Rehabilitation Strategies for Multiple Sclerosis

Patient Expert

Patients diagnosed with any form of MS may experience a variety of symptoms, several of which can interfere with everyday living. Symptoms might affect strength, mobility, balance, gait, agility, cognitive function, speech, and functions taken for granted such as swallowing. Rehabilitative therapies can help to counteract some of these symptoms and address very specific patient needs.

Rehabilitation specialists work with patients to help maximize physical abilities, function effectively at work and at home, learn strategies to compensate for symptoms and challenges, increase patient safety and independence, and promote general health and well-being. To gain most benefit from rehabilitative therapy, patients must take an active role in following the treatment plan prescribed and guided by therapists. Common rehabilitative strategies used in MS include the following:

Physical therapy (PT):
Patients of almost any level of ability or disability may derive benefit from working with a physical therapist who specializes in neurological diseases. At your first meeting, the physical therapist will evaluate your physical condition and functional abilities including posture, balance, mobility, strength, range of motion, motor function, neurologic function, and use of mobility aids. Common goals of physical therapy are to help you improve and maintain physical functioning so you can meet demands of family, work, and social life.

The physical therapist will provide instruction in exercises to address strength, stamina, balance, gait, flexibility, range of motion, and fatigue reduction. When appropriate, the physical therapist will also teach you how to use mobility aids and ambulation devices, as well as teach you safe ways to transfer if you use a wheelchair. Your physical therapist may work with you to design a home exercise program to extend the benefit of sessions in the rehabilitation office.

Occupational therapy (OT):
The goals of occupational therapy overlap somewhat with those of physical therapy, but focus more on removing barriers which impact quality of life. The occupational therapist can help you develop strategies to cope with symptoms related to fatigue, cognition, upper body strength, and coordination. He/she can teach you how to use assistive devices or adapt your environment to maintain independence or improve productivity at home, work, and in the community.

Depending upon your needs, occupational therapy may focus on self-care and functional mobility, adaptations to environment to improve productivity and safety at home and work, strategies to compensate for impairments in cognitive, sensation, and vision, and practical solutions to reduce fatigue and maximize enjoyment of leisure time activities. An occupational therapist may visit you at home or work to evaluate the environment before making recommendations or suggesting adaptations you might incorporate to compensate for changing abilities or functional limitations.

Speech-Language pathology:
Multiple sclerosis can cause problems with speech and swallowing which the speech-language pathologist is specially trained to evaluate and treat. There are two major types of speech problems associated with MS: 1) dysarthria, a loss of control over the muscles involved in speech, and 2) dysphonia, a problem with voice quality.  MS can affect any one of the elements involved in speech: use of air to support sound (respiration) that is produced by the vocal cords (phonation), articulation (use of lips, tongue, and soft palate to create clarity in speech), resonance, and the natural flow of speech (prosody) which combines rhythm, stress, and intonation to help communicate ideas.  Common problems with speech in MS include lack of precision in articulation, loss of conversational flow, and difficulty with rate of speech, loudness, or vocal quality.

Problems with swallowing (dysphagia) in people with MS result from lesions in the brainstem that cause loss of control over the muscles involved in swallowing which can increase the risk of aspirating food or liquid into the lungs. Signs of a swallowing problem include pocketing of food in the mouth, repeated attempts to swallow food, unexplained weight loss, weak or hoarse voice quality, increased body temperature during the hour after eating, drooling or regurgitation, food sticking in the throat, or signs of food aspiration (such as wheezing, fever, or pneumonia).

After careful evaluation, the speech/language therapist can focus on strategies to improve the effectiveness and increase the safety of swallowing. Changing head position can help prepare food for swallowing in patients who have poor tongue control or impaired swallowing reflex. Exercises to increase strength and range of motion of the tongue may be recommended. Patients might be taught to cough after swallowing if they are at risk of aspirating food due to problems with their larynx or other dysfunction.

Cognitive rehabilitation:
The neuropsychologist is specially trained to evaluate cognitive problems commonly affected by MS, involving the ability to think, reason, concentrate, and remember. Cognitive dysfunction may include problems with verbal fluency, executive functioning, attention and concentration, and information processing. The neuropsychologist can recommend practical, solution-oriented strategies (such as improving organization and using reminders) to manage and compensate for cognitive changes and suggest restorative interventions (such as computerized exercises to improve attention and memory) which act as physical therapy for the brain.

Vocational rehabilitation:
The goals of vocational rehabilitation are two-fold: to provide work-related guidance and counseling, including the recommendation of assistive or adaptive technologies to increase your ability to work, and to provide work training to help you gain and maintain employment. Each state is required to establish a vocational rehabilitation program designed to help disabled persons become or remain employed. The US Department of Labor’s Job Accommodation Network (JAN) is one resource that provides information regarding your legal rights under the Americans with Disabilities Act (ADA) and accommodation strategies and options.