For many people with MS, pharmacological therapy alone is not able to address particular symptoms adequately or, in some cases, disease progression. Rehabilitation is a component of the comprehensive management of MS that focuses on function, and adds non-pharmacological strategies for the care of the person.
The objectives of rehabilitation in MS are to encourage autonomy and improve the quality of life through goal-oriented programmes that directly involve the person with MS in deciding on treatment priorities. For example, an individual may want help moving around, or ideas for helping them to remember things better, or to help them feel less fatigued.
To ensure rehabilitation is most effective, it is important that all members of the team work together. The team should include the person with MS and their family, who work closely with experts from a number of specialised disciplines, including professionals knowledgeable in exercise, technical aids, speech and swallowing, vocational aspects and counselling. Working in collaboration, the rehabilitation team aims to create a plan with specific goals that meet the individual needs of the person with MS, taking into account his or her priorities, lifestyle and desires.
Some of the main disciplines are discussed below. More comprehensive information can be found in MS in focus - rehabilitation (free download).
This type of rehabilitation is mainly used following a relapse or when a person finds they can no longer do specific tasks. For example, if a person has increased weakness in their legs, physiotherapist can help improve strength and control through resistance exercises. Spasticity and muscle stiffness can be relieved by stretches and positioning techniques taught by a physiotherapist.
Speech and swallowing therapy
Some people with MS may have problems with speech and swallowing, depending on where lesions occur in their central nervous system. A speech and swallowing therapist would undertake a thorough assessment of the lips, throat, tongue and larynx areas to identify the main issues, and then use strategies to help correct the problems, such as changing the head or body position, suggesting controls during swallowing or changing diet textures.
The type of therapy focusses on skills that are important for continuing the daily occupations of life, for example, washing, dressing, cooking, walking, writing, going to work or taking part in social or leisure activities. The occupational therapist will assess each individual and then work with them to help restore function, provide alternative methods for doing something or give advice on an aid or adaption that may help, for example grab rails in the bathroom.
This involves rehabilitation that provides services, supports and training to enable people with MS to obtain, maintain and advance in their job. For example, therapists can work with someone to identify and help implement workplace accommodations or changes that will help them stay in their job, such as schedule modifications or memory aids. They can also advice on the legal rights within the country they live in.
Counselling for people with MS is not just about listening and giving advice, it can also help with the uncertainties and unpredictability of MS. Counselling also gives people with MS a chance to discuss the personal problems related to the disease with someone neutral. For example, talking about pressures on the family brought about by MS and discussing strategies such as re-assigning household tasks. Getting a diagnosis of MS can be bewildering and a person may feel isolated and lonely; counselling can provide emotional support during this time.