Could You Benefit from MS Rehab?

“Rehab is definitely part of a holistic approach to our treatment of people with MS—because our disease-modifying therapies are not corrective, and many of our symptomatic therapies don't necessarily improve mobility and function,” says Kalina Sanders, M.D., a board-certified neurologist at Baptist Neurology Group in Jacksonville Beach, Florida. “And so that's where rehabilitation therapy comes in.”

5 Types of MS Rehabilitation

The type of MS rehab your neurologist or physiatrist (physical medicine and rehabilitation physician) recommends will depend on the symptoms you’re experiencing and how they’re affecting your daily life. Options include the following:

1. Physical Therapy

Physical therapy (PT) is one of the more common types of rehab for people with MS, since symptoms can interfere with motor function—most often, walking and mobility.

“Physical therapists help people maintain or regain their lower-extremity strength, balance, and walking ability,” says Brittany Ferri, Ph.D., an occupational therapist and adviser in Rochester, New York. PT can include an exercise program, gait training, and/or pelvic floor exercises for people with bladder issues.

For those having trouble walking, physical therapists will frequently recommend the use of adaptive equipment, such as a brace or other orthosis, nerve stimulators for those experiencing foot drop, or wheelchairs or walkers for people with more severe mobility issues. People with MS can use this equipment on and off as their symptoms relapse (get worse) or remit (improve).

2. Occupational Therapy

Another common type of MS rehab is occupational therapy (OT), which is designed to help you strengthen the skills you need to complete everyday tasks and activities. In OT, the focus is on a person's ability to function within their usual environment, so depending on the person, it could include interventions to help them get out of bed, get dressed, cook for themself, bathe or shower, or complete duties at home or work.

“People really describe OT as the sister discipline to PT,” Ferri says. “The two professions do have a lot of overlap, but while PT is focused on the biomechanics of movement, OT is really focused more on function.” OT tends to be more centered on the upper body, while PT tends to be concerned with the lower extremities.

Think of it this way: If you need to develop or maintain skills needed to do your job, socialize, or drive, occupational therapy is probably the kind of MS rehabilitation you need.

Therefore, OT may include work rehabilitation, which can help a person with MS go back to a job after their symptoms have halted their ability to work. Different types of work rehab can be helpful for people with multiple sclerosis after they’ve undergone PT and need more tailored help, and can be found in larger neurology centers.

“For example, if a person is a carpenter, they'll make sure that they're able to go back and do all of those basic job functions that a carpenter would need to do in order to have gainful employment,” Ferri says. This could mean working on tasks such as crouching, lifting, bending, or pushing.

In some cases, a multiple sclerosis OT program can also include exercises that help people manage their mood and emotions. It really can offer a wide range of assistance.

3. Speech-Language Pathology

Some people with MS have speech and swallowing difficulties due to damage in the central nervous system that affects the muscles used in these functions. If that’s the case, they may be referred to work with a speech-language pathologist.

Speech-language pathologists for people with MS can work with them on oral exercises, give voice training, help them overcome swallowing problems, or teach them to use special devices to communicate with others.

4. Cognitive Rehabilitation

Multiple sclerosis can cause changes in a person’s ability to think clearly, reason, and remember. “A lot of times, the changes that MS causes in the body result in a lack of safety awareness and body awareness,” Ferri says.

There are two types of cognitive rehabilitation for MS:

• Restorative cognitive rehabilitation uses cognitive exercises, usually done with help from computers. Its goal is to help boost and/or regain cognitive skills, such as memory and vocabulary.
• Compensatory cognitive rehabilitation teaches the person strategies to function despite the cognitive issues they’re experiencing.

Physical therapists (PTs), occupational therapists (OTs), speech-language pathologists, and neuropsychologists may all use different MS cognitive rehab techniques to help a person function better.

5. Vocational Rehabilitation

MS vocational rehab is designed for people who may need help finding, preparing for, or keeping a job. Vocational rehab counselors work to help people with disabilities find work they’re well suited to, and help them stay at a job or adapt as needed. A vocational therapist can help people find ways to prevent their mental illness and its stigma from negatively affecting their work or ability to find and keep employment.

The good news is that each state has a vocational rehab agency that can help you find a service.

How to Get the Most Out of MS Rehab

Because MS symptoms can vary so widely, it may be hard to predict how successful rehabilitation will be for each person. “A lot of times, it's something that's going to be gradual,” Ferri says. “Some people might see improvements more readily than others.”

You’ll likely undergo baseline testing before you start MS rehabilitation, to gauge your movement, balance, and cognition. Regular testing (often, conducted annually) is done to see how things have changed.

There are some ways you can increase your odds of finding improvement through MS rehab:

• Follow your doctors’ orders. “If you’re attending treatment regularly, you're going to see better results,” Ferri says. It’s also important to take any medications as your doctor prescribes. Adherence to your treatment regimen can help your odds of benefitting from multiple sclerosis rehab.
• Be prepared to talk about how you’re functioning. To provide you the right therapy plan, your therapist will have many questions about your medical background and how you’re currently doing. If you think you might have some trouble answering those questions, it’s a good idea to bring along a family member or caregiver who can help you remember important details, or speak on your behalf, if necessary.
• Do your therapy homework. Often, therapists will give people exercises and practices to do at home. "It may seem like a therapist is kind of giving you extra homework, but they're giving you exercises or home programs only because safety is really front of mind for them—and that's truly how we see the best results," Ferri says. Follow your therapist’s recommendations, she recommends, and keep up with your exercises.

How to Find MS Rehab Services

If you see a doctor at a larger neurology center, they may have some rehab professionals—like PTs, OTs, or speech-language pathologists—in the same building. But if you see a neurologist who works in their own office, you’ll likely need to see a therapist in a different location. Nevertheless, it’s still a good idea to ask your doctor for referrals. “Your neurologist may be familiar with who in their area may be best for you,” Sanders says.

It’s also a good idea to see another specialist, a physiatrist, to create a personalized rehabilitation plan to help you live your best with your unique symptoms and concerns.

The National Multiple Sclerosis Society has a provider locator tool to look up providers, including MS rehab practitioners, who are knowledgeable and experienced in working with people who have multiple sclerosis.

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