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12 Specialist Baseline When to request a referral evaluation Neuropsychologist Yes When cognitive problems are suspected or apparent including issues with memory concentration information processing speed etc. Speech Language Yes Often subtle changes in cognition speech Pathologist and voice occur early in MS that are effectively treated with a home exercise program. If changes in swallowing occur early intervention can prevent worsening. Physical Therapist Yes As early as possible to initiate a home exercise program. Reinitiate if relapsesprogression create mobility dexterity strength or balance issues. Also when assistive technology orthotics or mobility devices are needed for proper selection and customizationfitting. Occupational When MS symptoms begin to interfere with Therapist ones job or activities of daily life including work driving household chores and self- care tasks. For fatigue management or cognitive rehabilitation. Psychologist If 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. Urologist When changes in frequency of urination frequency or retention or repeated urinary tract infections occur or for erectile dysfunction in men with MS.