Thrower says. The three drugs used are Avonex, Betaseron, and Copaxone, all approved by the U.S. Food and Drug Administration.
"What the drugs do is slow down any progression of disability and any relapses of the neurological symptoms," Thrower says. "Then we look at symptom management also, including common things we see in mild MS: spasticity pain, urinary frequency, or urgency."
• Rehab services: MS patients who have had the disease for 20 years or longer typically have a higher level of disability and are more likely to need rehab services, including occupational therapy, physical therapy, speech therapy, swallowing therapy, and sometimes vocational therapy. Also, they may receive therapy from the neuropsychologist.
• Patient education: "Looking at the demographics of MS, we’re most likely to be dealing with someone who is well-educated, has a college degree, is professional, and we have lots of folks who are doctors, nurses, school teachers, and lawyers," Thrower says.
"Of all the conditions I’ve worked with, this probably is the most knowledge-hungry group of people, who are well-connected to the Internet and well-read," Thrower says. "They stay up on things, and they sometimes get bad information over the Internet, and we have to do re-educating."
A team consisting of RNs, the neurologist, and a physiatrist will educate the patient about multiple sclerosis.
Case managers help find funding
• Case management: Patients are encouraged to begin treatment immediately. If their disease has progressed to the point where they experience some disability, then they will be assessed for wheelchairs or other devices.
Also, case managers will help patients find creative ways to obtain funding for their treatment and medications. The drugs can cost as much as $10,000 per year. Health insurers typically cover all therapy visits, and they usually do not pressure the center to select a discharge date, Thrower says.
"Some insurance companies have a cap on how much therapy a person can receive each year," he adds.
• Day program: Patients who have rehab needs in at least two areas, such as physical therapy and occupational therapy, may qualify for the more aggressive therapy that is offered in the day program. This program can entail eight hours of working with various therapists.
• Therapy for older patients: These patients may start with therapy three times a week and progress to once a week.
"We’re big believers in getting people as self-sufficient as possible," Thrower says. "We take advantage of family members to set up a home program, because some patients come from long distances and it’s not practical for them to come in often." These patients may visit the center once a year for a check-up.
• Treating depression: Depression and fatigue are quite common in multiple sclerosis patients. Cognitive dysfunction occurs in 50% of MS cases.
"It can be very difficult to sort those things out," Thrower says. "Our neuropsychologist does a wonderful job in helping us with those folks to sort out how much is true dysfunction vs. how much is mental fatigue."
Depression can result from the patient being taken out of the work place or because the disease is adversely affecting the patient’s job performance.
"Depression has a lot of potential clinical implications," Thrower says. "We used to think depression was always situational, a reaction to having a long-term health issue, but it turns out that may be only a small part of it."
There may be a biological cause of depression, and some of the medications used to treat MS may worsen depression, Thrower says.
"Most of the nurses and professionals who work with multiple sclerosis patients are well aware of how to look for depression," Thrower says. "They know when someone seems to be in a psychological crisis and how we should intervene."
Training the caregiver more than the patient
• Caregiver services: The center provides education to caregivers when a patient is newly diagnosed, and center staffers strongly encourage caregivers to be present at the initial evaluation.
"Half of what we tell new patients they won’t remember because it’s all new and they’re stressed by the situation," Thrower notes. "So the more ears we have in the room, the better."
Therapists realize that sometimes they are training the caregiver more than the patient, so they’ll show caregivers how to do range-of-motion activities and transfers.
MS Center staff also watch for signs of caregiver burnout, and there are respite services available through the day program.
Need More Information?
- Ben Thrower, MD, Medical Director, MS Center, Shepherd Center, 2020 Peachtree Road NW, Atlanta, GA 30309. Telephone: (404) 350-7784.
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