The Clinical Team

The Neurologist Prof. Orla Hardiman, B.Sc, MD, FRCPI, FAAN
The neurologist is the person who makes the diagnosis, and who directs the medical management of the patient. Although discussions with patients and their families may overlap with other therapists, repetition by different team members usually helps patients and families to more fully understand their condition, not only because they hear the information again, but because each team member will have his or her own individual educational perspective.

 

MND Clinical Nurse Specialist Ms. Bernie Corr, R.S.C.N, R.G.N
One of the most important roles of the MND clinical nurse specialist is that of patient advocate. They coordinate care provided by all health professionals, and liaise between hospital and community-based services. A MND clinicalnurse specialist has a unique role which interfaces between the patient and the health care system, making their role essential to ensuring the needs ofthe patient are met. Ms Bernie Corr can be contacted at 087 211 0663.

 

The Physiotherapist
Physiotherapists most frequently evaluate lower-extremity muscle strength, trunk muscle function and motor skills. They develop individualized exercise programs for each patient, and, to maintain the patient’s existing motor function, they evaluate the need for walking aids and orthoses. Physiotherapists also work closely with occupational therapists to recommend equipment for the home that will ensure patient safety and mobility.

 

The Occupational Therapist
The aim of Occupational Therapy is to maximize a person’s ability to self care, engage in everyday activities and also to work. An occupational therapist will focus on physical components such as muscle strength, tone and dexterity in relation to how these affect performance in daily living.An assessment on how the environment can best optimize a person’s independent living will be carried out and suggestions for relevant modifications of work and home environments maybe provided. During an occupational therapy session advise will be given to help a person conserve energy, work simplification and life management strategies. Advise and recommendations on issues pertaining to driving may also be discussed.

 

The Dietician / Nutritionist
Careful assessment of nutritional status during an MND consult is of upmost importance. The Dietitian works closely with people who are experiencing reduces appetite or weight loss. The early introduction of nutritional supplementation is important when weight loss is noticed. The dietitian will work closely with the neurologist in deciding whether supplementation should take place in oral form or indeed via a gastrostomy tube.

 

The Speech and Language Therapist
The Speech and Language Therapist work with people who experience difficulty with communication and swallowing. Strategies for optimizing communication will be identified and illustrated. A low tech strategy maybe to use writing as a method of communication or a high tech strategy may introduce a machine which will verbalize the users intent (lightwriter). During a speech and language consult swallowing difficulties will be assessed and interventions to prevent problems will be introduced.

 

Social Worker
The medical social worker works with the MND medical team and family to provide all relevant support, advice and counselling. The medical social workers consultation will be tailored to meet individual needs. Typically, issues will include assistance with planning for future care needs, ensuring all community resources are in place-including support organizations. Advise will be given regarding practical and financial matters and counselling will be made available for individuals and families.

 

Voluntary Disease Organization Service Coordinator
Voluntary disease organizations often send a patient service representative to an MND clinic. This provides a valuable contribution to the clinic, as the Association can provide educational literature and information about the many services they offer, including equipment loans and patient transportation services. As many Associations also operate a help line and accredit MND clinics, a close working relationship between the clinic and the Association often develops.

 

Respiratory Physician
A respiratory physician usually sees selected patients who have an impending respiratory problem or if the neurologist suspects they need a thorough respiratory evaluation. If impending respiratory distress develops, non invasive positive pressure ventilation (NIPPV) devices should be used when appropriate. Most patients undergo admission to hospital for respiratory evaluation and the introduction of NIPPV, as considerable reassurance is usually required to encourage long term compliance with the device.

 

Interventional Radiologist / Gastroenterologist
The interventional radiologist or gastroenterologist is consulted when enteral feeding (feeding directly into the stomach)  is necessary and the patient agrees to undergo radiologically inserted gastrostomy (RIG) or percutaneous endoscopic gastrostomy (PEG). The current evidence suggests that outcome following RIG is superior to PEG in MND.

 

The Psychiatrist and Psychologist Dr. Niall Pender
Diagnosis of a fatal illness with a shortened life expectancy can lead to significant stress-induced adjustment problems. Underling relationship or marital problems can be uncovered as a result of the stress of illness. Appropriate referral to qualified counselling services is essential for patients and families experiencing such difficulties. As a significant minority of MND patients also develop cognitive impairment, utilization of neuropsychological and psychiatric services may be required to manage the implications of the evolving frontal dysexecutive syndrome, and to provide appropriate pharmacotherapy for the associated cognitive decline.

 

The Palliative Care Service
The focus of the Palliative Care Services is to optimize quality of life, symptoms management and the maintenance of dignity and autonomy. The chosen palliative care teams will liaise with Public Health Nurse and General Practitioner to provide advice on all aspects of care during the later stages of MND.