Jana (start) Good morning everyone, my name is Jana and I am Connie’s neurologist.
Thank
you all for coming today. Before we start I’ll just have everyone introduce themselves. (...)
Mihda (introduction): Hi I’m Mihda, I’m the physiotherapist.
Jana (start continued): So the patient that we are working with is 58 year old Connie who has
been diagnosed with primary progressive multiple sclerosis. She recently had a relapse and as
a result, a variety of issues concerning her health status have arisen. She has noticed a
decrease in her speech and mobility and is experiencing altered sensation in her root foot, and
has concerns regarding the development of foot drop. Connie has mentioned that she would like
to increase the amount of exercise she does as well as be able to connect/socialise with other
people who have multiple sclerosis. Overall, I truly believe her health concerns can be efficiently
addressed. How does everybody else view this case?
(strategy/intervention) After my assessment of Connie, I have concluded that the altered
sensation that she is experiencing in her right foot can be narrowed down to nerve damage,
which is a common side effect of multiple sclerosis. And so to target that, there is a non-invasive
treatment known as scrambler therapy that utilises electrical stimulation to relieve her pain. It
works by sending “no-pain” signals to the brain through small electrodes that will be placed on
her skin. I think that in combination with some physiotherapy exercises will provide the most
relief to Connie, whilst also addressing her concerns regarding foot drop.
Questions for OT
- What are some of the barriers you may encounter?
Questions for physio
- What type of exercises are you going to prescribe Connie?
Mihda (assessment of function): Yes, I’ve been seeing Connie daily since her relapse and her
admission. She does have some trouble with her right leg and foot - she’s been concerned
about loss of sensation in her foot and has brought up pain and muscle tightness in her leg. I
have been evaluating her function with some general tests and have observed some limited
range of motion in her leg. But Connie has been able to move independently on both stairs and
flat areas with a frame. Although, I’ve noticed at times she is a bit reluctant to move around but
that is mostly due to pain and discomfort because she is very motivated to get into exercise so
I’m looking into exercises that work for that.
Mihda (intervention): So initially for exercises, I would like to just give her some more simple
exercises like stretches of her leg. And then I am looking to progress into some strength training
exercises with light weights or resistance bands to gain some strength in her thigh and leg
muscles. That could help with the foot drop and even manage some of her pain.
Questions/phrases: What type of modifications are you thinking of making?
I just wanted to check first if she has any other health problems that may affect her?
Yeah, sounds good to me.
I was going to see her later today.
Thank you.
(Mena continues on)
Hi I'm Mena, the speech pathologist.
I am here to help Connie regarding her mealtime difficulties so I just met connie and from what I
know she hasn’t been doing well in terms of her speech and her mealtimes as she complains
about having a wet gurgly voice after each meal that she consumes which also follows up with
her struggling to communicate as her voice is becoming unclear and in audible when
communicating with other people and often it is frustrating for connie to be understood by others
which may reduce her confident levels and self esteem.
( intervention) "To help Connie, I have gathered several assessments that I want to conduct and
perform on her. I really think that the most appropriate tool that I would like to use to start my
journey with connie would be the modified barium swallow study so basically i will provide
connie with the food that is both liquid and solid for example a sandwich and a juice that will be
mixed with the barium like a minty paste, which will allow me to see images of her mouth, throat
and esophagus to be seen on the x-ray and so i will tell connie when to chew and swallow which
then will be followed up by the radiologist who will then take x-ray pictures. And so whilst she
is swallowing during that process i can pin point and observe what is going on and what seems to
be the issue and so from there i will figure out different strategies to help her cope with this daily
struggle.
However other forms of exercise could be therapy that could help treat Connie with her unclear
and cluttering speech. Such as her vocal cords/ folds also play a role in her speech production as
she may have hypernasality too much air flow going in at the same making her speech
inaudible and unclear, non-typical for us to hear properly and really pick up on those
words she is trying to convey
But in the meantime "I might consider short-term medications for her reflux while I gather
information to further help improve Connie's swallowing difficulties."
How her speech going to progress overtime and if her speech is going to be temporary and
if she will be able to express herself?
- Uhh yes i believe she could show improvements through regular therapy sessions that i
could work on with her specifically focusing on her vocal cords and utilising different
types and methods of exercises to use with her voice
- So as of right now i cant really provide an estimate or a guarantee on how well connie
will be doing later on, However my goal is to achieve an outcome with connie and
hoping to see improvements with more therapy sessions and the use of equipment that
will be conducted during our time together
