NDIS Initial Assessment

Recognised Disability, Other Conditions & Current Health

• The participant, Marcus Vance (DOB: 14/05/1972, NDIS: 430892174), has a primary diagnosis of Secondary Progressive Multiple Sclerosis (SPMS) diagnosed in 2012, alongside hypertension, hyperlipidaemia, and a surgical history of a laparoscopic cholecystectomy in 2018.
• Marcus currently presents with progressive lower limb weakness, right-sided foot drop, increased spasticity in bilateral calves, and severe neurogenic fatigue that significantly limits his functional mobility and daily endurance.
• Marcus has a history of reactive depression managed effectively through primary care, and he currently reports stable mental health with no acute psychological distress.
• Marcus is a lifelong non-smoker, denies any history of illicit substance use, and consumes approximately 2 standard alcoholic drinks per month.
• Marcus was admitted to Fiona Stanley Hospital from 10/11/2024 to 18/11/2024 following a mechanical fall at home and a concurrent urinary tract infection, which resulted in baseline functional deconditioning.

Medication Management

• Current prescribed medications include baclofen (Lioresal®) 10 mg PO TID, fampridine (Fampyra®) 10 mg PO BID, perindopril (Coversyl®) 5 mg PO daily, atorvastatin (Lipitor®) 20 mg PO nocte, and colecalciferol (OsteVit-D®) 25 mcg PO daily.
• Medications are prescribed by his general practitioner and neurologist, dispensed by a local pharmacy into weekly Webster-paks, stored securely in a kitchen cupboard, and self-administered independently by Marcus using smartphone alarm reminders.

Social History and Supports

• Marcus resides with his supportive wife, Sarah Vance, who works part-time as an administrative assistant.
• Marcus currently receives formal NDIS support comprising 10 hours per week of support worker assistance for morning personal care and domestic duties, supplemented by daily informal support from his wife for evening meals and transport.
• Marcus maintains strong relationships with his immediate family and a small circle of friends, demonstrating intact social skills and appropriate interpretation of social cues.
• Marcus has no forensic history, prior incarcerations, or current legal proceedings.

Education and Employment

• Marcus completed secondary education to Year 12 and subsequently obtained a Bachelor of Commerce from Curtin University.
• Marcus worked full-time as a certified practising accountant for 22 years before medically retiring in 2021 due to progressive MS-related cognitive and physical fatigue.

Cognition

• Marcus demonstrates mild executive dysfunction and slowed information processing speed secondary to MS, particularly when fatigued in the afternoon.
• Marcus is fully oriented to time, place, and person during the assessment conducted at 09:30 AWST on 24/03/2025.
• Immediate and delayed verbal recall are mildly impaired, requiring written lists to retain complex multi-step instructions.
• Long-term memory remains completely intact, while working memory shows mild deficits during dual-task activities.
• Visuospatial skills are mildly reduced, occasionally resulting in misjudging doorway widths when manoeuvring mobility aids.
• Sustained attention and concentration are adequate for single tasks up to 30 minutes but decline rapidly in distracting environments.
• Recognition of familiar faces, objects, and environments is fully intact.

Communication

• Marcus communicates verbally in clear English with intact receptive and expressive language, though he exhibits mild hypophonia and slurred speech (dysarthria) when severely fatigued.

Behaviour

• Marcus does not exhibit any challenging behaviours or behaviours of concern.
• No behavioural triggers, durations, or frequencies are applicable as no behaviours of concern are present.
• Marcus presents with a euthymic mood and congruent affect, demonstrating high motivation to engage in physiotherapy and good insight into his functional limitations, despite occasional frustration regarding his physical decline.
• No formal behaviour management strategies are required, though pacing strategies are utilised to prevent fatigue-induced frustration.

Sensation and Sensory

• Vision is corrected with prescription bifocal glasses, though he experiences intermittent diplopia during episodes of overheating (Uhthoff's phenomenon).
• Tactile sensation is reduced distally, characterised by bilateral lower limb paraesthesia and numbness in a stocking distribution below the mid-shin.
• Hearing is functionally intact bilaterally with no assistive devices required.
• Gustatory function (sense of taste) is fully intact and unchanged.
• Olfactory function (sense of smell) is fully intact and unchanged.
• Proprioception and joint position sense are significantly impaired at the bilateral ankles and great toes, contributing to ataxia and foot placement errors.
• Marcus experiences thermal sensitivity, where ambient temperatures above 28 °C markedly exacerbate his neurological fatigue and motor weakness.
• Marcus denies any history of visual, auditory, or tactile hallucinations or other perceptual disturbances.

Mobility

• Indoors, Marcus ambulates short distances (up to 15 metres) using a four-wheeled seat walker and a right-sided carbon fibre ankle-foot orthosis (AFO) under supervision, exhibiting a steppage gait and reduced right foot clearance.
• Outdoors, Marcus is unable to ambulate safely due to uneven terrain and fatigue, relying on a prescribed power wheelchair (Permobil M3) for independent community mobility or a manual transit wheelchair pushed by his wife for short outings.
• Static sitting balance is independent, dynamic sitting balance is fair, and standing balance is poor (Berg Balance Scale score: 28/56), requiring upper limb support to prevent loss of balance.
• Marcus is a high falls risk, having sustained 3 falls in the past 6 months primarily during turning manoeuvres and transfers when fatigued.
• Marcus is right-hand dominant with mild bilateral upper limb intention tremor and reduced grip strength (Right: 22 kg, Left: 26 kg via hand-held dynamometry), impacting fine motor tasks like fastening small buttons.
• Passive and active range of movement are within functional limits in the upper limbs, while lower limb assessment reveals reduced right ankle dorsiflexion (-5 degrees passive, -15 degrees active) and bilateral hamstring tightness (popliteal angle 40 degrees).
• Marcus reports chronic neuropathic pain (burning sensation) in both feet rated at 4/10 on the Numerical Rating Scale (NRS), alongside nociceptive lower back pain rated at 5/10 after prolonged sitting.

Transfers

• Bed transfers (supine to sit and sit to stand) are performed independently during the morning using an adjustable electric profiling bed and a bed stick, but require minimal physical assistance from one person in the evening.
• Chair transfers are completed with modified independence using high-backed armchairs with firm armrests, requiring prolonged time and forward trunk lean to achieve lift-off.
• Shower transfers are completed using a stationary shower chair, requiring standby assistance from a support worker to step over a 40 mm shower hob while holding grab rails.
• Toilet transfers are achieved with modified independence using an over-toilet frame raised to 520 mm and bilateral wall-mounted grab rails.
• Car transfers into the front passenger seat of the family SUV require moderate physical assistance from his wife to lift his right leg into the footwell and a swivel cushion to assist with trunk rotation.

Pressure Management

• Marcus has a history of a Stage 1 pressure injury on his sacrum during his November 2024 hospitalisation, which resolved completely with conservative offloading.
• Skin integrity is currently intact across all bony prominences, though he remains at moderate risk of pressure injuries (Waterlow score: 16) due to prolonged wheelchair sitting and reduced lower limb sensation, mitigated by a Roho pressure-relieving cushion.

Personal Activities of Daily Living

• Marcus requires standby assistance for showering to ensure safety during transfers and minimal assistance to wash his lower limbs and feet while seated on a shower chair.
• Upper body dressing is completed independently while seated, whereas lower body dressing requires moderate assistance from a support worker or his wife to thread trousers over his feet and apply his right AFO and footwear.
• Toileting hygiene is managed independently once seated on the over-toilet frame, though he requires extra time to manage clothing adjustments.
• Marcus experiences neurogenic bladder dysfunction characterised by urinary urgency and occasional urge incontinence, managed with scheduled voiding every 3 hours and continence pads.
• Grooming tasks including brushing teeth, combing hair, and using an electric shaver are performed independently while seated at the vanity, though podiatry services are required for safe toenail cutting.
• Marcus eats and drinks independently using standard cutlery, though he avoids carrying hot liquids due to his upper limb tremor and reliance on a walking aid.
• Marcus sleeps approximately 6 hours per night (22:30 to 04:30), with sleep quality disrupted by nocturnal lower limb flexor spasms and nocturia (waking twice nightly), requiring an alternating air mattress overlay for comfort.
• Marcus reports reduced libido and erectile dysfunction secondary to MS, which he discusses and manages privately with his general practitioner and wife.
• Marcus is highly motivated to maintain independence in personal care but requires structured pacing and morning support worker assistance to conserve energy for the remainder of the day.

Instrumental Activities of Daily Living

• Meal planning is completed collaboratively with his wife using a shared digital calendar and grocery app.
• Marcus can prepare simple cold meals and hot beverages independently using a perching stool in the kitchen and a kettle tipper, while his wife prepares all main cooked evening meals.
• Major grocery shopping is completed online for home delivery or by his wife, though Marcus occasionally accompanies her using his power wheelchair for small top-up shops.
• Marcus is unable to complete laundry tasks due to the physical demands of carrying baskets and accessing the rear clothesline, relying entirely on his support worker and wife.
• Domestic cleaning tasks (vacuuming, mopping, bathroom cleaning) cannot be performed by Marcus due to balance deficits and fatigue, and are completed by NDIS support workers and his wife.
• External home and garden maintenance are fully outsourced to a commercial gardening contractor funded privately and through NDIS core supports.
• Marcus has two adult children who live independently, so no child care responsibilities are required.
• Financial and health management are managed independently by Marcus using online banking and telehealth platforms on his desktop computer, leveraging his professional accounting background.
• Community access is achieved independently within a 2 km radius using his power wheelchair on accessible footpaths, or with support worker accompaniment for further distances.
• Marcus no longer holds a driver's licence; he travels as a passenger in his wife's SUV or utilizes wheelchair-accessible taxis (Maxi Taxis) for medical appointments.
• Preferred leisure activities include listening to audiobooks, watching cricket, and attending a local MS peer support group fortnightly with support worker transport.
• Marcus demonstrates strong cognitive motivation to engage in domestic decision-making and community outings, requiring physical assistance and assistive technology solely to overcome motor and fatigue barriers.

Home Environment

• Marcus resides in a single-storey detached brick-veneer house built in 2005.
• The property is privately owned by Marcus and his wife with no mortgage.
• The home comprises 4 bedrooms, 2 bathrooms, an open-plan kitchen and living area, a laundry, and a double garage.
• Front access features a portable rubber threshold ramp over a 35 mm step at the front door, while rear access to the patio is level through sliding glass doors with a flush sill track.
• The internal layout is entirely level with no internal stairs or split levels, featuring wide hallways (1,050 mm) and laminate timber flooring throughout.
• The living area is spacious with furniture arranged to provide a 1,500 mm turning circle for his seat walker and power wheelchair, requiring no physical assistance to navigate.
• The master bedroom accommodates a king-single electric profiling bed on one side and a standard single bed for his wife on the other, with adequate clearance (900 mm) for walker access.
• The ensuite bathroom is compact and inaccessible for mobility aids, so Marcus uses the main bathroom which contains a hobbed shower recess (40 mm lip), a standard toilet fitted with an over-toilet frame, and bilateral grab rails.
• The kitchen features standard 900 mm high benchtops without under-bench knee clearance, requiring Marcus to sit sideways on a perching stool to access the sink and preparation areas.
• The outdoor area consists of a paved undercover alfresco area with level access and a small lawn section that Marcus does not physically access.

Other

• Marcus experiences significant symptom fluctuation depending on ambient temperature, requiring all physiotherapy sessions to be conducted in air-conditioned environments during morning hours before fatigue peaks.
• Marcus identifies as Anglo-Australian, speaks English as his primary language, and reports no specific cultural or religious requirements impacting service delivery.

Goals

• Marcus's primary goals are to reduce his falls frequency to zero over the next 12 months, maintain his ability to ambulate indoors with a seat walker, and improve his lower limb strength and transfer safety to reduce carer burden on his wife.
• Physiotherapy priority areas include progressive resistance training for the lower limbs, dynamic balance and gait re-education, spasticity management via stretching protocols, and carer training for safe manual handling during fatigued evening transfers.
• The proposed physiotherapy intervention plan comprises weekly 60-minute home-based physiotherapy sessions for 40 weeks, alongside 10 hours dedicated to assistive technology trials (specifically reviewing his AFO prescription and trialling a standing transfer aid) and periodic progress reporting.
• Referrals are recommended to an Occupational Therapist for major bathroom modifications (level-access shower) and vehicle modification assessment, a Podiatrist for routine foot and nail care, and a Continence Nurse Advisor to review his neurogenic bladder management plan.