I-CAN v6 and Multiple Sclerosis

Preparing for an assessment when your condition fluctuates

Disclaimer: This article reflects publicly available information about the I-CAN v6 framework as at July 2026. It does not constitute professional disability support, medical, or legal advice. For personalised guidance, contact the NDIA on 1800 800 110, your Support Coordinator, or a disability advocacy organisation.

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Multiple sclerosis is one of the most challenging conditions to prepare for in an I-CAN v6 context — not because the assessment cannot capture MS support needs, but because MS actively works against accurate assessment if preparation is poor.

The most significant functional impacts of MS — neurological fatigue, cognitive difficulties ("cog fog"), heat sensitivity, spasticity, bladder and bowel dysfunction, pain — are all invisible to an observer. They do not show up on an MRI. They are not apparent from looking at someone. And they are highly variable: a person with MS on a good morning in a cool clinic may look, speak, and function very differently from the same person at 4pm in summer after a full day of appointments.

This guide covers how to document your realistic functional range, describe the invisible impacts of MS specifically, and ensure the assessment reflects your genuine daily needs.

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Understanding the Three Types of MS for Preparation

Relapsing-Remitting MS (RRMS)

RRMS involves periods of new or worsening symptoms (relapses) followed by partial or full recovery (remissions). Between relapses, functioning may be relatively stable — or may have accumulated disability from incomplete recovery of previous relapses.

For RRMS preparation:

• Describe your current stable-period functioning across all 12 domains
• Describe what a relapse looks like: what changes, for how long, and what extra support is needed
• Document the average frequency and duration of relapses
• If you have residual disability from past relapses (symptoms that never fully recovered), describe these specifically

Secondary Progressive MS (SPMS)

SPMS follows a period of RRMS, transitioning to gradual, steady worsening with or without relapses. The defining feature is accumulation of disability over time.

For SPMS preparation:

• Document the rate of change over the past two to three years
• Describe what you could do two years ago that you can no longer do
• The trajectory matters as much as the current status — the plan should reflect where things are heading, not only where they are now

Primary Progressive MS (PPMS)

PPMS involves steady neurological decline from the onset, without clear relapses. The focus is on the progressive accumulation of disability.

For PPMS preparation:

• Document current functional capacity across all domains
• Describe the trajectory and rate of change
• Note that PPMS often presents with prominent mobility and lower limb involvement

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The Core Challenge: Invisible Impact and Variable Functioning

Three aspects of MS require specific preparation attention because they are most likely to be missed in a standard assessment:

1. Neurological Fatigue

MS fatigue is qualitatively different from ordinary tiredness. It is a profound neurological symptom that is not related to activity level and does not resolve with rest in the same way. It is one of the most disabling MS symptoms and one of the most under-documented.

How to describe MS fatigue:

• What activities trigger significant fatigue?
• How severe does it become? (A 0–10 scale is useful)
• What time of day is functioning typically best — and what is it like by the afternoon?
• What cannot be done at all on a high-fatigue day?
• What is the recovery time after a demanding day?
• How does fatigue affect the days following high-demand activity?

Document the "energy budget" concept: Many people with MS have a limited daily energy budget. Spending it on one activity (work, an appointment, exercise) means it is not available for others (cooking, social activities, personal care). This cross-domain impact of fatigue should be documented.

2. Cognitive MS ("Cog Fog")

Cognitive difficulties affect at least 50% of people with MS, and in many cases they are more disabling than physical symptoms — yet they are almost universally under-reported in NDIS assessments because they are invisible and because many people with cog fog have learned compensatory strategies that mask the difficulties.

Common cognitive MS impacts to document:

• Memory difficulties: forgetting appointments, medications, conversations, instructions
• Processing speed: taking longer to understand information, respond to questions, complete tasks
• Word-finding difficulties: losing words mid-sentence, particularly when fatigued
• Executive function: difficulty planning, sequencing, initiating tasks
• Concentration: inability to sustain attention during demanding tasks

How to describe cog fog in functional terms: Not "I have memory problems" but "I regularly forget to take medication even with alarms. I cannot follow multi-step instructions without writing them down. On high-fatigue days I lose words in conversations with familiar people. I cannot manage my own finances reliably because of difficulty tracking numbers and making decisions."

3. Heat Sensitivity

Uhthoff's phenomenon — the temporary worsening of MS symptoms in heat — affects many people with MS and can be profoundly limiting in a warm climate or during exercise.

Document:

• What temperatures or activities trigger worsening
• Which symptoms worsen (vision, weakness, balance, fatigue, cognition)
• How long recovery takes after heat exposure
• What activities are not possible or significantly unsafe during warm weather or after physical exertion

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Domain-by-Domain: MS Preparation

Mobility

Describe your typical mobility range across the day — not just peak morning capacity. For many people with MS, functional walking distance is dramatically shorter in the afternoon than the morning, and on high-fatigue days.

Document: mobility aids in use; walking distance in the morning vs afternoon; impact of heat; fatigue-related mobility limits; fall risk; what happens after a day with more walking than usual.

Self Care

Document the full morning self-care routine: how long it takes, what the fatigue cost is, and how this leaves you for the rest of the day. For many people with MS, morning self-care is the most demanding activity of the day.

Heat sensitivity during showering is common and relevant. Describe any modifications you have made (shorter showers, cooler water, shower chair) and what happens without them.

Domestic Life

MS fatigue often makes cooking and household management a choice: if you cook, you may not be able to clean; if you have had a full day, dinner does not get prepared. Document this "energy trade-off" structure to your domestic life.

General Tasks and Demands

Cog fog directly affects routine management, medication management, and safety. If you regularly forget medications despite reminder systems, document this specifically. If cognitive load from task management is a significant daily burden, describe it here.

Mental & Emotional Health

Depression and anxiety are significantly more prevalent in people with MS than in the general population. Document any mental health conditions and their functional impact.

Life Long Learning

If MS has affected your ability to work or pursue career goals — through fatigue, unpredictable relapses, cognitive difficulties, or physical limitations — describe this specifically in terms of vocational impact and goals.

Physical Health

Document the full health management burden: neurological appointments, physiotherapy, occupational therapy, medication management, bowel and bladder management, pain management, and specialist monitoring. For many people with MS, health management is itself a significant daily functional demand.

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The Biggest Risk: Being on a Good Day

The single most important thing to understand about MS and I-CAN v6 assessment is the good day problem.

If your assessment is scheduled for a cool morning when you are relatively well-rested and not yet depleted by the demands of the day, the assessor may see a very different person from your typical functioning.

How to address this:

1. Your preparation document is your insurance. A thorough, specific written document that describes your bad days, your fatigue patterns, and your cog fog in detail gives the assessor the information they need even if they observe you at your best.

2. Tell the assessor at the start of the session. Say explicitly: "I tend to present better in the morning and in cool conditions. My typical daily functioning, particularly in the afternoon and on high-fatigue days, is significantly different from what you may observe today."

3. Bring your daily symptom diary. Four weeks of daily notes — fatigue levels, what was managed, what was not, what time things became difficult — provides specific, dated evidence that the assessor cannot dismiss.

4. Bring a carer or support person who can contribute observations. Someone who sees your typical daily functioning can provide context that compensates for any good-day effect in the session itself.

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Evidence That Carries Weight

Neurologist's report including MS type, disease course, recent MRI findings, current symptoms, and functional impact. Ask your neurologist specifically to describe functional impact on daily life, not only clinical findings.

MS nurse clinical notes — MS nurses often have the best functional picture of their patients' day-to-day lives and can provide highly relevant supporting documentation.

OT fatigue assessment — specifically documenting energy envelope, what activities are possible within it, and the functional consequences of exceeding it.

Daily symptom diary — four weeks of daily records including fatigue levels, symptoms, and what was and was not manageable.

Neuropsychological assessment (if available) — documents cognitive functional capacity, processing speed, memory, and executive function.

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ICANReady guides you through all 12 I-CAN domains, with prompts that help you describe the full functional impact of MS — including the invisible impacts of fatigue, cog fog, and heat sensitivity that most often go under-documented.

Try ICANReady free →

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Sources: Centre for Disability Studies I-CAN v6 framework, MS Australia (msaustralia.org.au), NDIA support needs assessment guidance (ndis.gov.au), Disability Advocacy Network Australia (dana.org.au)