b'Symptom ManagementSpecialistBaselineWhen to request a referral evaluation NeuropsychologistYesWhen cognitive problems are suspected or apparent, including issues with memory, concentration, information processing speed, etc.Speech LanguageYesOften subtle changes in cognition, speech, and Pathologistvoice occur early in MS that are effectively treated with a home exercise program. If changes in swallowing occur, early intervention can prevent worsening.Physical TherapistYesAs early as possible to initiate a home exercise program. Reinitiate if relapses/progression create mobility, dexterity, strength, or balance issues. Also,when assistive technology, orthotics, or mobility devices are needed for proper selection and customization/tting.OccupationalWhen MS symptoms begin to interfere with ones Therapistjob or activities of daily life, including work, driving, household chores, and selfcare tasks. For fatigue management or cognitive rehabilitation.PsychologistIf changes in mood or behavior begin to regularly occur, worsen over time, or are noticed repeatedly by friends and family. These can include symptoms of depression (feelings of sadness or irritability; difficulty concentrating or sleeping; or a desire to be left alone or loss of interest in activities), anxiety (restlessness or feeling keyed up, difficulty concentrating, irritability, muscle tension, sleep disturbances, or more serious symptoms such as sweaty palms, chest tightness, or shortness of breath), or pseudobulbar affect (uncontrollable or inappropriate bouts of laughing or crying).UrologistWhen changes in frequency of urination (frequency or retention) or repeated urinary tract infections occur, or for erectile dysfunction in men with MS.msfocusmagazine.org 8'