Wednesday, February 16, 2005

Care Plan Review

Care Reviews are interesting and helpful as I learn to work within a teamwork structure.

Surprisingly I learned that Patti had ebbed away from involvement in social activities but was beginning to return to participation.

Help with Activities of Daily Living
Her ability or interest to participate in ADL or Activities of Daily Living had also measurably declined. ADLs are the different tasks of everyday life such as dressing, eating, bathing; going to the bathroom … As Patti is incontinent with both bladder and bowels those are measured not in terms of her participation but in her interest or awareness to be changed.

The exception was in eating. This exception was in fact phenomenal, as Patti has demonstrated “learned” behavior resolving her problems with choking and swallowing. There wasn't much optimism for restorative eating therapy it had previously been rejected by insurance.

Now how one aspect could be so successful while every other area has slipped is baffling?

However, it is a reason for optimism that the same methodical and patient approach to therapy can now help with the other aspects of ADL. Programs will be implemented to attempt to reverse this decline in her skills.

With spasticity under treatment and accompanied by prescription of Ditropan XL a program to assist Patti in transferring to and from a commode 7X daily before and after every meal and before bed and after awakening will begin. This is the most aggressive program ever attempted to control incontinence, and the first attempt in two years. It could ONLY be affected in a care facility with such abundance in staff.

The phenomenal success of restorative eating therapy has allowed for some hopeful thinking. Obviously first the slipping ADLs need to be addressed. Down the road there is a more radical theory of “cognitive therapy” that could enable Patti to work around her memory and mental confusion and essentially learn to re-think. Who knows? Living with MS is always about hope. Now learning to live with teamwork, at least there are more options slowly and steadily.

Interestingly an ”EXPERT OPINION PAPER” from the National Multiple Sclerosis Society does support this expanded role of rehabilitation:
“… course cannot be altered by rehabilitation, a growing body of evidence indicates that improvement in mobility, activities of daily living (ADL), quality of life ...”

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