Peter: What assessments can someone with MS expect if they’re referred to you?
Nicola Hatton, Neurological Psychologist: Quite a detailed, what we call a subjective assessment initially, so having a chat about how you were diagnosed, how long you’ve had your symptoms for, what symptoms have come and gone, what symptoms do you have now. And looking at how you spend your time during the day, are you working, are you driving, do you have children to look after, all your social history really, so that we can establish what you need to be able to do in a day, what you want to be able to do and what is limited at that moment in time. And also, really importantly, as a person, what do you think your main problem is. Because I can look at somebody walking in and spot sort of various symptoms that I think, you know, we could work on, but when you ask the person themselves it may be something totally different that is more relevant to them at that time.
So establishing that person’s perception of their problems is really important and that allows you then to focus on your objective assessment, so that’s a physical hands-on assessment, which again can be very detailed. If you have an hour to do an assessment with somebody you don’t always get to assess everything all in one go, so you’d probably choose one or two things to look at and do that in depth and then bring the person back over a period of time to continue the assessment. But it would be sensation, power, balance, co-ordination, multi-tasking, cognition, you’ve got to look at the whole thing altogether to establish why that person is struggling with a particular task.
Peter: So quite detailed?
Nicola Hatton: Yes, yeah. And also, you might have some objective measures that you might want to use as well so that you can say whether somebody has improved or not over time, so that might be done on your initial assessment as well.
Peter: And then presumably the next step is a series of treatments?
Nicola Hatton: Yeah. And that actually forms part of the assessment as well, so what you can’t tell when you first see somebody and assess them, you then need to send them away to do something, whether it’s a home exercise programme or doing an activity differently or trying something out they may have not tried before, and then they’ll come back to you and you’ll reassess to see whether there’s been any changes. And that’s called trying to establish carry over, so has somebody been able to maintain those changes or make improvements, and over a period of time that allows us to determine whether the symptoms that person has got are directly attributable to the MS, ie primary symptoms, or whether they’re secondary. And we often find that the majority of patients’ symptoms are often secondary, so they’ve come about because of perhaps a reduction in activity, a loss of confidence, a loss of balance, fatigue, altered social circumstances. Lots of different reasons that have stopped that person doing what they normally do. Once we’ve tried to modify them or change them and – it’s again another cliché – peeling away the layers of this onion to try and get to what’s going on underneath. Because if you have a primary deficit, say if you’ve got a loss of sensation in your fingers, that may or may not come back. Keeping active, keeping your hands moving may help with it, but it may not change it because the damage has been done by the MS already. And that goes for all your different symptoms, you have to try to think what can we change, what can’t we change, so that you can focus your energies on the stuff that you’ve got control over, and that can take several weeks to get to that stage.
Peter: I was going to ask you, what timescale you’re talking about really?
Nicola Hatton: I can only speak for what we do here. If somebody comes to me where they’re initially diagnosed or even a bit later down the line, we’ll often see them for say, four or five, maybe six and seven sessions to try and get to that conclusion of where that patient needs to focus in order to maintain the current level of activity or improve what they’re doing now. As I say, you can’t do that in a one-off session because you don’t know how changeable somebody’s going to be. And there’s often lots of other factors you have to take into account, like fatigue, pain, all the other demands on that person’s time, because you want that person to be staying in work, looking after their children, going out and about, and we have to tailor our exercise and our treatments around that so it’s not all or nothing. What we don’t want patients to do is say, well, I was absolutely exhausted doing my exercises so I couldn’t go shopping. Yeah, that’s not the idea, you do your functional stuff and incorporate the exercise or the advice around that.
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