What steps would you take to assist Chase in maintaining independence and autonomy


Case Study: Multiple Sclerosis

Background Information

Chase is a 37 year old Caucasian male from a middle class background. He is a veteran, and served from 1994-1996 in the Marine Corps. He has recently purchased a new home and lives alone in rural Iowa.

Family History/Current Relationships

Chase was born in Whatcheer, Iowa. He was raised in a military family which consisted of both parents, and two brothers. Chase was the middle child. Chase parents had a health relationship but his mother had a history of multiple sclerosis, and suffered from bi-polar disorder. Chase left home shortly after graduation to join the Marine Corps. However, two years later his received a medical discharge and returned home to Whatcheer, IA. Chase had a fiancé but the relationship ended recently. He currently has no children.


Chase graduated from high school and is currently attending a local community college in Cedar Rapids, IA. After receiving a medical discharge from the Marine Corps., he found that he did not have any transferable skill sets that enable him to be competitive within the labor market. He is majoring is computer technology. Ultimately, his vocational goal is to open his own business as a cell phone application developer.


Chase is currently under employed. He has a contract with Google, and from time to time sells them application ideas. He holds a student work position at the community college, but due to his medical conditions, and lack of training, he has not been able to obtain suitable and gainful employment.

Support Systems

Chase has expressed some resentment because he considered his primary support system to be his fiancé, but she abruptly left him hanging with a new house and dog all alone. He now indicates that his father and older brother are his primary support systems. He indicates that when he is not doing well they help him out a lot.

Drug History and Current Pattern of Use

Chase reports no history of drug and alcohol use and/or abuse.

Description of Presenting Problem

Chase has a diagnosis of multiple sclerosis (MS). Multiple sclerosis is a chronic and often disabling disease that attacks the central nervous system (CNS). The disease involves the immune system attacking the central nervous system. The disease is thought to be found in genetically susceptible individuals. The result of the immune system attack results in myelin (fatty substance that surround and protect nerve fibers in the CNS) forming scarred tissue (sclerosis). Once the myelin, or nerve fibers are damaged, and/or destroyed the nerve impulses that travel between the brain and the spinal cord are disrupted, which produces symptoms such as dizziness, weakness, numbness, poor bladder control, spasticity, unsteadiness in motor skills, and gait, tremor, etc. The symptoms vary for each individual and there are times of exacerbation and remission. The rate of progression of the disease also shows variance amongst individuals.

Chase has recently recovered for a longstanding period of hospitalization. Although Chase is a veteran he has not been granted a service connected disability rating for MS. Veteran Affairs rating board determined that his condition was pre-existing prior to his enlistment, per Chase. Chase indicates that he is rated 10% for tinnitus, which he has verbalized as being unfair and ridiculous. Chase currently uses a motorized chair, or he uses Lofstrand crutches. He does currently drives and has a high level of independence. However, recently he has experienced issues with gait, balance, memory, and tremors. He has recently recovered from a broken hip because he slipped and fell on the ice and snow this past winter. He is also experiencing several issues with his memory. The veteran is currently in school and has difficulty with studying and retaining. Additionally, due to his declining motor skills, and tremors he is unable to effective take notes and type. He also indicates that he is experiencing depression. However, in spite of his current medical status he remains motivated to complete his associate’s degree in computer science.

Discussion Questions

1. Do you think the fact that Chase sees a future for himself as a computer programmer/developer/networker as a realistic or unrealistic goal? (Discuss and explain)

2. What are possibilities for resources and ancillary services that can be recommended for chase?

3. Do you think vocational assessment and counseling can play a role in career planning?

4. How would you address instances in which help seekers insist on the pursuit of unrealistic or inappropriate goals?

5. What steps would you take to assist Chase in maintaining independence and autonomy?

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