Multiple Sclerosis (MS) is an insidious disease that can rob people of their functional abilities slowly, degree by degree. So despite being diagnosed with MS at the age of 25, Catherine Bisson continued to be an active, athletic person. She was a wife and mother, worked full time and went to college as an adult. But when she was officially labeled “disabled” and received her first disability check, her emotional reaction was immediate.

“I should have been happy when the first check came but I felt as though my life had ended,” Cathy said. “I was probably not ever going to work again. The reality of having the disease and it changing my life for good was horrible. I felt as though I was going over a cliff and would never get back up.”

Over time, due to the progression of MS, Cathy had begun to experience slurred speech, balance issues and ankle pain. Routine tasks were increasingly more difficult.

Judy Sweeney, NERHP physical therapist, assists Catherine with balance training.

During an appointment with her neurologist, Paul Muscat, MD, he suggested that Cathy “check out” the new outpatient MS Clinic at New England Rehabilitation Hospital of Portland (NERHP).

“I thought Cathy would be a good candidate due to her many manifestations of the disease, physically as well as psychologically,” says Dr. Muscat. “A number of her issues would be difficult to treat in the setting of a pure neurology practice, such as physical therapy, gait training, cognition and perhaps orthotics.”

Elissa Charbonneau, DO, NERHP Medical Director, provided Cathy’s initial medical evaluation at the clinic.

“When Cathy came to the NERHP MS Clinic, she had become quite isolated at home,” said Dr. Charbonneau. “She did have deficits but we recognized that there was potential for her to regain some functional activity and live her life more fully.”

At the time of her evaluation, Dr. Charbonneau remembers Cathy as having very little activity outside of the home. She felt that Cathy would benefit from the Clinic’s interdisciplinary approach to treatment.

“NERHP offers a rehab-focused clinic,” Dr. Charbonneau said. “Cathy’s rehabilitation included the combined therapies and strategies of physical therapy, occupational therapy, speech therapy, recreational therapy and case management.”

“The MS Society of Maine has a strong connection with NERHP. A representative from the MS Society is an integral part of the team and meets with each patient privately, just as a clinician does. The MS Society representative discusses what the MS Society offers, including education and support groups.”

Penny McGonagle, RN, Case Manager, is responsible for coordinating the evaluation process and therapeutic treatment plan for patients being referred to the MS Clinic.

“A neurologist usually does not discuss rehabilitation interventions to improve function, but a physiatrist will,” explains Penny. “So once the evaluations are complete, we meet with the patient and make recommendations as to what will help the patient reach their functional potential.”

“Once a neurologist evaluates a patient, it is beneficial to get the patient into a rehabilitation program before the MS gets to a progressive state,” explains Dr. Charbonneau. “Complications often occur due to a lack of mobility or there may be swallowing issues that have never been addressed. To avoid complications later, rehabilitation addresses function by managing spasticity, bracing, and wheelchair and adaptive equipment needs.”

During her evaluation, Cathy was surprised by the team’s perspective on her therapy plan. Instead of explaining her limitations, they asked her which activities were important to her to make her life more productive.

“The MS clinic was not about what I could not do and adjusting to it, it was about setting goals that I wanted and having caring people help me achieve them,” said Cathy. “We started with small tasks and identified goals that would be meaningful for me. I wanted to return to shopping, cleaning the house, cooking meals and maybe getting a part-time job. I wanted to walk to my mailbox without my cane.”

Judy Sweeney, physical therapist, helped with gait, balance and strength training; she provided bracing for Cathy’s weakened ankle. With exercise and encouragement from Judy, her progress was rapid.

“Over time, Cathy had slowly adopted sedentary and isolated lifestyles because of her MS fatigue issues. In only five or six treatment sessions, she literally blossomed,” said Judy.

Susie Kelley, occupational therapist, showed Cathy how to pace herself for energy conservation. She taught Cathy to schedule tasks and activities with rest periods in between. They worked on visual processing and hand-eye coordination.

“Cathy grabbed hold of our advice and encouragement and was her own driving force to increase her engagement in life and social and functional activities,” explained Susie. “We provided some guidance and Cathy made things happen!”

Because Cathy was also experiencing periodic slurred speech and loss of memory, she was seen by Jen McCullum/SLP for speech therapy. Jen worked with Cathy on cognition and attention skills.

Therapeutic Recreation helped Cathy reclaim some fun in her life. Kathy Kroll, recreation therapist, invited Cathy to her therapeutic art classes where she found that she loved to paint.

Within months, Cathy was achieving her goals and became more productive at home. Today, she goes shopping, prepares meals, cleans her home and walks beyond her mail box - without her cane. She also enjoys leisurely activities like sewing, crafts and painting. Cathy plans on joining Maine Handicapped Skiing this summer and looks forward to learning how to kayak.

NERHP occupational therapist, Susie Kelley does ball throwing and catching exercises with Catherine to help her with perception of movement and spatial orientation.

“The MS clinic opened doors that helped Cathy realize her functional potential,” said Dr. Charbonneau. “Too many people suffering from MS have never had rehab services and as a result are not functioning to the best of their capacity. Because many patients, like Cathy, become homebound, they do not have connections to helpful resources, the stamina or ability to do tasks, the equipment to help them, or the link to therapeutic recreation programs.”

Of Cathy’s progress, Dr. Muscat tells us, “When I saw Catherine, I thought her gait had improved. Just as importantly, her attitude in general was much more positive.”

“If you are motivated, they will help you,” says Cathy. “I’ve learned that I need to move on and stop being afraid. I don’t want to feel sorry for myself. It’s ok now.”

New England Rehabilitation Hospital of Portland began its Multiple Sclerosis specific rehabilitation clinic October 28, 2008. Catherine Bisson was the first “graduate.” The clinic provides a comprehensive evaluation of individuals with MS including evaluations by a physiatrist (a physician who specializes in rehabilitation medicine) and physical, occupational and speech therapy. Upon completion of the evaluations, patients are provided with recommendations for follow-up rehabilitation care and any recommendations for equipment needs. Individuals also have an opportunity to meet with a case manager from the MS Society during their visit for education on the multiple services and resources available through the MS Society and in the state.