Rehabilitation Therapies in Multiple Sclerosis

Therapy is a critical element of your MS care plan

Physical therapist
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Along with the medications that treat multiple sclerosis (MS), rehabilitation is a key part of managing your condition effectively, particularly after a relapse. Depending on your symptoms, you may only occasionally need rehabilitation or you may require these therapies regularly to help you stay as healthy as possible.

From physical therapy to speech-language therapy to cognitive therapy (and more), there are a number of effective, engaging rehabilitation options that can minimize the impact of MS-related disabilities and help you function at your best in every aspect of your life.

Physical Therapy

Physical therapy can help treat a number of MS-related symptoms and needs.

Mobility and Muscle Problems

Walking problems are extremely common in MS and may be one of the first symptoms you experience. Physical therapy can help you improve your mobility and independence.

A physical therapist can teach you exercises to reduce muscle pain, spasticity, and weakness, as well as help you improve your balance, coordination, strength, and flexibility. This may delay your need for a mobility device and help prevent falls, something that can put you five steps back in your MS care.

If you do need a mobility device (or you're not sure if you're using the right one), a physical therapist can help you find what's best for you. Examples of mobility devices include single-point or quad canes, motorized scooters, rolling walkers, and manual or power wheelchairs.

Fatigue

You may also be surprised to learn that, in addition to muscle and mobility problems, physical therapy exercises can improve MS-related fatigue. Treating fatigue is pretty crucial since it affects between 75 percent and 95 percent of patients, and 50 percent to 60 percent report that it's one of the most difficult MS symptoms to deal with.

One of the reasons that exercise helps is that being inactive actually contributes to fatigue by causing your body to work harder to do everything because it's out of shape. Exercise can also combat stress, help you sleep better, and improve your mood—all factors that can affect your fatigue level.

A 2019 Cochrane overview of Cochrane reviews on rehabilitation therapies for people with MS determined that physical therapies such as exercise and physical activity may not only improve functions such as strength, mobility, and lung capacity, they can also reduce fatigue and improve your overall quality of life.

Exercising with MS requires a delicate balance. You don't want to overexert or overheat yourself, so designing an exercise regimen with a physical therapist who works with people who have MS is your best bet.

Posture and Positioning

A physical therapist can teach you how to maintain good posture and body positioning, which may alleviate some of your MS-related pain. If you're in a wheelchair or you have limited mobility, proper positioning can also prevent pressure sores.

Occupational Therapy

Occupational therapy helps you maximize your daily functioning at home and/or in the workplace.

Energy Management

An occupational therapist can work with you on ways to conserve your energy. For example, if your fatigue limits your ability to go grocery shopping, your occupational therapist may suggest using a scooter when running errands.

Skills and Devices for Daily Activities

Occupational therapists may recommend changes in your home to prevent falls and ease your comfort in performing activities of daily living, such as:

  • Getting rid of loose rugs to prevent falls
  • Installing handrails in the bathroom to maximize safety and accessibility
  • Adjusting lighting to address vision problems
  • Teaching you and/or loved ones how to evaluate and maintain the safety of mobility devices
  • Providing tips on hiring and working with a caregiver
  • Instructing you on how to dress, bathe, and prepare meals based on MS-related disabilities
  • Giving you exercises that strengthen your hands and arms and improve your coordination
  • Determining what adaptations you may need to keep driving
  • Assessing what sort of devices or adaptations you need to use a computer and other electronic equipment

Some occupational therapists also focus on cognitive rehabilitation and vocational rehabilitation (see below).

Speech-Language Therapy

As MS progresses, you're at an increased risk for developing problems with swallowing, speaking, and taking deep breaths. Often, these problems coincide because similar muscles are used to control all of these functions.

A speech-language pathologist can help you tackle these difficulties with specific strategies.

Improve Breathing

To improve breathing capabilities, speech-language pathologists may work with pulmonologists (lung specialists). Strategies a speech-language pathologist may use include:

  • Techniques to clear mucus from your throat
  • Exercises to help you breathe more easily
  • Medical therapies like nebulizers or oxygen

Minimize Aspiration

When a person with MS develops difficulty swallowing foods and liquids, this causes major concerns, including dehydration, poor nutrition, choking, and aspiration (when you breathe food or drink into your lungs).

A speech-language pathologist may recommend eating techniques that will maximize your nutritional intake while minimizing your risk of aspiration. These approaches often include:

  • Resting before eating
  • Sitting in an upright position
  • Keeping your chin parallel to the table
  • Performing double swallows

Reduce Speech Difficulties

Speech problems are common in MS, affecting up to 40 percent of patients at some point. These problems may include difficulties with articulation (slurred speech), slowed speech, soft speech, or impaired voice quality like hoarseness, breathiness, or a nasally speaking voice.

A speech-language pathologist can help reduce these speech difficulties by teaching you mouth-strengthening exercises. He or she may also recommend communication devices like voice amplifiers so you can be heard better.

Some speech-language pathologists also do cognitive evaluations and cognitive rehabilitation (see below).

Cognitive Rehabilitation

Cognitive problems affect an estimated 34 percent to 65 percent of MS patients. They usually come on gradually and can occur at any time during the disease course. For some people, they're even the first symptom of MS.

Possibilities include issues with:

  • Thinking
  • Memory
  • Attention
  • Speed of information processing
  • Organizing
  • Reasoning and problem solving
  • Visual-spatial abilities
  • Verbal fluency

While there's no medication for such problems in MS, cognitive rehabilitation may help. It's performed by a qualified neuropsychologist, occupational therapist, or speech-language pathologist and helps you learn to compensate for your cognitive concerns and improve your overall function.

The good news about cognitive function in MS is that it's rarely ever severely impaired. Regardless, even with mild cognitive deficits, you may feel isolated or anxious about engaging with others at home or at work.

Cognitive Evaluation

The cognitive therapies you need hinge on your cognitive evaluation. Some people with MS who have cognitive dysfunction choose to be evaluated if their cognitive issues are affecting how they function in their daily lives.

Although cognitive testing can be time-consuming (it requires a number of standardized tests), it can help you develop a clear picture of how MS has affected your cognition or if there's another health concern going on, like depression or MS-related pain, which can worsen cognition.

Seeking cognitive evaluations early in your disease and having follow-ups allows your provider to compare recent results to those of prior years, helping establish whether your cognition has worsened, stayed the same, or even improved.

Cognitive testing can be expensive. Some insurance plans will cover it, though, so it's best to contact your carrier for more information.

Strategies

Based on your evaluation, your cognitive therapist may recommend one or more of the following, among other possibilities. The strategies you may use over time may also be changed.

  • Planning your most brain-intense activities for the part of the day when you're most alert
  • Using electronic devices or simply a pen and paper to remember things
  • Focusing on a single task at a time and learning how to block out potential distractions
  • Engaging in brain-stimulating activities like reading or card games
  • Engaging in pleasurable activities, which can improve your brain's resiliency to MS-related damage
  • Engaging in physical exercise, which has been shown in studies to help improve cognitive function

Stress management and psychotherapy may also be a part of cognitive rehabilitation, especially considering the fact that depression is so common in MS.

A 2017 review of studies on rehabilitation therapies in MS found moderate-quality evidence that cognitive-behavioral therapy (CBT), a type of psychotherapy, is beneficial for treating depression and helping patients accept and cope with MS. If you have symptoms of depression, be sure to talk to your doctor about getting treatment.

Vocational Rehabilitation

Vocational rehabilitation specialists can train you to use assistive devices or make accommodations that adapt your current workplace to meet your needs, or help you find a new job that does. They also assess job readiness and perform job coaching and mobility training.

Some occupational therapists also do vocational rehabilitation since there's quite a bit of overlap between the two disciplines.

Vocational rehabilitation programs may be available through your county or state. Contact either of these for more information.

Multidisciplinary Programs

Multidisciplinary rehabilitation programs involve a team of healthcare professionals from two or more specialties, such as medical, physical therapy, occupational therapy, speech-language therapy, cognitive rehabilitation, neurology, nursing, etc. These programs can be in-patient or out-patient.

The aforementioned 2019 Cochrane review found that a comprehensive multidisciplinary rehabilitation program improves function and disability and leads to longer-term improvement in quality of life and activity. These findings suggest that utilizing all the rehabilitation therapies you need is a good way to maximize the potential benefits.

A Word From Verywell

Rehabilitation therapies play a paramount role in your MS health, but they aren't a quick fix—it takes time and patience to see results. You may experience obstacles and some frustrations along the way, but the overall benefits to your long-term health are worth it. Talk to your doctor about which rehabilitation therapies are appropriate for your individual needs and when you might need them.

Keep in mind, too, that it's OK to switch therapists or therapy sites if you're not content with your current one. Getting a second opinion is never a bad idea, and sometimes it takes time to find the right healing, trusting relationship.  

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